Discussion Topic-Ch 6,7

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Delegation, Prioritization, and Decision Making

Chapter 7

Delegation of Client Care: Definition

The reassigning of responsibility for the performance of a job from one person to another.

(ANA, 1996)

Concepts of Delegation

The responsibility of the task is transferred.
Accountability remains with the delegator.
Delegation may be direct or indirect.

Direct Delegation

Usually verbal direction
RN decides which staff member is capable of performing a specific task.

Indirect Delegation

Contained in an approved listing of tasks established by an institution
Permitted tasks may vary from institution to institution

Assigning Tasks

The RN may assign a more skilled individual to perform a task.
The RN may not assign an individual to perform an activity outside a job description or the scope of practice.

Delegation vs. Supervision

Supervision

Supervision is usually more direct than delegation.
It requires directly overseeing the work or performance of others.
It includes checking with individuals during the day.
It may entail delegation of tasks and activities.
The nurse manager performs both.

The Nursing Process and Delegation

Assessment

Assess client needs.
Set client-specific goals.
Match the personnel with the appropriate skills to care for the client.

Planning

Mentally identify who is best suited for the task or activity.
Planning prevents later problems.

Implementation

Assign the appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities.

Evaluation

Oversee the care or activities.
Determine if client care needs have been met.
Allow for feedback.

Coordinating
Assignments

Methods to Help Organize Care

Critical pathways
Computerized information sheets
Personalized worksheets
Delegation tree

Tips for Organizing Care

Plan time around activities that must be performed at a certain time.
Perform high-priority activities first.
Cluster activities that may be performed together.
Consider your peak time when performing optional activities.

The Need for Delegation

Changes in the Health-Care Environment

Nursing shortage
Health-care reform
Increased need for nursing services
Demographic trends
Use of unlicensed assistive personnel

Unlicensed Assistive Personnel (UAPs)

Individuals trained to function in an assistive role to the nurse
Perform delegated tasks
Under direct supervision of the RN
May or may not be certified

Delegation to UAPs

Examples of Tasks

Vital signs
Skills learned through special training
Blood drawing
ECGs
Measuring intake and output
Non-nursing duties

Safe Delegation

Criteria for Safe Delegation

Potential for harm
Complexity of the task
Problem-solving and innovation necessary to complete the task or activity

Considerations for Safe Delegation

Ability of the individual
Fairness of the task

Guidelines for Delegation

Task-Related Concerns

Primary Concern

Does the individual assigned to the task have the ability to perform the task?

Other Task-Related Concerns

Ability
Priorities
Efficiency
Appropriateness

Relationship-Oriented Concerns

Fairness
Learning opportunities
Health
Compatibility
Preferences

Summary of Expectations of Professionals

Respect of others
A reasonable workload
Appropriate wages
Determining his/her own priorities
Ask for what he/she wants
Accountability
Give and receive information as a professional

Barriers to Delegation

Barriers

Experience
Licensure
Quality of care
Assigning work to others

The Five Rights of Delegation

Right task
Right circumstances
Right person
Right direction/communication
Right supervision/evaluation

Conclusion

Points to Consider

Delegation is not new.
The role is essential for good working relationships.
Organizational skills are a prerequisite for delegation.
Understanding client needs is essential for appropriate delegation.

The RN Needs to Understand

The State Nurse Practice Act
The capabilities of each staff member
The tasks that may be delegated
The concept of accountability in delegation