Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal

Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 13 Delegation of Nursing Care

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company3 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company4 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company5 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company6 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 person’s obligation to perform at an acceptable level.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company7 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company8 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company9 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company10 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

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company11 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company12 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company13 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

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company14 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company15 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

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company16 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.

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company17 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

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company18 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

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company19 Five Rights of Delegation  The right task  The right circumstance  The right person  The right direction and communication  The right supervision and evaluation

Chapter 13Copyright © 2003 Delmar Learning, a Thomson Learning company20 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