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Element 3: An individual’s requirements For nurses, midwives and the assistive workforce Delegation and Supervision for Victorian Nurses and Midwives.

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Presentation on theme: "Element 3: An individual’s requirements For nurses, midwives and the assistive workforce Delegation and Supervision for Victorian Nurses and Midwives."— Presentation transcript:

1 Element 3: An individual’s requirements For nurses, midwives and the assistive workforce Delegation and Supervision for Victorian Nurses and Midwives

2 Regulatory requirements The Nursing and Midwifery Board of Australia (NMBA) undertakes functions as set by the Health Practitioner Regulation National Law. NMBA sets the registration standards as well as professional codes, standards and guidelines that underpin safe and competent practice. The NMBA’s requirements of nurses and midwives relating to delegation and supervision are outlined in its publication ‘A national framework for the development of decision-making tools for nursing and midwifery practice’.

3 Delegation and supervision guidelines for Victorian nurses and midwives In order to become registered, nurses and midwives must meet the National Board’s mandatory registration standards. To be effective, nurses and midwives need to have a clear understanding of the requirements. Released in 2014, the guide seeks to reinforce the NMBA publications around decision making, by making practical recommendations and outlining a framework.

4 Delegation and supervision guidelines for Victorian nurses and midwives The guide was developed following consultancy with key stakeholders, discussions with Victorian nurses/midwives and an international literature review. Makes a number of recommendations, assuming a shared responsibility between: o individuals, o employers, o education providers, o professional bodies, and the o Department of Health and Human Services.

5 Accountability when delegating Delegation and supervision is, and always has been, a core responsibility of Registered Nurses and Midwives The Registered Nurse or Midwife remains accountable for monitoring and evaluating the effect of any care that has been delegated

6 Accountability when accepting a delegation Can include EN’s, unlicensed healthcare workers, junior RN/RM’s, other workers: A staff member who accepts a delegation is accountable for their actions or decisions A staff member should not accept a delegation if it is beyond their training and competency, and/or if they are not confident undertaking the delegation

7 Principles of Delegation Delegation is an exercise in professional judgement by the RN/RM. It involves the transfer of authority to a competent person to perform a specific activity in a specific context. Considerations when delegating include: Patient health status (stability and complexity) Complexity of the delegated activity Context of care Level of knowledge, confidence, skill and experience of the person to whom the task has been delegated The expected outcomes of the delegated task How outcomes will be monitored and communicated Legislative requirements

8 The Five Rights of Delegation 1.Right Activity 2.Right Circumstances 3.Right Person 4.Right Communication 5.Right Supervision and Evaluation Acknowledgement: National Council of State Boards of Nursing, 2005

9 Right Activity The right activity that, in the professional judgement of the RN/RM: Can be safely delegated to another staff member who has the level of knowledge and competency to perform the task, and Is appropriate for the needs of the specific health consumer The activity being delegated needs to be within the scope of practice of the enrolled nurse or role boundaries unlicensed healthcare worker accepting the delegation

10 Right Circumstances Consideration of appropriate and right circumstances include: The appropriate patient or patient group (based on the severity and complexity of their condition) The resources available including skill mix, staff availability and capacity for supervision, and Other relevant factors including monitoring and communication of progress

11 Right Person The right person is delegating the right activity to the right person with the right skills and knowledge to assist the right patient: The delegating RN/RM can only delegate care that they themselves are competent to perform The nurse/unlicensed healthcare worker accepting the delegation needs to have the appropriate training and knowledge and competence to provide the required care The patient whose care is delegated must not require complex observations, decision making, critical thinking or nursing judgement

12 Right Communication The right communication is clear, concise description of the activity to be undertaken, including the objective and expected outcomes. The delegating RN/RM should ensure that the enrolled nurse or unlicensed healthcare worker clearly understands: What activities are being delegated Who and when to ask for assistance or report concerns How concerns should be reported The enrolled nurse or unlicensed healthcare worker must inform the delegating RN/RM if they have not been trained to perform an activity or if they are uncertain of any aspect of the delegation

13 Right Supervision and Evaluation The right supervision and evaluation refers to appropriate monitoring, evaluation, intervention as needed, and feedback. The delegating RN/RM retains accountability for ensuring that: The delegated activities are performed to the required standard, Monitoring and evaluating the impact and outcome of delegated care is undertaken, Direct or indirect supervision is available as required, The person performing the delegated activity has the necessary support and guidance.

14 Decision making tree Right activity Has there been a RN/RM assessment of patient care need? Are there organisational guidelines that support the delegation? Can the task be routinely performed without complex observations, decision making or clinical judgement? Right circumstance Does the RN/RM have the skills and knowledge to safely delegate? Does the skill-mix in your ward/unit/environment enable you to undertake appropriate supervision? Right person Is the task within the scope of practice or role parameters of the person you are delegating to? Does the person you are delegating to have the appropriate knowledge, skills and competency to perform the delegated tasks? Right communication Does the person being delegated to understand and accept the delegated task; know when and who to ask for assistance, and who to report to? Right supervision and evaluation Is there ongoing monitoring and evaluation of the outcomes of care by the supervising RN/RM? YES Do not delegate Delegation is appropriate NO Acknowledgements: National Council of State Boards of Nursing, 2005 Nursing Council of New Zealand, 2011

15 Supervision The NMBA identifies 3 types of supervision within nursing/midwifery practice; specifically managerial supervision, professional supervision and clinically focused supervision. Clinically focused supervision Clinically focused supervision specifically relates to supervision of delegated nursing and/or midwifery tasks and activities, including: Providing education, guidance and support for individuals who are performing the delegated activity Directing the individual’s performance Monitoring and evaluating outcomes, especially the consumer’s response to the activity

16 Supervision The level of supervision should be appropriate to the degree of risk of the activity Direct Supervision Is when the supervisor is present and personally observes, works with, guides and directs the person being supervised Indirect Supervision Is when the supervising RN/RM is on site and easily contactable and available for reasonable access but does not directly observe the activity

17 Responsibilities when delegating The professional’s responsibilities include: teaching (although this may be undertaken by another competent person, and teaching alone is not delegation) competence assessment providing guidance, assistance, support and clinically focussed supervision ensuring that the person to whom the delegation is being made understands their accountability and is willing to accept the delegation evaluation of outcomes reflection on practice.

18 Responsibilities when accepting a delegation The recipient’s responsibilities include: negotiate, in good faith, the teaching, competence assessment and level of clinically focussed supervision needed notify in a timely manner if unable to perform the activity for an ethical or other reason be aware of the extent of the delegation and the associated monitoring and reporting requirements seek support and direct clinically focussed supervision until confident of own ability to perform the activity perform the activity safely participate in evaluation of the delegation.

19 Case Scenarios

20 Introductory video There are 8 case scenarios included in the package. Each case scenario highlights key elements of delegation. Whilst some of the scenarios take place in a particular setting and involve a specific role, the learning is applicable across settings and can be applied working with other types of roles and workers. Working through case scenarios can help link theory to the application to real-life workplace scenarios.

21 Introductory video YouTube link:

22 You are an experienced nurse/midwife that has been assigned a third-year undergraduate student to work with you for the shift. One of your patients is Ms Sullivan, is a 30 year old lady who is normally ambulate and self caring however due to pain and limited range of movement needs assistance in the shower. What are the key things to consider relating to the level of delegation that could occur to the undergraduate student? Case scenario 1: Delegating to undergraduate students

23 YouTube link:

24 Case scenario 2: Scope of role and responsibilities You are an enrolled nurse and you have been asked by a doctor to assist with a procedure. You have not learnt about the procedure, or achieved competency in this task. How should you respond? Things to consider: Who is able to delegate activities to an enrolled nurse? How can I respond without seeming unhelpful? What do I do if I have concerns about undertaking the task being asked of me?

25 Case scenario 2: Scope of role and responsibilities YouTube link:

26 Case scenario 3: Responsibilities of roles You are the registered nurse in charge of your ward/unit/facility. You have allocated an enrolled nurse to take care of Ms Smith. During that morning the enrolled nurse is assisting Ms Smith with her hygiene requirements in the bathroom. Whilst the enrolled nurse is removing Ms Smith’s anti-embolitic stockings she notices a pressure injury on her leg, which Ms Smith states it is very painful. What are the enrolled nurse’s responsibilities? What are the registered nurse’s responsibilities?

27 Case scenario 3: Responsibilities of roles YouTube link: S25j2ohttp://www.youtube.com/watch?v=oHxR- S25j2o

28 Case scenario 4: Right supervision and evaluation You are a registered nurse working with a relatively new enrolled nurse, who has been working on the ward for a few months following completion of their Diploma. When working with this enrolled nurse which tasks or activities will require direct supervision and which will require indirect supervision? Things to consider: Are the tasks or activities within the scope of practice for EN’s? If so, has the EN received education and training in a particular task or activity, and have they been formally assessed as competent? Have you personally provided direct supervision for them undertaking the task or activity before? How has their learning and competence progressed since commencing employment? How will you know that the task or activity is been undertaken satisfactorily?

29 Case scenario 4: Right supervision and evaluation YouTube link:

30 Case scenario 5: ENs working with unlicensed healthcare workers You are an experienced enrolled nurse working a busy morning shift. An unlicensed healthcare worker is also working that morning as part of the team. What are your responsibilities as an enrolled nurse and how do you work with an unlicensed healthcare worker? Things to consider: How do I differentiate the responsibility and accountability of the registered nurse and enrolled nurse in the delegation of nursing care? Have I already been delegated the task by a registered nurse? Has the unlicensed healthcare worker been allocated or assigned to work with me by a registered nurse? Are there shared activities where both the unlicensed healthcare worker and I are competent to undertake the task, and is this supported by my employer? Am I able to supervise the unlicensed healthcare worker in any aspects of their work?

31 Case scenario 5: ENs working with unlicensed healthcare workers YouTube link:

32 Case scenario 6: Right activity, circumstance and communication You are a registered nurse working along side an unlicensed healthcare worker, and together you have been allocated 4 patients. It is 8am, and you have completed your initial assessments. You want to ensure you are effectively delegating to the unlicensed healthcare worker. Select how you would delegate, and explain your rationale.

33 Case scenario 6: Right activity, circumstance and communication Your patients: Mr Lee (70-year-old male, diagnosis: urinary tract infection). Mr Lee is alert but is experiencing some confusion. Vital signs are ordered every four hours. He is experiencing urinary frequency. He is a falls risk, and needs to be reminded to use the urinal rather than getting out of bed on his own to use the bathroom. Ms White (43-year-old female, diagnosis: admitted for a hysterectomy). Ms White had a hysterectomy two days ago. Her postoperative course has been uncomplicated. The surgeon wants Ms White to ambulate three times per day. Her vital signs are stable. She is alert, oriented, and cooperative. Mr Williams (46-year-old male, new admit, diagnosis: suspected Crohn’s disease). Mr Williams has been having abdominal pain and severe bouts of diarrhoea for the past several months. He was admitted this morning. He is NBM to rest his bowels and to prepare for an upper gastrointestinal diagostic series. He has been hypotensive and has IV fluids running and prn pain medications. Mrs Taylor (66-year-old female, diagnosis: congestive heart failure). Mrs Taylor was transferred onto the ward early this morning. She was admitted four days ago with acute pulmonary oedema. She has history of CHF and takes diuretics, digoxin, and an ACE inhibitor at home. She is alert and oriented. She is short of breath, on 2L of O 2 with oxygen saturation at 93%. She has an IDC in situ and is on strict fluid balance.

34 Case scenario 6: Right activity, circumstance and communication YouTube link:

35 Case scenario 7: Effective and safe allocation and assignment You are an associate nurse unit manager working on a busy acute ward. You are in charge of a morning shift and have an unlicensed healthcare worker as part of your ward team. The team has just received handover and after reviewing the patient profile and the staff skill mix you are about to allocate your staffing resources for the shift. Which patients will you allocate the unlicensed healthcare worker to and why? How will you undertake the allocation and assign the unlicensed healthcare worker and will the unlicensed healthcare worker be allocated to work with one nurse or, more than one nurse? How will the unlicensed healthcare worker be assigned once they have completed a set of activities?

36 Case scenario 7: Effective and safe allocation and assignment Things to consider: How do I allocate the unlicensed healthcare worker to enhance the safe, efficient and effective provision of care for that shift? How do I ensure that the unlicensed healthcare worker is being utilised where they are needed most, making the best use of their competencies within the parameters of their role? How do I manage the demand from the nursing team for assistance from the unlicensed healthcare worker? How do I prevent the unlicensed healthcare worker being subjected to competing demands from different members of the ward team?

37 Case scenario 7: Effective and safe allocation and assignment YouTube link:

38 Case scenario 8: Right communication, supervision and evaluation Develop a sequence of sentences to effectively delegate a task to an enrolled nurse or unlicensed assistive worker. Ms Jackson is a 45-year-old female admitted two days ago for a hysterectomy. Her postoperative recovery has been uncomplicated. The surgeon wants Ms Jackson to ambulate three times per day. You have assessed Ms Jackson and have determined that an unlicensed healthcare worker could help with the ambulation. You approach the unlicensed healthcare worker on your team.

39 Case scenario 8: Right communication, supervision and evaluation YouTube link:

40 More information available: Nursing in Victoria Nursing & Midwifery Board of Australia Statements/Codes-Guidelines.aspx#dmf Statements/Codes-Guidelines.aspx#dmf Full reference list included in the guideline. Questions and discussion


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