Delegation FALL 2020
Discuss the nurse leader’s role to effectively and efficiently manage financial, technological and human resources in the health care organization
Week 9 SLO 5
The person who accepts the assigned work also accepts responsibility for performing the work
• Understanding management and delegation skills are part of nurses leading teams by being responsible for the nursing processes and outcomes of patient care. Delegation is one of the key factors in effective teamwork • Understanding staffing needs, unit budget, Staff recruitment, and retention
Grohar-Murray, M. E. (2011). Chapter 14: Managing resources: the staff, p. 272-285. Cherry, B. and Jacob S. (Eds.), (2019). Chapter 20: Effective delegation and supervision, p. 345– 358.
What does delegation look like
• ANA and National Council of State Board of Nursing developed • National Guidelines for Nursing Delegation • Nurse Practice Act • APRN > RN >LVN/LPN >AP
https://www.ncsbn.org/NGND-PosPaper_06.pdf
Delegations: Transfer of responsibilities
• What is the difference between delegation and assignment?
https://www.ncsbn.org/NGND-PosPaper_06.pdf
Delegations: Transfer of responsibilities
Delegations: match definition A
Accountability:
1
A licensed nurse includes APRNs, RNs and LPN/VNs. In some states/jurisdictions, LPN/VNs may be allowed to delegate.
B
Delegated Responsibility:
2
One who is delegated a nursing responsibility by either an APRN, RN or LPN/VN (where jurisdiction NPA allows), is competent to perform it and verbally accepts the responsibility. A delegatee may be an RN, LPN/VN or AP.
C
Delegatee:
3
One who delegates a nursing responsibility. A delegator may be APRN, RN, or LPN/VN (where jurisdiction NPA allows).
D
Delegator:
4
A nursing activity, skill or procedure that is transferred from a licensed nurse to a delegatee.
E
Assignment:
5
Any assistive personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. This includes but is not limited to certified nursing assistants or aides (CNAs), patient care technicians, CMAs, certified medication aids, and home health aides (formerly referred to as ‘‘unlicensed” assistive personnel [UAP])
F
Licensed Nurse:
6
The routine care, activities and procedures that are within the authorized scope of practice of the RN or LPN/VN or part of the routine functions of the AP.
G
Assistive Personnel (AP):
7
“To be answerable to oneself and others for one’s own choices, decisions and actions as measured against a standard…” (American Nurses Association, 2015, p. 41).
• 2. An RN on a medical‐surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LVN? • A. Obtain vital signs for a client who is 2 hr post procedure following a cardiac catheterization. • B. Administer a unit of packed red blood cells (RBCs) to a client who has cancer. • C. Instruct a client who is scheduled for discharge in the performance of wound care. • D. Develop a plan of care for a newly admitted client who has pneumonia
Delegations: Transfer of responsibilities
• Prioritize systemic before local (“life before limb”). • Prioritize acute (less opportunity for physical adaptation) before chronic (greater opportunity for physical adaptation). • Prioritize actual problems before potential future problems. • Listen carefully to clients and don’t assume
Prioritization principles in client care
• 3. A PN ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? • A. Complete an incident report. • B. Delegate this task to the PN. • C. Ask the AP if they need assistance. • D. Notify the nurse manager.
Prioritization principles in client care
• Recognize and respond to trends vs. transient finding • Recognize indications of medical emergencies and complications vs. expected findings • Apply clinical knowledge to procedural standards to determine the priority action
Prioritization principles in client care
Evaluating a client • Acute vs. chronic • Urgent vs. nonurgent • Stable vs. unstable
Prior to delegating client care, consider the following.
1. Is the delegaee legally able to perform the task and do they have the skills necessary? * 2. Is there a need to provide psychosocial support or A.Predictability of education during the performance of the task? & outcome 3. Will the completion of the task B. Potential for harm have a predictable outcome? % 4. Is there a chance that C. Complexity of care something negative can happen D.Need for problem to the client (risk for bleeding, solving and innovation risk for aspiration)? @ 5. Is nursing judgment required E. Level of interaction while performing the task? # with the client
1. A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? • A. Notify the provider to determine whether the client needs further examination and treatment, but there is another action to take first. • B. Ask a staff member for assistance getting the client back in bed. • C. Use the nursing process is to assess the client in order to determine which interventions
DELEGATION AND SUPERVISION GUIDELINES
Harriet Tubman | Black History in Two Minutes https://youtu.be/fn-mKoA4odI
Ellen Dougherty, the First Registered Nurse in the World • Ellen Dougherty was born on September 20, 1844 at Port Underwood, New Zealand. Ellen was inspired to be a nurse after learning about Florence Nightingale. It is believed that before nurse training, she worked with Charles Barraud in his Wellington pharmacy. Ellen completed a certificate in nursing in 1887 at Wellington Hospital. In 1893 she accepted a post as matron of Palmerston North Hospital.