Delegation

Underdelegating Causes: Fear

Fear delegation may be interpreted as a lack of ability to do the job. Delegation need not limit the manager's control, prestige, and power, rather delegation can extend the manager's influence and capability by increasing what can be accomplished. The right to delegate and the ability to provide formal rewards for successful completion of delegated tasks are a reflection of the legitimate authority inherent in the management role.

Underdelegating Causes: Fear that Subordinate will Resent

Fear that subordinates will resent delegated work and not like me. Delegated work actually increases employee satisfaction and fosters a cooperative working relationship b/w managers and staff. Leads to motivation

Benefits of Delegation

Frees manager to handle complex problems when others may be better prepared for other tasks. Provides learning or "stretching" opportunities. Increases power: expands your influence and capability by increasing what can be accomplished.

Accountability

Someone must be able to explain actions and results. Legally the RN is accountable for nursing care. Nurses... For: decision to delegate, delegated task, client outcomes. To: self, clients, employer, licensing board, profession. Assistive personnel accountability... For: decision to accept delegation, performance. To: self, delegating nurse, employer.

Direct Ideas about Prioritization

Systemic before local: life before limb. Acute before chronic. Actual before potential problems.

Delegating to AP

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 nursing AP.

Delegating a Trans-cultural Team

Communication: what type of dialect, volume, eye contact. Space: need adequate space. Social organization: family and importance of it. Time: valued or not, future, past or present look. Environmental control: internal, external, harmonious. Biological variations: susceptibility to infectious diseases.

Poor Time Management Symptoms

Constant rushing. Caught in crisis mode. Fatigue or listlessness, "overwhelmed" feeling. Constantly missing deadlines. Insufficient time for rest or personal relationships. Sense of being overwhelmed by demands and details. Having to do what you don't want to do, most of the time.

Communication with Delegation

Define task clearly. Delineate end results/outcomes, time frame, and standards. Delegate the objective, not the procedure. Be careful though to delegate the objective, not the procedure. Allow employees some creativity in achieving the desired end product and know that the procedure or policy in the organization is a guide to carry out the task For example don't tell an aide how to organize his/her work

State NPA Essential Elements with Delegation

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. Must know your states guidelines that are in the nurse practice act.

Delegation

Delegation is allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee's traditional role and not routinely performed.

3 Main and Critical Skills

Delegation. Time management. Prioritization.

Underdelegating Causes: Desire to Complete Job Self

Desire to complete the whole job himself/herself. Implies a lack of trust in subordinates because manager believes he or she needs the experience or because he or she can do it better and faster than anyone else Time spent training another to do a job is much repaid in the future Delegation (in addition to productivity) provides the opportunity for subordinates to experience feelings of accomplishment and enrichment

Rules of Delegation

Do not delegate responsibility without authority. Delegate the right task, to the right person, with the right communication, for the right reason/circumstance, and with the right supervision. Say no when you must when receiving delegation. Reward when the task is completed. Accountability stays with the delegator.

Setting Priorities

Do what is most critical first, don't do whatever "hits" first. Don't do the easiest task first; trivial can be done later. Remember to delegate even if it takes more time, in the long term delegation is more effective. Try to avoid responding to the "squeaky wheel" first. Don't do something just because no one else wants to do it - delegate.

Setting Priorities: Skills

Gather all that you need for a task first Anticipate complications and calculate that the task may take longer Group similar activities Document nursing care right away Take your breaks (leave the area!) Keep interruptions to a minimum, don't hesitate to state you will get back to someone Don't try to socialize to be nice; set aside time for more social interactions Avoid time wasting activities Be punctual, implies you value other people's time Three Categories... Dont do. Do later. Do now.

Definitions of Delegation

Getting work done through others. Directing the performance of one or more people to accomplish organizational goals. Transfer of authority to perform the work. Essential element of the directing phase of the management process.

Underdelegating Causes: Lack of Experience

Lack of experience in job or delegation, or need to control or be perfect. Refusal to allow mistakes limits the opportunities available for subordinate growth and results in wasted time as the manager recompletes delegated tasks Does the manager want 'satisficing' or 'maximizing' work completed? This must be clear at the outset, not all delegated activities need to be maximizing. Some novice managers emerging from the clinical nurse role under delegate because they find it difficult to assume the manager role. This occurs, in part because nurses have traditionally been rewarded for their clinical expertise, not their management skills.

Delegating to AP: Potential Cost

Liable for negligence, increases scope of liability for the RN. Accountability for patient outcomes. Issues with task delegation... Job description Knowledge base Demonstrated skills Complexity of task Potential for harm

Procrastination

Means to put off something until a future time, to postpone, or to delay needlessly. Not a character flaw but is a set of behaviors which were developed over a period of time; they are a behaviors that can be changed. The dread of doing a task uses more time and energy than doing the task itself.

Delegating to Licensed Practical Nurse (LPN)

Monitor assessment findings and report to RN. Reinforce teaching initiated by the RN or standard care. Trach care, other treatments. Administer enteral feedings. Administer meds (may not be IV in some state). All these tasks must be initiated by the RN.

Time Management

Need to take time to plan. Start with the highest priority task first!!! Thus start with the most critical patient first. Finish one task before beginning another. Always reprioritize as you manage your tasks/assignment based on new information and what tasks are remaining. Should be proactive and not crisis driven.

Titles of Assistive Personnel (AP)

Nurse extenders Care partners Nurse's aides Orderlies Assistants Attendants HCAs Technicians

Delegation: EAT

Nurse may not delegate... E: evaluation. A: assessment. T: teaching.

Supervision of Delegated Tasks

Nurses should ask the individuals to whom they are delegating, delegatee 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.

Overdelegating Causes

Poor management of time and spending too much time trying to get organized. Insecurity in ability to perform a task. Overdelegation can lead to burden on their subordinates and lead to burnout and less productive work from emloyees.

Time Wasters: Internal

Procrastination Poor planning Failure to establish goals and objectives Inability to delegate Inability to say no Management by crisis Haste Indecisiveness

Supervision: Nurses

Provision of guidance or direction, evaluation and follow-up by the licensed nurse for the process and the outcomes of a delegated task. Nurses are constantly supervising. RNs supervise other RNs, LPNs, APs, and patients. LPNs can supervise and delegate to other LPNs and APs.

Time Wasters: External

Telephone interruptions Socializing Meetings Lack of information Poor communication Lack of feedback Lack of adequately described policies and procedures Incompetent coworkers Poor filing system Paperwork and reading Open-door policy

Delegation with Professional Nursing

RNs at all levels are increasingly expected to make assignments and supervise the work of different levels of employees. Need education programs on delegation principles and role clarity. Many RNs continue to feel uncomfortable with delegation of responsibilities despite education programs.

Responsibility

Refers to reliability, dependability, and obligation to accomplish work. Each person must perform at an acceptable level.

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.

5 Rights of Delegation

Right task. Right circumstance. Right person. Right direction/communication. Right supervison/evaluaton. Nurse must consider... Predictability that the outcome will be achieved Any potential for harm to the patient How complex is the task Is there a need to make an individual judgement during the task Is there a need to additional support during the task

Principles of Delegation

The RN takes responsibility and accountability for the provision of nursing practice. The RN directs care and determines the appropriate utilization of any assistant involved in providing direct patient care. The RN may delegate components of care but does not delegate the nursing process itself to APs or LPNs. The practice functions of assessment, planning, evaluation, and nursing judgment cannot be delegated. e.g. AP cannot assess vital signs, but can be directed to measure them. The decision of whether or not to delegate is based upon the RN's judgment concerning the condition of the patient, the competence of all members of the nursing team, and the degree of supervision that will be required of the RN if a task is delegated. The RN delegates only those tasks for which she or he believes the other health care worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience and facility/agency policies and procedures. The RN individualizes communication regarding the delegation to the nursing assistive personnel and client situation and the communications should be clear, concise, correct and complete. The RN verifies comprehension with the nursing assistive personnel and that the assistant accepts the delegation and responsibility that accompanies it. Communication must be a two-way process. Nursing assistive personnel should have the opportunity to ask questions and/or for clarification of the expectations. The RN uses critical thinking and professional judgment when following the Five Rights of Delegation. Chief Nursing Officers are accountable for establishing systems to assess, monitor, verify and communicate ongoing competence requirements in the areas related to delegation. There is both individual accountability and organizational accountability for delegation. Organizational accountability relates to providing sufficient resources.

Truth About Time

The Truth About Time—It Is Irreversible and Irreplaceable We can't save it and use it later! We can't elect not to spend it! We can't borrow it! We can't leave it or retrieve it

Underdelegating Causes: Enjoyment of the Work

The nurse may want to do the work him or herself because of enjoying the tasks.

Making Lists

These are planning tools and thus they must be flexible. Re-examine items that remain on the list day after day, perhaps they don't needs to be done or they need to be broken down into smaller tasks. Only put as many items on the daily list as can be reasonably be accomplished in a day.

Delegating to AP: Ideal Tasks

UAPs may complete tasks, measure VS, I & O, and other indicators, but RN analyzes the data for comprehensive assessment, nursing diagnosis, and the plan of care. The RN is responsible for the nursing process. UAP may perform simple nursing interventions related to hygiene, nutrition, elimination or an activity but the RN remains accountable for patient outcomes. UAPS do not carry out independent thinking tasks.

Time Management: Two Common Mistakes

Underestimating importance of a daily plan. Not allowing adequate time for planning.

Assignment vs Delegation

When performing a fundamental skill on the job, the delegatee is considered to be carrying out an assignment. The routine care, activities and procedures assigned are those which would have been included in the delegatee's basic educational program. A licensed nurse is still responsible for ensuring an assignment is carried out completely and correctly. Delegation is allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee's traditional role and not routinely performed. This applies to licensed nurses as well as AP.

Improper Delegating Causes

Wrong time, to the wrong person, or for the wrong reason. Beyond the capability of the person or should be done by the manager. Decision making without providing adequate information.

Assignment

the distribution of work and fundamental skills that each staff member is responsible for during a given work period that were learned during a basic educational program

Supervision

the provision of guidance and oversight of assigned and delegated care. It occurs after delegation