Delegation

Chapter20.pptx

Chapter 20 Delegation

Learning Objectives

1. Differentiate between assignment and delegation (ATI p 7-9) (Text 528 & 538)

2. Identify specific strategies that increase the likelihood of effective delegation (ATI p 8) (Text 530-32)

3. Describe delegation as a learned skill imperative to professional nursing practice –5 Rights of Delegation (ATI p 9-10) (Text p 529)

4. Delegate tasks using appropriate priority setting and personnel in specific situations (Text 535-540)

Learning Objectives

* Delegating and Supervising/the health care team (ATI p 8) (Text p 530-31)

5. Differentiate between tasks that should and should not be delegated to licensed and unlicensed personnel based on skill and education level as well as individual state scope of practice guidelines (ATI p 8) (Text 538-39)

6. Identify common causes of underdelegation, overdelegation, and improper delegation as well as strategies to overcome these delegation errors (Text 533-34)

Learning Objectives

7. Provide adequate information and authority to others to successfully complete delegated tasks (Text 529 & 531)

8. Identify factors that must be considered when determining what tasks can be safely delegated to subordinates (Text p 539)

9. Determine whether delegation to an unlicensed worker is appropriate in a specific situation, using a decision tree by the National Council of State Boards of Nursing (NCSBN) or a State Board of Nursing (Text p 539)

Definitions of Delegation #1

Getting work done through others

Directing the performance of one or more people to accomplish organizational goals

Giving someone else the authority to complete a task or

action on your behalf

Transferring or handing

off to a competent

individual, the authority

to perform a task/activity

in a specific setting/situation

Definitions of Delegation #2

Delegation should be used for assigning routine tasks and tasks for which the manager does not have time. It is also appropriate as a tool for problem solving, changes in the manager’s own job emphasis, and building capability in subordinates.

Strategies for Successful Delegation #1

Plan ahead.

Identify necessary skill and education levels to complete the delegated task.

Select capable personnel.

Communicate goals clearly.

Strategies for Successful Delegation #2

Empower the delegate.

Set deadlines and monitor progress.

Monitor the role and provide guidance.

Evaluate performance.

Reward accomplishment.

State NPA Essential Elements Regarding Delegation #1

Definition of delegation

Items that cannot be delegated

Items that cannot be routinely delegated

Guidelines for RNs about tasks that can be delegated

Description of professional nursing practice

Description of LVN/LPN nursing practice and unlicensed nursing roles

State NPA Essential Elements Regarding Delegation #2

Degree of supervision required to complete a task

The guidelines for lowering delegation risks

Warnings about inappropriate delegation

If there is a restricted use of the word nurse to licensed staff

Common Delegation Errors

Underdelegating

Overdelegating

Improper delegating

Causes of Underdelegating #1

Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly

A desire to complete the whole job himself or herself

Fear that subordinates will resent delegated work

Lack of experience in the job or with delegation, or the need to control or be perfect

Enjoyment of the work

Causes of Underdelegating #2

It will likely be unnerving (at least initially) to allow a team member to complete a task for which you are ultimately responsible.

Causes of Overdelegating

Poor management of time; spending too much time trying to get organized

Insecurity in the ability to perform a task

Causes of Improperly Delegating

Wrong time, to the wrong person, or for the wrong reason

Beyond the capability of the person, or something the manager should do

Decision making without providing adequate information

The Five Rights of Delegation

Right task

One that is delegable for a specific patient

Right circumstances

Appropriate patient setting, available resources, and other relevant factors considered

Right person

Right person is delegating the right task to the right person to be performed on the right person.

Right direction/communication

Clear, concise description of the task, including its objective, limits, and expectations

Right supervision

Appropriate monitoring, evaluation, intervention, as needed, and feedback

Rules of Delegation

Always delegate to the right person, at the right time, and for the right reason.

Say no when you must.

Reward subordinates for jobs well done.

Clear Communication and Delegation

Define the task clearly.

Delineate end results, time frame, and standards.

Delegate the objective, not the procedure.

“Satisficing” Versus Maximizing Mode in Delegating

If the delegator requires a higher quality than “satisficing,” this must be made clear at the time of the delegation. Not everything that is delegated needs to be handled in a maximizing mode.

Delegation as a Function of Professional Nursing #1

Organizations must have a clearly defined structure where RNs are recognized as the leaders.

Job descriptions must clearly define the roles and responsibilities of all.

Educational programs must be developed to help personnel learn roles and responsibilities of each other’s roles.

Adequate programs must be developed to foster leadership and delegation.

Delegation as a Function of Professional Nursing #2

Although the Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of “certified nurse’s aides” (minimum of 75 hours of theory and practice and successful completion of an examination in both areas), no federal or community standards have been established for training the more broadly defined NAP.

Delegating to Unlicensed Assistive Personnel (UAP)

Potential Costs

Liability for negligence

Issues for task delegation

Job description

Knowledge base

Demonstrated skills

Responsibility for patient outcomes

Sample Titles Given to UAP and NAP #1

Nurse extenders

Care partners

Nurse’s aides

Orderlies

Assistants

Attendants

HCAs

Technicians

Sample Titles Given to UAP and NAP #2

In assigning tasks to NAP, the RN must be aware of the job description, knowledge base, and demonstrated skills of each person.

The NAP has no license to lose for “exceeding scope of practice” and nationally established standards as to what the limits should be for NAP in terms of scope of practice do not exist.

Sample Titles Given to UAP and NAP #3

Professional nursing organizations and regulatory bodies are actively engaged in clarifying the scope of practice for unlicensed workers and delegation parameters for RNs.

Sample Titles Given to UAP and NAP #4

Assuming the role of delegator and supervisor to the NAP increases the scope of liability for the RN. Although the NAP does bear some personal accountability for their actions, this does not negate accountability for the RN who delegated the task(s).

Monitoring Delegated Tasks

Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task but should also validate this perception by direct observation.

Monitoring delegated tasks keeps the delegated task before the subordinate and the manager so that both share accountability for its completion.

Resistance to Delegation

Resistance is a common response by subordinates to delegation.

One of the most common causes of subordinate resistance to, or refusal of, delegated tasks is the failure of the delegator to see the subordinate’s perspective.

Resistance to delegation may also occur when tasks are overdelegated in terms of specificity.

Elements Affecting Delegation to a Transcultural Work Team

Communication

Space

Social organization

Time

Environmental control

Biological variations