DELEGATION

Delegation

• Definition– An essential decision-making skill– “Transferring to a competent individual the

authority to perform a selected nursing task in a specific situation.”

• Purpose– For effective use of available personnel to deliver

safe, cost-effective health care – Involves coordination with UAP

Delegation

• Nurse retains accountability for the delegation– To be accountable is to be legally responsible– May be held liable for any related consequences– The “delegator” is responsible for the decision to

delegate, an assessment of the situation, planning desired outcomes, providing proper communication and adequate supervision

Delegation

• “Adequate” Nursing supervision– “the provision of guidance or direction,

evaluation, and follow-up by the licensed nurse for the accomplishment of a nursing task delegated to unlicensed assistive personnel.”

Delegation

• Principles of Delegation– Frequently, the RN must delegate tasks when the

skill levels of personnel are mixed.– Level of skills may include: UAP, LPN, RN staff

members– Before delegation, essential to identify the roles of

available staff– 3 sources that provide guidelines for safe

delegation

Delegation

– 3 sources (for decision making) 1. State Nurse Practice Act

Defines nursing practice and scope of practice

Primary purpose – to protect the health and safety of the public

2. Institutional Policy and Procedures3. Job description

consider caregiver competency

Delegation

• Five Rights of Delegation:– Right Task:

1. Determine tasks that need to be completed

2. Who should perform the tasks?[Can the task legally be delegated?]

Delegation

3. RN cannot/should not delegate:a. Own personal accountability for pt. outcomesb. Management skills – eg. Recognition, praise, or discipline of employeesc. Nursing actions that require professional judgment including teaching, assessment, decision-making, priority setting, critical thinking and the nursing process.

Delegation

• Five Rights (cont.)– Right Circumstance – Consider the factors related

to the client condition. Outcome of care needs to be reasonable and predictable• The task must be one that does not require ongoing

assessment or critical decision-making– Right Person • Consider the job classification of each team member

Delegation

• Five Rights (cont.)– Right Person (cont.)• Consider the RN/LPN roles [Table 6-1, Ch. 6, Critical

Thinking text]• LPN – can deliver physical care to stable patients with

predictable outcomes. May include tasks with sterile technique, medications, etc.• UAP – Unlicensed Assistive Personnel

– Requires special consideration– Regulated by each state– Some Common Guidelines

Delegation

• Five Rights (cont.)– Right Person (cont.)• UAP (cont.) Common Guidelines:

– Stable patients with predictable outcomes» This includes stability in their reaction to illness and

hospitalization– Examples of tasks: bathing , making beds, routine VS, feeding,

transferring– Accountable for accepting the delegation, reporting requested

information to the RN/LPN, and for accomplishing the tasks assigned

Delegation

• Right Direction/Communication– Identify the task– Evaluate whether instructions were clear and

understood– Be sure that communication is:• CLEAR• CONCISE• CORRECT• COMPLETE

Delegation

• Right Supervision and Evaluation– Includes monitoring of delivery of care• Provide guidance and direction

– Quality of care –Evaluated by pt. progress toward desired outcomes

– Plan of care is essential to direct the RN’s decisions.

Care Prioritization

• Definition – Deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent

Priority Setting

• Prioritizing Patient Needs– Use Maslow’s Hierarchy of Needs• A theory of motivation based on human needs• The basic needs found at the base of the pyramid

(physiologic needs) must be at least partially met before the individual can concentrate on the other needs.– Eg. If a person is starving, self-esteem is not a

pressing issue.

Priority Setting

• Prioritizing Patient Needs (cont.)– This pyramid can help the nurse in selecting nursing dx.,

and determining the priority of the dx.– Physiologic needs always take precedence.• Exception: when a psychosocial problem interferes with

the patient’s ability to participate in the physiologic care.– Eg. Mastectomy patient unable to learn how to

dress the wound for home management because she is not able to look at the surgical site.

Care Prioritization

• Guidelines (cont.)– High: Client needs that are life threatening or

could result in harm to the client if they are left untreated.

– Intermediate: Non-emergency and non life threatening client needs

– Low: Client needs that are not directly related to the client’s illness or prognosis.

Priority Setting

• High-Priority Situations– Life-threatening• Airway difficulties• Cardiovascular changes• Tissue perfusion changes• Alteration in fluid volume

– Threats to patient safety– Situations in which pain and anxiety relief is a

concern

Priority Setting

• Medium-priority situations– Nursing diagnoses that involve problems that

“could result in unhealthy consequences, such as physical or emotional impairment, but are not likely to threaten life” (Craven & Hirnle, 2003. p.187)

– Examples• Anxiety caused by a Lack of Knowledge• Urgent events that are not life threatening• Preparation for a test or discharge preparation

Priority Setting

• Low-priority situations– Nursing dx. involve problems that can usually be

resolved with minimal interventions – Have little potential to cause significant

dysfunction– No major effect on the person– See Box 4-3 [Critical Thinking…]

Care Prioritization

• Consider time constraints and available resources– Which tasks can be delegated?

• May be guided by principles, models, or theories such as Maslow’s Hierarchy of Needs

• Use the ABCs: Airway, Breathing, Circulation