Continuing Education Presentation 2008 Delegation Continuing Education Presentation 2008

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 perform a selected nursing task in a selected situation. American Nurses Association (1996) Transfer of responsibility for the performance of a task from one individual to another.

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).

Four Components of Delegation care outcomes - patient care is safely provided accountable and responsible - both RN and delegatee have an obligation to care for that patient and ensure the task is completed sharing activities – both the RN and delegatee work together to accomplish care appropriate authority – the RN selects the appropriate person to delegate the task

Need for Delegation Increased acuity of patients Increased use of Unlicensed Assistive Personnel (UAPs) and Practical Nurses (PN) Increased RN responsibilities in the management of the nursing unit/organization Accelerated pace and changing health care environment.

Five Rights of Delegation Right Task Right Circumstance 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 An awareness of the staff mix – distribution of Practical Nurses(PNs) and Unlicensed Assistive Personnel(UAPs) Organization documents – the job descriptions, 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 Renders official opinions which guide practice Organization guidelines – each organization has statements that guide practice. Mission statement Policies and procedures (determine what can be done and what level of personnel can carry out the task) Job descriptions – identifies job responsibilities

Right Communication Clear and concise communication is imperative from the RN to the delegatee. This communication should include the : Task with clear expectations of what is to be done, why 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 an environment where feedback is seen as constructive, consider the following. Timing of the feedback – the RN should give the delegatee 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

Five Rights of Delegation Please go to this web site for further information on the five rights of delegation. https://www.ncsbn.org/fiverights.pdf

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

Legal Authority to Delegation Legal responsibility for the RN to delegate a task to the PN or UAP is determined by Nurse Practice Act Employer’s statements including job descriptions, policies, and procedures National standards of care American Nurses Association (ANA) Other national organizations

ANA Standard of Care According to the ANA Standards of Care, RNs can not delegate the following tasks Initial nursing assessment and additional 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

Additional Legal Principles RN remains legally responsible for delegated activities RN is accountable for appropriateness of delegated 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

Challenges with Delegation Delegatee refuses to accept the delegated task. Delegator – go rapidly through the 5 rights Ask the delegatee why the request is being refused May be due to Fear – afraid can not complete the task correctly and safely Told not to do by others – other RNs have told the delegatee never to carry out this task Lack confidence – the delegatee may be new or lack the confidence to complete the task Overwhelmed – may be concerned about the workload already assigned

Challenges with Delegation Some additional challenges with delegation include “I have to do it myself” belief system – the RN feels that because of the responsibility of care, the tasks need to be completed by the RN Lack of confidence in PN/UAP – the RN may not know the PN or UAP and therefore is not comfortable with delegation

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.