communication

NCSBN-ANADelegationDecisionTree.pdf

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Joint Statement on Delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

Appendix B National Council of State Boards of Nursing Decision Tree for Delegation to Nursing Assistive Personnel Step One – Assessment and Planning

Do not delegate NO

Is the task within the scope of the delegating nurse?

Is the delegating nurse competent to make delegation decisions?

Has there been assessment of the client needs?

If not in the licensed nurse’s scope of practice, then cannot delegate to the nursing assistive personnel (NAP). Authority to delegate varies; so licensed nurses must check the jurisdiction’s statutes and regulations.

Do not delegate

Assess client needs and then proceed to a consideration of delegation

Do not delegate until can provide and document additional education, then reconsider delegation; otherwise do not delegate

YES

YES Is the task consistent with the recommended criteria for delegation to nursing assistive personnel (NAP)? Must meet all the following criteria:

Is within the NAP range of functions Frequently recurs in the daily care of a client or group of

clients; Is performed according to an established sequence of

steps; Involves little or no modification from one client-care

situation to another; May be performed with a predictable outcome; Does not inherently involve ongoing assessment,

interpretation, or decision-making which cannot be logically separated from the procedure(s) itself; and

Does not endanger a client’s life or well-being

Are there laws and rules in place that support the delegation?

Do not delegate until evidence of education and validation of competency available, then reconsider delegations; otherwise do not delegate

YES Does the nursing assistive personnel have the appropriate knowledge, skills and abilities (KSA) to accept the delegation? Does the ability of the NAP match the care needs of the client?

YES

ANA • 8515 Georgia Avenue, Suite 400 • Silver Spring Maryland 20910-3492 • 301.628.6500 • Fax 301.628.5001 • www.nursingworld.org NCSBN • 111 E. Wacker Drive, Suite 2900 • Chicago, Illinois 60601-4277 • 312.525.3600 • Fax 301.279.1032 • www.ncsbn.org

Joint Statement on Delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

Do not delegate NO

NO Are there agency policies, procedures and/or protocols in place for this task/activity?

Is appropriate supervision available?

Do not proceed without evaluation of need for policy, procedures and/or protocol or determination that it is in the best interest of the client to proceed to delegation. YES

Proceed with delegation*

YES

Step Two – Communication Communication must be a two-way process The nurse: Assesses the assistant’s understanding

o How the task is to be accomplished o When and what information is to be reported,

including Expected observations to report and record Specific client concerns that would require prompt reporting.

Individualizes for the nursing assistive personnel and client situation

Addresses any unique client requirements and characteristics, and clear expectations of:

Assesses the assistant’s understanding of expectations, providing clarification if needed.

Communicates his or her willingness and availability to guide and support assistant.

Assures appropriate accountability by verifying that the receiving person accepts the delegation and accompanying responsibility

The nursing assistive personnel Ask questions regarding the

delegation and seek clarification of expectations if needed

Inform the nurse if the assistant has not done a task/function/activity before, or has only done infrequently

Ask for additional training or supervision

Affirm understanding of expectations Determine the communication

method between the nurse and the assistive personnel

Determine the communication and plan of action in emergency situations.

Documentation: Timely, complete and accurate documentation of provided care Facilitates

communication with other members of the healthcare team

Records the nursing care provided.

Joint Statement on Delegation American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

Step Three – Surveillance and Supervision The purpose of surveillance and monitoring is related to nurse’s responsibility for client care within the context of a client population. The nurse supervises the delegation by monitoring the performance of the task or function and assures compliance with standards of practice, policies and procedures. Frequency, level and nature of monitoring vary with needs of client and experience of assistant. The nurse considers the: Client’s health care status

and stability of condition Predictability of

responses and risks Setting where care occurs Availability of resources

and support infrastructure. Complexity of the task

being performed.

The nurse determines: The frequency of onsite

supervision and assessment based on: o Needs of the client o Complexity of the

delegated function/task/activity

o Proximity of nurse’s location

The nurse is responsible for: Timely intervening and follow-up on problems and

concerns. Examples of the need for intervening include: Alertness to subtle signs and symptoms (which allows

nurse and assistant to be proactive, before a client’s condition deteriorates significantly).

Awareness of assistant’s difficulties in completing delegated activities.

Providing adequate follow-up to problems and/or changing situations is a critical aspect of delegation.

Step Four – Evaluation and Feedback

Evaluation is often the forgotten step in delegation. In considering the effectiveness of delegation, the nurse addresses the following questions: Was the delegation successful?

o Was the task/function/activity performed correctly? o Was the client’s desired and/or expected outcome achieved? o Was the outcome optimal, satisfactory or unsatisfactory? o Was communication timely and effective? o What went well; what was challenging? o Were there any problems or concerns; if so, how were they addressed?

Is there a better way to meet the client need? Is there a need to adjust the overall plan of care, or should this approach be continued? Were there any “learning moments” for the assistant and/or the nurse? Was appropriate feedback provided to the assistant regarding the performance of the delegation? Was the assistant acknowledged for accomplishing the task/activity/function?