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Objectives
Define delegation and its component parts. Discuss the need for delegation. Discuss the five rights of delegation. Explain the process of delegation. Identify a delegation model to select the appropriate delegatee Identify the legal authority for an RN to delegate. Identify challenges with delegation.
Definitions of Delegation
National Council of State Boards of Nursing
(1995)
Transferring to a competent individual the authority to
Definition of Delegation
Achieving performance of care outcomes for which you are accountable and responsible by sharing activities with other individuals who have the appropriate authority to accomplish the work (Yoder-Wise, 2008).
have an obligation to care for that patient and ensure the task is completed
sharing activities both the RN and delegatee work
(UAPs) and Practical Nurses (PN) Increased RN responsibilities in the management of the nursing unit/organization Accelerated pace and changing health care environment.
Right Person
Right Communication
Right Supervision
Right Task
Questions to ask when determining the right task
Is there potential for harm if there is a great
potential for harm if the task is done incorrectly, be careful with delegation How complex is the task if the task is very complex, be careful with delegation What problem-solving is required to carry out the task if significant problem-solving is require while performing the task, be careful with delegation What is the predictability of the outcome if in completing the task there is potential for many different outcomes, be careful with delegation Patient interaction/ability if the patient has limited ability to assist or respond to the task, be careful with delegation
Right Circumstances
Delegating a task under the right circumstances
includes
Considering the condition and acuity of the patient
policies, and procedures within the organization will guide to whom and what can be delegated.
Right Person
Nurse Practice Act each state has a nurse practice act
that will define and determine what task can be delegated to what level of personnel.
Determines the scope of practice for each position Issues standards of care that guide practice
level of personnel can carry out the task) Job descriptions identifies job responsibilities
Right Communication
Clear and concise communication is imperative from
it is being done, and when the task should be completed Correct patient Information that should be reported back to the nurse and when that information should be given to the nurse Expected outcome of the task
Right Supervision
The RN must provide sufficient follow up including:
Checking on the progress of the task Checking on the outcomes once the task is
performed Obtaining feedback about the completed task from the delegatee Evaluate the effectiveness of the delegation with the delegatee
Right Supervision
Giving feedback to the delegatee is important. To create
feedback as soon as possible after the task is completed Focus on the behavior/performance of the task Provide clear feedback addressing the completion of the task Use assertive I statements Ask for a restatement of the feedback from the delegatee so there is clear understanding of what was said Provide feedback privately with the delegatee Ask for feedback from the delegatee to clarify any concerns that person may have as well
Delegator
As the delegator, the RN must Have a view of the big picture in the care of the assigned patients Select the appropriate activities to delegate Select the appropriate staff to carry out the activities Clearly communicate the expectations and required follow up Follow up periodically while the task is being completed Evaluate and provide feedback on the effectiveness of the delegation to staff
Delegatee
The delegatee also has responsibilities including
Accepting the delegated activities as directed by the RN Give report to RN as requested on the delegated task Give feedback to delegator on the effectiveness of the
delegation process
Delegation Model
The National Council of State Boards of Nursing have a decision model to assist the RN to correctly delegate the task to the correct delegatee. Please go to this web site to view this decision model. http://www.ncsbn.org/pdfs/delegationtree.pdf
assessments that require nursing judgment Nursing diagnosis related decisions Decisions about patients outcomes Approval of plan of care Tasks that require nursing judgment Evaluation of nursing care
activities and its accurate completion UAPs can not supervise other UAPs UAP or PN can not redelegate activities. UAP can not complete a pain assessment PN can not complete discharge teaching
Conclusion
Delegation is a powerful tool when used correctly can create an effective and safe environment in which staff and patients work together to achieve positive outcomes.
References
National Council of State Boards of Nursing
(http://www.ncsbn.org) Yoder-Wise, P. (2007). Leading and Managing in Nursing (4th ed.). Sullivan, E. & Decker, P. (2005). Effective Leadership & Management in Nursing. Huber, D. (2006). Leadership and Nursing Care Management.