Nursing Leadership & Management

Patricia Kelly-Heidenthal 0-7668-2508-6

Delmar Learning
Copyright 2003 Delmar Learning, a Thomson Learning company

Chapter 13
Delegation of Nursing Care

Delmar Learning
Copyright 2003 Delmar Learning, a Thomson Learning company

Objectives

Upon completion of this chapter, the reader should be able to:

Review the history of delegation. Define delegation, accountability, responsibility, authority, and assignment making. Identify responsibilities the health team members can perform. List the five delegation rights. Identify three potential delegation barriers. List six cultural phenomena that affect transcultural delegation.
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Historical Perspective of Delegation

Delegation in nursing has been emphasized and deemphasized at different periods in history. Delegation has not always been emphasized in nursing education. Current staffing practices require a greater amount of delegation from the nurse.

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Delegation Defined

Delegation is the transfer to a competent individual of the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

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Accountability and Responsibility

Accountability means that the nurse is legally liable for her actions and is answerable for the overall nursing care of her patients. Responsibility involves reliability, dependability, and the obligation to accomplish work. Responsibility also includes each persons obligation to perform at an acceptable level.

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Authority

Authority occurs when a person who has been given the right to delegate, based on the state Nurse Practice Act, also has the official power from an agency to delegate.

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Assignment Making

Assignment making is the process of delegating the duties and all aspects of care for a patient to individual personnel. The assignment includes giving clear, concise directions, and delegating the responsibility and the authority for the performance of the care.
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Assignment Making

The education, skill, knowledge, and judgment levels of the personnel being assigned to a task must be relative to the assignment. The expected outcome of the assignment, time frame for completion, and any limitations on the assignment should be specified when the assignment is made.
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Responsibilities of Health Team Members

Care should be used in delegating or accepting responsibility for any action that:
May carry the potential for harm May be highly complex or require advanced skill May require a high level of problem-solving skill Has a greater than average degree of unpredictability Requires a complex level of patient interaction

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Functions of the Professional Nurse

The registered nurse is responsible and accountable for the provision of nursing care. The registered nurse is always responsible for patient assessment, diagnosis, care planning, and evaluation. The registered nurse remains responsible for the patient outcome. Nurses must be alert and avoid misuse of UAPs and LPN/LVNs.
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UAP Functions

UAPs can deliver supportive care. They are expected to document and report information related to such activities. UAPs cannot practice nursing or provide total patient care. They cannot be delegated to assess or evaluate responses to treatment. The RN has an increased scope of liability when delegation takes place to a UAP.
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UAP Functions

The ANA states that since the RN is accountable for the delegation of nursing care activities, the RN must consider the following in determining the appropriate use of a UAP:
An assessment of patient condition The capabilities of the UAP The complexity of the nursing task The amount of supervision the RN will be able to provide The available staff assigned to accomplish the unit workload
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Licensed Personnel Functions

Even though LPN/LVNs are able to perform duties and functions that UAPs are not allowed to do, LPN/LVNs are held to a higher standard of care and are responsible for their actions. The RN is still primarily responsible for overall patient assessment, planning, and evaluation of the quality of care delegated.

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Licensed Personnel Functions

Common LPN/LVN duties include:

Teaching from a standard care plan Reinforcing teaching Updating initial assessments Removal of sutures In some states, starting and or maintaining intravenous lines, after receiving additional education

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Direct Delegation Versus Indirect Delegation

Direct delegation is usually verbal direction by the RN delegator regarding an activity or task in a specific nursing care situation. Indirect delegation is done using an approved listing of activities or tasks that have been established in the policies and procedures of the health care institution or facility.

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Underdelegation

Usually occurs when a person is in a new job role Potential causes:

Trying to avoid resentment from old guard staff Not knowing who to delegate to Not knowing scope of staff duties Seeking approval by demonstrating competency

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Delegation Barriers

Barriers in the delegator

Do-it-myself attitude, inability to ask others, inability to organize/manage, uncertainty

Barriers in the delegatee

Inexperience, incompetence, disorganization, irresponsibility

Barriers in the situation

Inadequate support, hurried atmosphere, hostile management
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Five Rights of Delegation

The right task The right circumstance The right person The right direction and communication The right supervision and evaluation

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Transcultural Delegation

Transcultural delegation is the process of having personnel perform duties with the diversities of culture taken into consideration. Cultural phenomena (areas where cultures have different interpretations or preferences) include:
Communication Space Social organization Time Environmental control Biological variations
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