N419 Unit 12 Delegation

Which priority setting trap ("whatever hits first," "path of least resistance," "squeaky wheel," "default," "inspiration") is described below? o The individual feels obligated to take on tasks that no one else has come forward to do o Nobody else on the team is doing it so you feel so uncomfortable that nobody is stepping up to the plate that you just volunteer

"default"

Which priority setting trap ("whatever hits first," "path of least resistance," "squeaky wheel," "default," "inspiration") is described below? o Individuals wait until they become "inspired" to accomplish a task. § Some of us will never be inspired to put somebody on a bedpan or to do a number of things o Some tasks will never be inspiring, and the wise time manager recognizes that the best way to complete these tasks is hard work and appropriate attention to the matter. § " I feel like if there are some things I really don't care to do, as long as I'm not putting other thing that are more important in front of it I just do them first to get them out of the way"

"inspiration"

Which priority setting trap ("whatever hits first," "path of least resistance," "squeaky wheel," "default," "inspiration") is described below? o The individual makes the assumption that it is easier to do a task by himself or herself and fails to delegate appropriately. § Sometimes we don't want to have to deal with asking somebody else to help us. We think it's easier to do it ourselves and don't want to deal with so and so bc they have an attitude and never want to help me. That is a separate issue that needs to be dealt with but make sure you don't take on more than you should

"path of least resistance"

Which priority setting trap ("whatever hits first," "path of least resistance," "squeaky wheel," "default," "inspiration") is described below? o The individual falls prey to those who are most vocal about their requests and then feels a need to respond to the time frame imposed by the "squeaky wheel" rather than his or her own. o We all know that a lot of times the squeaky wheel gets greased. That could be a patient that is just whining about something, they may have a valid concern or they may not. They may be occupying all your time. And you may have a patient in a room that hardly presses the call bell and has very few requests but they are really sick and you probably need to be spending more time with them. "I kind of feel like in order for somebody to be making a lot of noise they have to be feeling pretty good to do that"

"squeaky wheel"

Which priority setting trap ("whatever hits first," "path of least resistance," "squeaky wheel," "default," "inspiration") is described below? o Occurs when an individual simply responds to situations as they happen rather than thinking first and then acting. o Common to new nurses. o So you hit the floor, call bell goes off and your patient says they need a glass of water but you are just out of report. You could delegate this to a CAN, and im not saying you don't address the patients need but there are going to be lots of things that come up and you are going to feel like bc it was first on the list it needs to be addressed first, not necessarily true

"whatever hits first"

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Airway o Airway concerns include apnea, stridor § Obviously these are two things that should get pushed to the top of the list, if we are not breathing we are not going to live o Establish patent airway if needed o Remember cerebral anoxia occurs without oxygen/patent airway § This is why airway is at the top of the list, the brain can only go so long before we start having tissue injury · Breathing o Assess effectiveness of breathing and intervene as necessary § You could have an open airway with ineffective breathing, maybe the patient is breathing very shallow, maybe they are over sedated § You might have to bag the patient in order to get deeper respirations · Circulation o Hypotension, inadequate cardiac output § You can have all the oxygen in the world but if it's not getting to the tissues or the brain, you still have big problems · Disability o Assess for neurological deficits § We all know how traumatic a CVA can be, this is a significant disability

ABCD - Airway, breathing, circulation

What are the 5 factors to assess when deciding to delegate nursing tasks? *HIGHLIGHTED IN NOTES.

1. potential for harm 2. complexity of the task 3. amount of problem solving and innovation required 4. unpredictability of outcome 5. level of patient interaction

What are the 5 rights of delegation?

1. right task 2. right circumstance 3. right person 4. right direction and communication 5. right level of supervision and evaluation

The Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of which health-care worker? A) Nurse aide (NA) B) NAP C) Licensed practical nurse (LPN) D) RN

A

What occurs when a manager has the false assumption that delegation may be interpreted as a lack of ability on the subordinate's part to do the job correctly or completely? A) Underdelegating B) Overdelegating C) Improper delegating D) Inappropriate delegating

A

Which action on the part of a manager demonstrates the mark of a great leader? A) Acknowledging the accomplishment of staff members at the unit's staff meeting B) Providing onsite in-services on new equipment for the staff C) Including funds in the unit's budget of staff development D) Stressing the importance of patient safety to all new employees

A

Which assessment must the RN do initially when assigning tasks to non-licensed personnel (NAP)? A) Evaluating the NAP's skills and knowledge level B) Assessing which tasks the NAP is interested in assuming C) Evaluating how patients rate the NAP's performance D) Assessing how team members like working with the NAP

A

What is the most important consideration for the manager when identifying the appropriate person to whom to delegate a specific task? A) Whose turn it is to delegate a task B) The qualifications of the person regarding the task C) The fiscal cost of delegating the task D) Whether the person has experience with similar tasks

B

Which characteristic is most important when the nurse-manager is considering staff for a delegated role? A) Years of experience B) Willingness to grow professionally C) Aversion to risk taking D) Pervious experience with similar tasks

B

Who's scope of practice (RN, LPN, AP) is described below? --activities of daily living --hygiene --linen change --routine stable vital signs --documenting intake and output

AP

What is the first step the manager takes when a subordinate is having difficulty carrying out a delegated task? A) Take over the task so the employee will not become demoralized B) Be available to the employee as a role model and resource for the task C) Assign another more experienced employee to help with the task D) Re-assign the employee a different, less complex task

B

Periodically during the day the RN checked with the team members to determine whether they are having difficulty completing their assigned tasks. This describes which manager role? A) Skills evaluation B) Patient safety C) Effective delegation D) Micromanagement

C

What is a common cause of a manager to underdelegation? A) A high degree of trust in subordinates B) A democratic leadership style C) A need for perfectionism D) Sufficient time to accomplish unit goals alone

C

What is an inappropriate reason for delegation? A) To empower subordinates by "stretching" them in their work assignment B) To free the manager to address more complex, higher-level unit needs C) When the task is not a challenge for the manager D) Because someone else is better qualified to do the task that needs to be done

C

What must managers delegate to another RN in order to assure completion of a task? A) Time and space B) Leadership and creativity C) Authority and responsibility D) Personnel and knowledge

C

What statement concerning the delegating of tasks by the nurse to unlicensed assistive personnel (NAP) is true? A) One can safely assume that the NAP has at least a high school diploma as a minimum hiring criterion B) All unlicensed assistive personnel have achieved at least minimum standardized training pursuant to the Omnibus Budget Reconciliation Act of 1987 C) No federal or community standards have been established for training the broad classification of NAP D) The nurse is protected from liability when allowing the NAP to perform only those tasks the employee includes in the job description

C

When a manager appropriately recognizes the successful completion of a delegated team task, what is the primary reward for the manager? A) Less involvement in uncomplicated tasks B) A staff that is familiar with team-related delegated tasks C) Professional recognition as a leader D) Staff that is growing as professional caregivers

C

Which action is considered a leadership role associated with delegation? A) Creating job descriptions for all personnel B) Providing formal recognition or reward for completion of delegated tasks C) Demonstrating sensitivity to how cultural phenomena affect transcultural delegation D) Reprimanding employees who demonstrate overt resistance to the tasks they are delegated

C

Which factor has the greatest impact on the need for nurses to possess excellent delegation skills? A) Increase in patient acuity levels B) Decrease in patient hospitalization time C) Increase in the use of NAP D) Decrease in nurse-to-patient ratios

C

Which restraining force occurs when a subordinate "tests the water" to determine what the consequences are of not completing a delegated task? A) Failure of delegator to see subordinate perspective B) Subordinate incapable of completing the task C) Subordinate inherent resistance to authority D) Overdelegation of specificity of the task

C

Which situation presents an example of inappropriate delegation? A) Temporary authority is given to support completion of a delegated task B) The person to whom a task is delegated considers it a challenge C) The employee is given exact instructions on completing the task D) Regular updates on the task are exchanged with the manager and the employee

C

Which statement by the nurse-manager demonstrates an understanding of the need to provide effective guidance to those a project has been delegated? A) "Don't be afraid to let me know if you feel the project is overwhelming you." B) "What do you suggest we do to address the problems that exist with the project?" C) "I can give you a few solutions for the issues you have been having with the project." D) "Do you want more time to complete the project?"

C

Which statement is true regarding the general delegation liability of the registered nurse (RN)? A) It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification B) It is great because the RN is automatically held liable for the tasks delegated to all recognized subordinates C) It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks D) It is avoided entirely by delegating tasks to only other licensed personnel

C

Which task would the director of a home health agency not delegate another staff RN? A) Assigning home health aides to specific patient care B) Serving on a diabetic study committee of community resources C) Meeting with the agency's administration regarding budget cuts D) Reviewing staff time cards for completion and accuracy

C

A member of the team reports that they have been given too much to do and are not going to be able to complete the work on time. What action will the RN take to effectively manage this situation? A) Assign the work to another team member B) Take on the responsibility of the tasks C) Have the team member perform only the necessary tasks D) Examine the workload and assist the individual in reprioritizing

D

What cultural phenomena must be considered for the biopsychosocial differences between racial and ethnic groups that have susceptibility to disease and physiologic differences? A) Space B) Social organization C) Environmental control D) Biologic variations

D

What managerial action is important when supporting the delegation of a task to a subordinate? A) Always requiring a maximizing quality outcome B) Frequently reassuring the employee that if they are incapable of completing a delegated task, it will be reassigned C) Drafting a preliminary plan of how the task will be redone if the outcome does not meet stated expectations D) Occasionally providing learning or "stretching" opportunities for employees

D

Which organization is actively engaged in clarifying the delegation parameters for RNs? A) American Hospital Association (AMA) B) The federal government C) National League for Nursing (NLN) D) State Boards of Nursing Licensure

D

Who bears the ultimate responsibility for ensuring that the nursing care provided by team members meets or exceeds minimum safety standards? A) The patient's primary healthcare provider B) The facility's Director of Nursing C) The unit's nursing manager D) The team's RN

D

Who's scope of practice (RN, LPN, AP) is described below? --monitoring RN findings --reinforcing education --routine procedures (ex: cauterization) --most medication administrations --tube latency and enteral feeding --specific assessments example: assessing respiratory status

LPN

LA State Board of Practical Nurse Examiners: A _______ must practice under the direction of one of the following: licensed physician, optometrist, dentist, psychologist, or registered nurse. A _________ may perform duties consistent with his/her educational preparation. The ________ may also, with appropriate training (which is approved by this board, and documented), perform additional specified acts which are authorized by the Louisiana State Board of Practical Nurse Examiners when directed to do so by the licensed physician, optometrist, dentist, psychologist, or registered nurse.

LPN (licensed practical nurse)

The Louisiana State Board of Practical Nurse Examiners (LSBPNE) has no "laundry list" of tasks/skills an _______ can perform. Such lists tend to limit practice. Scope of practice is a fluid concept. It changes as knowledge and technology expand. ______s must possess the knowledge, skill, and ability to perform their duties, therefore, scope of practice comes down to the competency of the individual ________.

LPN (licensed practical nurse)

The following is delegation to an _______: ******RN may delegate to a ______ the major part of the nursing care to individuals in stable nursing situations when the following three conditions exist:**** The nursing care: 1. Requires abilities based on a relatively fixed and limited body of scientific fact 2. Can be performed by following a defined nursing procedure with minimal alteration 3. Responses are predictable

LPN (licensed practical nurse)

The following is delegation to an _______: -- Change in the patient's clinical conditions is predictable -- Medical and nursing orders are not subject to continuous change or complex modification. --> If you have to alter anything along the way, it probably shouldn't be delegated. If there are any questions about how it needs to be performed and is not very clear and if response to care is not predictable then it should not be delegated

LPN (licensed practical nurse)

The following is delegation to an _______: -- In complex (unstable) situations, the RN may utilize the expertise of the LPN by delegating **selected** tasks that you feel they are competent in --> In a complex situation you wouldn't ask the CNA to responds in a rapid response but you would tell them to get a BP while you are getting a drip together

LPN (licensed practical nurse)

_______ is the safety net for nursing. Don't want to box them in or put them in a corner because if we don't have enough RNs, which we typically never do, we need _______s to fill in and provide patient care They provide quality patient care but their education and background and knowledge are limited. This is why the ________ program might be 12-18 months and BSN program is 4 years

LPN (licensed practical nurse)

T or F. Plan ahead when identifying tasks to be accomplished. Always try to delegate before you become overwhelmed. In addition, always be sure to carefully assess the situation before delegating and to clearly delineate the desired outcomes.

T

T or F. The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments.

T

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Remember the needs at the base of the pyramid are of higher priority than those above it. o Starting at the base: § Physiological needs- probably a lot of what we are studying and learning about in nursing school § Personal safety- the patient has to feel secure § Social affiliation- we all need to feel connected § Self esteem § Self-actualization o Basic needs are at bottom and as we climb the pyramid, those basic needs will turn into personal safety, self actualization, etc.

Maslow's hierarchy

The following are the state ______ Essential Elements regarding delegation: · 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 · Know the official job description for each worker classification in the organization, it may be more restrictive than the State _______.

NPA

The following are the state ______ Essential Elements regarding delegation: · State Nurse Practice Act definition of delegation · Scope of practice for the RN · Scope of practice for LVN/LPN and unlicensed nursing roles (ex: UAPs) · Guidelines for RNs about tasks that can be delegated · Items that cannot be delegated · Items that cannot be routinely delegated · For example, in most states LPNs can administer IV therapy after completing a course in IV therapy administration; in some states, dialysis therapy can be delegated to LPNs.

NPA

The following are the state ______ Essential Elements regarding delegation: · State Nurse Practice Act definition of delegation · Scope of practice for the RN · Scope of practice for LVN/LPN and unlicensed nursing roles (ex: UAPs) · Guidelines for RNs about tasks that can be delegated · Items that cannot be delegated · Items that cannot be routinely delegated · For example, in most states LPNs can administer IV therapy after completing a course in IV therapy administration; in some states, dialysis therapy can be delegated to LPNs. · 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 · Know the official job description for each worker classification in the organization, it may be more restrictive than the State _______.

NPA

ID the skill or educational level necessary to complete the job. Often, legal and licensing statutes such as the ____ ____ ____(NPA) determine the scope of practice for the RN in each state. The challenge is that the RN must also understand the scope of practices of others on the nursing team who are providing patient care. For example, each state regulates what LPNs or LVNs can do. IV therapy is within the scope of practice for both RNs and LPNs/LVNs in most states but some states require the LPN/LVN to complete a course in IV therapy to administer IV solutions. Other other states allow the LPN/LVN to add vitamins to an IV solution but not to give IV antibiotics. IN some states, dialysis therapy can be delegated to LPN/LVNs whereas in others it is prohibited.

Nurse Practice Act

Nurses must then be aware of they ___ ____ ___ essential elements regarding delegation including the following: --the state's NPA definition of delegation --items that cannot be delegated --items that cannot be routinely delegated --guidelines for RNs about tasks that can be delegated --a description of professional nursing practice --a description of RN, LPN/LVN, and UAP scope of practice --teh 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 --In addition, the manager should know the official job description expectations for each worker classification in the organization as they may be more restrictive than the state ____ ____ ____

Nurse Practice Act

Who's scope of practice (RN, LPN, AP) is described below? --admission assessment --initial patient education --discharge education --clinical judgement --initiating blood transfusion

RN

T or F. Scope of Practice--> AP o Some hospitals the AP may have other tasks that they are assigned but that is usually above and beyond these and they are going to be trained and have proven competency in those tasks

T

The LA ____ ____ ____ ____ provides us with guidance and regulations regarding delegating. -- RNs must not delegate: 1. the analysis phase of assessment (admission assessment) important for initial assessment to be accurate 2. planning of nursing care 3. evaluation of nursing care 4. nursing judgment 5. teaching especially if regard *****Review LSBN Rules and Regulations—SECTION ON DELEGATION****

State Board of Nursing

The LA ____ ____ ____ ____ provides us with guidance and regulations regarding delegating. -- RNs retains the accountability for the total nursing care of the individual. --> Even though you are giving a certain task away that person is responsible for that task but you are still responsible for the overall state of the patient -- RN is responsible for and accountable for the quality of nursing care a client receives regardless if the care is provided by the RN or care was delegated to LPN and/or AP. --> That means the nurses are supervising the assistive personnel

State Board of Nursing

The LA ____ ____ ____ ____ provides us with guidance and regulations regarding delegating. --Assistive Personnel (APs) work under RN/LPN/LVN supervision -- Only **selected** nursing tasks in **selected** situations may be delegated. --> You may choose not to delegate certain things for good reasons -- RNs may not delegate total nursing practice. --> You cannot give away everything that is yours even though technically you could

State Board of Nursing

T or F. Assigning is the act of handing over a patient to someone else whereas delegating is the act of handing over a task. When delegating, you are sill in charge of the patient's care and ultimately responsible for your teammate's work. When assigning you are giving the responsibility to someone else.

T

T or F. In delegation, the responsibility for a task can be transferred from the licensed person to the NAP but accountability is shared by both. The NAP has no license to lose for "exceeding scope of practice" and nationally established standards for scope of practice do not exist for NAP.

T

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

T

T or F. National Council of State Boards of Nursing Delegation Model states: Delegation is dependent on the work environment. If you have a positive work environment, chances are people are going to be used to working as a team and accepting delegating tasks.

T

T or F. New decision trees created by the NCSBN and State Boards of Nursing guide RNs in deterring what can safely be delegated to unlicensed workers.

T

T or F. PRIORITIZATION OF NURSING CARE · ".....things that matter most must never be at the mercy of things that matter least." · Johann Wolfgang von Goethe

T

T or F. 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.

T

T or F. While you remain responsible for dealing the results of the tasks you delegate, excessive supervision can actually demoralize the employee.

T

T or F. the RN, although well trained in the role of direct care provider, may not be adequately prepared for the role of delegator. Nurses must believe they can delegate without fearing they will be perceived as lazy or incompetent.

T

definition: "To be answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard" (ANA, 2015, p.41)

accountability

RNs are always ______ for the care given and must be responsible for instructing NAP as to who needs care, what type of care is needed, and when that care should be provided. NAP should be ______ for knowing how to properly perform their segment of assigned care and for knowing when other workers should be called in for tasks beyond the limit of their knowledge and experience to carry it out safely; if the task is something they have not done before or is not a part of their normal duties or if the super vision provided is inadequate. As such, the NAP does bear some personal accountability for their actions. this does not however, negate accountability for the RN who delegated the tasks. The RN continues to be ______ for the care they deliver and for that which is delegated. **delegating to UAP

accountable

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · Prioritizing care of patient with actual problem over care of patient at risk for a problem o You need to prioritize care of patients with actual problems and not necessarily patients that are at risk of a problem o "I would see a lot of this on the care map. Patients that had a lot of real big actual problems and at the top of the list would be risk for..." § Not saying the at risk problems don't need attention, they do! But when somebody has active infection, or they have significant skin breakdown vs a patient that is at risk for skin breakdown. You need to deal with the one who has the breakdown. You need to be turning both of them but if you have skin breakdown you definitely want to be diligent about turning that patient

actual problem before potential future problems

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · Prioritize care of patient with new injury or illness or experiencing an acute exacerbation over care of patient with a long-term chronic illness o We see patients that come I with acute exacerbation of heart failure or acute exacerbation of COPD. They have the chronic long term disease of heart failure but something has occurred that has triggered and put them into a decompensated state where they now have acute heart failure o You may have a patient with a chronic illness in the hospital that still needs management, but you can someone with a new injury or illness that needs to take precedent over the more stable chronic patient

acute before chronic

When talking about the delegation process, the fourth step (#4) is to reach _______. · Outline your expectations · Assure that the delegate agrees to accept responsibility and authority for the task

agreement

There are 5 factors to assess when deciding to delegate nursing tasks: 1. potential for harm, 2. complexity of the task, 3. amount of problem solving and innovation required, 4. unpredictability of outcome, and 5. level of patient interaction. Which of these 5 factors is described below? If an uncomplicated activity requires special attention, adaptation, or an innovative approach, it should not be delegated.

amount of problem solving and innovation required

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · Recognize that timing of administration of hyperglycemic and antimicrobial medications is more important than administration of a routine daily medication o So we all know it's important that we time patients insulin, especially if its fact acting and we have to give it around meal times o Antimicrobials, antibiotics. If somebody is on antibiotics every 6 hrs. you don't want to be an hour late and then give the next one an our early, bc then you really only have a time difference of four hours o So you want to be more timely with meds that are given around the clock that you are counting on a peak affect and it needs to last throughout the day. Same thing with antihypertensives

apply clinical knowledge to priority setting

What information is needed to establish priorities?? · Communication from team members o Shift report § Critical. The kind of report you receive can make or break your day o SBAR § Some sort of methodology of communicating so that its thorough o Review of documents § The EHR, documentation from previous hospitalizations · __________ of patient! o Nurses who start their day and don't start with assessing their patients as one of the first things they do, "I don't see how they can set their day, how they can prioritize bc what you get in report and wat you see in the room could be two different things. You have to get report and you have to assess your patient before you can plan your day

assessment

Still Confused? · "The decision of whether to delegate or ______ 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." (National Guidelines for Nursing Delegation, 2019) **under delegation vs. assignment

assign

Delegation is often confused with assignment. Which of these (delegation or assignment) is described below? o Involves distributing work to a qualified person or persons for implementation of a specific activity or set of activities within their job description (the routine care, activities & responsibilities)—expected to be able to perform o Giving someone else a task within his/her own authorized practice § No transfer of authority occurs o Downward or lateral transfer of both responsibility and accountability § Reflects the job description and patient or organizational needs

assignment

The following is talking about delegation versus _______: · Delegation is often confused with _________... · ________: o Involves distributing work to a qualified person or persons for implementation of a specific activity or set of activities within their job description (the routine care, activities & responsibilities)—expected to be able to perform o Giving someone else a task within his/her own authorized practice § No transfer of authority occurs o Downward or lateral transfer of both responsibility and accountability § Reflects the job description and patient or organizational needs · Delegation o Giving someone else a task from the delegator's practice—it's not something that is normally a part of the delegatee's practice o Involves transfer of responsibility and authority to perform a specific activity, but the delegator retains accountability

assignment

Delegating to _____ _____ (AP): -- AP can free professional nurses from tasks and assignments that can be completed by less well-trained personnel at a lower cost -- ***Increases the Scope of Liability for the RN** -->RN may be liable if they were negligent in the supervision of those employees at the time they committed the negligent acts. Liability based on a supervisor's failure to determine which patient needs could safely be assigned to a subordinate or for failing to closely monitor a subordinate who requires such supervision.

assistive personnel

Delegating to _____ _____ (AP): -- In assigning tasks to AP, then the RN must be aware of the UAP job description, knowledge base, and demonstrated skills of each person. -- AP training is not federally monitored through standards and community standards are also not established.

assistive personnel

Delegating to _____ _____ (AP): -- Potential Costs: 1. Liability for negligence --> Increased liability with the more that we delegate to AP --> If we are not providing adequate supervision at the time of negligence, we too can be held accountable because at the end of the day, we are responsible for total patient care 2. Issues for task delegation --> Job description - make sure that the task you are delegating falls within the job description of the organization for that person --> Knowledge base - adequate knowledge of task you are delegating --> Demonstrated skills -- RN has the responsibility for patient outcomes so overseeing the delegation process is important not just from a liability standpoint but also for patient outcomes and quality care

assistive personnel

Delegating to _____ _____ (AP): -- Unlicensed -- Trained to function in an assistive role to the RN--> Designed to be an extension of the RN -- Performs patient care activities as delegated by the nurse--> Delegate to _____ ______ quite frequently

assistive personnel

Delegating to _____ _____ (AP): IDEAL: APs may complete tasks, measure VS, I & O, and other indicators, but RN who analyzes the data for comprehensive assessment ND and the plan of care. RN is responsible for pt assessment, diagnosis, care planning, and evaluation. AP may perform simple nursing interventions related to hygiene, nutrition, elimination, or activity but the RN remains responsible for patient outcomes. Not independent thinking tasks

assistive personnel

Reminders: -- In assigning tasks to _____ _____, the RN must be aware of the job description, knowledge base, and demonstrated skills of each person. -- The _____ _______ has no license to lose for "exceeding scope of practice," plus nationally established standards to state what the limits should be for ____ ______ in terms of scope of practice ******do not exist.***** --> It is not outlined what an ____ _____'s scope of practice is so that is a judgment call by the nurse. The job description tells us which skills they have been assigned and trained to do but those skills in different situations may not be something you want to delegate. It depends on all the things we've talked about

assistive personnel

What elements of care can the RN delegate to an _____ _____(AP) ? -- Routine and standard -- Outcomes that are predictable -- Consider: 1. Any activity such as the nursing process of assessment, diagnosis, planning and evaluation MAY NOT be delegated to AP!*********** 2. Delegation activities fall within the ****implementation phase***** of the nursing process and are non-complex --> The *****implementation phase****** is a lot of the doing. Things you can give to someone to go and do. They are not evaluating, decision making, judging, and assessing

assistive personnel

the following are the different types of ______ ______(AP): Nurse extenders Care partners Nurse's aides Orderlies Assistants Attendants HCAs Technicians

assistive personnel

definition: The right to act or command the actions of others (such as the unit manager)

authority

Elements Affecting Delegation to a Transcultural Work Team: · Communication - especially dialect, volume, use of touch, and eye contact o Every culture is different o Some people speak softy—others speak loudly and with their hands which may come off as aggressive · Space - interpersonal space differs between cultures · Social organization - family unit is of primary importance in some cultures (less so in others) · Time - cultures tend to be past, present, or future oriented · Environmental control - cultures have internal or external locus of control · _____ ______ - susceptibility to diseases and physiological differences (some races are more susceptible to diseases than others) · Delegation delivered in a softer tone may be perceived as less important - delegator must recognize the personal space needs of individuals - importance of a unit providing social support in a person's life - past, present or future oriented affects delegation (strategic planning for future oriented) - locus of control (fate or internally driven) - psychosocial differences between racial & ethnic groups

biologic variations

the following is a ______ for delegation: · ✓ Develop a good attitude · ✓ Decide what to delegate · ✓ Select the right person · ✓ Communicate responsibilities (be succinct, tell them expectations and time frame—the more information the better) · ✓ Grant authority · ✓ Provide support · ✓ Monitor the delegation (make sure that it gets done and that they don't need help doing it)

checklist

The following is considered NOT important and NOT ______: --wasting time --various trivia --gossip **prioritization

urgent

Clear ______ and Delegation: · Define the task clearly · Delineate end results, time frame, and standards · Delegate the objective, not the procedure o Allows creativity from the subordinate; ex. delegate tasks to the Assistive Personnel but do not tell them how to organize their work o Don't micromanage—allow them to perform the task (doesn't mean that you don't have to provide proper guidance and supervision)

communication

Elements Affecting Delegation to a Transcultural Work Team: · ________ - especially dialect, volume, use of touch, and eye contact o Every culture is different o Some people speak softy—others speak loudly and with their hands which may come off as aggressive · Space - interpersonal space differs between cultures · Social organization - family unit is of primary importance in some cultures (less so in others) · Time - cultures tend to be past, present, or future oriented · Environmental control - cultures have internal or external locus of control · Biologic variations - susceptibility to diseases and physiological differences (some races are more susceptible to diseases than others) · Delegation delivered in a softer tone may be perceived as less important - delegator must recognize the personal space needs of individuals - importance of a unit providing social support in a person's life - past, present or future oriented affects delegation (strategic planning for future oriented) - locus of control (fate or internally driven) - psychosocial differences between racial & ethnic groups

communication

What information is needed to establish priorities?? · ________ from team members o Shift report § Critical. The kind of report you receive can make or break your day o SBAR § Some sort of methodology of communicating so that its thorough o Review of documents § The EHR, documentation from previous hospitalizations

communication

definition: An individual's capability to perform up to defined expectations o Cannot delegate a task that someone is not competent in

competency

There are 2 types of complexity of tasks: Non-complex task and complex task (should NOT be delegated). Which of these is described below? Requires: -- Judgment to safely alter the standard procedure to meet needs of the patient -- Consideration of a number of factors in order to perform the procedure --> Maybe there is multiple things you have to take into consideration as you do a specific procedure -- Judgment to determine how to proceed from one step to the next --> If you have to figure it out as you go it is probably something you should keep

complex task (should NOT be delegated)

There are 5 factors to assess when deciding to delegate nursing tasks: 1. potential for harm, 2. complexity of the task, 3. amount of problem solving and innovation required, 4. unpredictability of outcome, and 5. level of patient interaction. Which of these 5 factors is described below? Only RNs should perform activities requiring complex skills, expert nursing assessment and clinical judgment.

complexity of the task

What is one of the 3 reasons why we delegate?? o Makes more efficient use of nursing time and facility's resources o Practicing at the top of your license—so nurses should not get caught up running around and doing a bunch of little things all day when they can delegate to someone who is qualified to take these tasks

cost savings

The following is considered NOT important and ______: --trivial interruptions --random phone calls --unimportant mails **prioritization

urgent

The following is considered important and NOT _______: --relationships --health and exercise --personal growth **prioritization

urgent

Still Confused? · Ex: normally CNAs take vital but if it is a critical patient then the RN may take the BP themselves (if they do _______ it to the CNA then it will be with very specific instructions about reporting back to the nurse—certain parameters will be involved) o If it's a CNA that just started last week then chances are you are not going to ask them to take the BP of someone who is running very low but if it's a CNA that has been there for a long time and is very reliable then they may be competent to perform that **under delegation vs. assignment

delegate

The following are the 3 reasons why we ______: · Time Savings o In nursing, the zone of responsibility exceeds one person's ability to complete all the tasks o No one person can do everything · Team Building o Achieves goals o Productivity increases o Provide learning opportunities (delegating can become a teaching moment—helps people learn and grow) · Cost Savings o Makes more efficient use of nursing time and facility's resources o Practicing at the top of your license—so nurses should not get caught up running around and doing a bunch of little things all day when they can delegate to someone who is qualified to take these tasks

delegate

definition:The person to whom an activity is delegated—the person receiving the task § Is competent to perform it and verbally accepts responsibility (have to have both)

delegate or delegatee

When talking about the delegation process, the second (#2) is to decide the ________. · Match the task to the individual o Cant give it to someone who doesn't have the skill to perform what you are asking · Analyze individuals' skill levels and abilities to evaluate their capability to perform the various tasks · Determine characteristics that might prevent them from accepting responsibility for the task

delegatee

When talking about the delegation process, the second (#2) is to decide the ________. · Match the task to the individual o Cant give it to someone who doesn't have the skill to perform what you are asking · Analyze individuals' skill levels and abilities to evaluate their capability to perform the various tasks · Determine characteristics that might prevent them from accepting responsibility for the task · Rule of thumb: delegate to the lowest person in the hierarchy who has the requisite capabilities and who is allowed to do the task legally and by organizational policy. o Ex: if the CNA has the skill to do something then you don't want to give it to an LPN because you may need the LPN to do something that the CNA cannot do, like give a medication (CNA can't do that)

delegatee

When talking about the delegation process, the second (#2) is to decide the ________. · Rule of thumb: delegate to the lowest person in the hierarchy who has the requisite capabilities and who is allowed to do the task legally and by organizational policy. o Ex: if the CNA has the skill to do something then you don't want to give it to an LPN because you may need the LPN to do something that the CNA cannot do, like give a medication (CNA can't do that)

delegatee

Delegation is often confused with assignment. Which of these (delegation or assignment) is described below? o Giving someone else a task from the delegator's practice—it's not something that is normally a part of the delegatee's practice o Involves transfer of responsibility and authority to perform a specific activity, but the delegator retains accountability

delegation

Strategies for Successful _____: Need for nurses to have _________ skills is greater than ever with increasing patient loads and the current nursing shortage. _______ must be appropriately done, ultimately the RNs responsibility to ensure patient safety. When NAPs are allowed to encroach into professional nursing care, patients are placed at risk.

delegation

The following is the ______ Process: · Assess the situation · Plan for specific tasks to be delegated · Assure appropriate accountability · Supervise performance of the task · Evaluate the entire _____ process · Reassess and adjust the overall plan of care as needed o NCSBN

delegation

The goals for _________ and the expected deliverables should always be clearly communicated. This includes identifying any limitations or qualifications that are being imposed on the delegated task. In addition communication should include what is being delegated, the purpose and goal of the task, any limitations for task completion including a timeline and the expectations for reporting. The leader manger however should always leave the employee room for some independent thought and creativity. **communicate goals clearly

delegation

The rules of ______ should: · Always delegate to the right person, at the right time, and for the right reason. · Say no when you must. o Shouldn't except a task if you are already too busy or if you are uncomfortable doing it · Reward subordinates for jobs well done.

delegation

________ can be defined simply as getting work done through others or as directing the performance of one or more people to accomplish organizational goals. It is NOT the same as "assignment" which involves distributing work to a qualified person or persons for implementation of a specific activity or set of activities within their job description. In ______, the individual transfers the authority to perform a specific activity from their own practice to an individual qualified to perform that task but retains accountability for the delegated task.

delegation

_________ has been a function of registered nursing, although the scope of ______ and the tasks being delegated have changed dramatically the past 3 decades with the increased use of unlicensed personnel in acute care settings. As a result, the professional nurse (RN) role has change din many acute care institutions from one or direct care provider to one requiring the ______ of direct patient care to others.

delegation

definition: The process by which responsibility and authority are transferred to another individual o Directing the performance of one or more people to accomplish organizational goals o Transfer or hand-off to a competent individual, the authority to perform a task/activity in a specific setting/situation

delegation

defintion: The person doing the delegating

delegator

Experts also agree that delegation is an essential element of the _____ phase of the management process because much of the work accomplished by managers (first, middle, top) occurs not only through their own efforts but also through those of they subordinates. Frequently, there is too much work to be accomplished by one person. In these situations, delegation often becomes synonymous with productivity and is not an option but a necessity

directing

Elements Affecting Delegation to a Transcultural Work Team: · Communication - especially dialect, volume, use of touch, and eye contact o Every culture is different o Some people speak softy—others speak loudly and with their hands which may come off as aggressive · Space - interpersonal space differs between cultures · Social organization - family unit is of primary importance in some cultures (less so in others) · Time - cultures tend to be past, present, or future oriented · _____ _____ - cultures have internal or external locus of control · Biologic variations - susceptibility to diseases and physiological differences (some races are more susceptible to diseases than others) · Delegation delivered in a softer tone may be perceived as less important - delegator must recognize the personal space needs of individuals - importance of a unit providing social support in a person's life - past, present or future oriented affects delegation (strategic planning for future oriented) - locus of control (fate or internally driven) - psychosocial differences between racial & ethnic groups

environmental control

When talking about the delegation process, the fifth step (#5) is to monitor performance and provide ________. · Ensures that the delegated tasks are carried out as agreed. · If problems are identified, privately investigate and explain the problem, provide an opportunity for _________, and inform the delegate how to correct the mistake in the future · Provide additional support as needed · Give praise and recognition that's due o Shouldn't ask someone to do something for you without thanking them for it and showing your appreciation

feedback

The following are the different _______ for Priority Setting: · Maslow's Hierarchy · ABCD - Airway, breathing, circulation, disability · Prioritization Principles · Time Management · Infection Control Issues

frameworks

Look for employees who are innovative and willing to take risks. It is important that the person to whom the task is being delegated considers the task to be important. This does not suggest, however, that skill and expertise are not needed. Leader managers should always ask the individuals to whom they are delegating if they can complete the delegated task and validate this perception by direct observation. Also, delegate the authority and responsibility necessary to complete the task. Nothing is more _______ to a creative and productive employee than not having the resources of authority to carry out a well developed plan. **select and empower capable personnel

frustrating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of ______ delegating: · Delegating decision making without providing adequate information can happen in complex organizations when efforts have been made to delegate decision making to middle level managers. When this occurs new channels for sharing information need to be established if the delegated decision making process has moved from one level of management to another. Delegate don't abdicate - consult with the employee.

improperly delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of ______ delegating: · Wrong time, to the wrong person, or for the wrong reason · Beyond the capability of the person, or something the manager should do o There are certain things the manager should not delegate · Decision making without providing adequate information o Communication is key and adequate information is also critical

improperly delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of ______ delegating: · Wrong time, to the wrong person, or for the wrong reason · Beyond the capability of the person, or something the manager should do o There are certain things the manager should not delegate · Decision making without providing adequate information o Communication is key and adequate information is also critical · Delegating decision making without providing adequate information can happen in complex organizations when efforts have been made to delegate decision making to middle level managers. When this occurs new channels for sharing information need to be established if the delegated decision making process has moved from one level of management to another. Delegate don't abdicate - consult with the employee.

improperly delegating

_______ delegation includes such things as delegating at the wrong time, to the person person or for the wrong person. It may also include delegating tasks and responsibility that are beyond the capability of the person to whom they are being delegated or that should be done by someone with greater expertise, training, or authority. Delegating decision making without providing adequate information is another example of improper delegation. If the manger requires a higher quality than satisfying this must be made clear at the time of the delegation. not everything that is delegated needs to be handled in a maximizing mode.

improperly delegating

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · See the most infectious patient last whenever possible. o That just makes sense. Every time you go into a patient room that has infections, hopefully if you are gowning and gloving and masking, you are doing that correctly. But the more times you go into the room the greater the chances that you are going to carry that you are going to carry that microbe out of the room. o So you want to cluster care when you go into those patients rooms and you don't want to take care of an infected patient and then a fresh surgical patient. You don't want those two patients to be side by side, you probably need to give-up your surgical patient if possible

infection control issues

ID which individuals can complete the job in terms of capability and time to do so. It is a ______ role to stretch new and capable employees who want opportunities to learn and grow. It is important through to have reasonable expectations of what the selected individual can do with the time and resources available. Managing employee workload is critical when delegating because overburdened employee may find it impossible to complete assigned tasks and will be less likely to learn the desired skills. **select and empower capable personnel

leadership

There are 5 factors to assess when deciding to delegate nursing tasks: 1. potential for harm, 2. complexity of the task, 3. amount of problem solving and innovation required, 4. unpredictability of outcome, and 5. level of patient interaction. Which of these 5 factors is described below? -- Every time one or more additional caregivers become involved, a patient's stress level may increase and the nurse's opportunity to develop a trusting relationship is diminished. -- This is all about continuity of care. The patient is not going to like it if they see a bunch of different people coming in and out of their room. They are going to be confused as to who their nurse is -- You want to be careful no to have a variety of HCP going in and out of the room

level of patient interaction

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · Recognize that report of pain could be due to something other than what is expected (such as a patient with a surgical incision) o So lets say your patient just had abdominal surgery two days ago and they press the call button and they are complaining of pain. You say "oh yeah you just had surgery, that's why you are having pain, ill get you some pain medicine" you walk to the room and they are like "it really hurting, more than it was yesterday" you could right them off and just give the pain medicine or you could assess their abdomen, maybe they have some internal hemorrhaging going on and that is why it's hurting worse. but unless you assess their abdomen you aren't going to catch that the problem is bigger than what you think it is. So listen to your patients.

listen carefully and do not assume

Important - _______ 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. · _______ delegated tasks keeps the delegated task before the subordinate and the manager so that both share accountability for its completion.

monitoring

There are 2 types of complexity of tasks: Non-complex task and complex task (should NOT be delegated). Which of these is described below? -- Can safely be performed according to exact directions, It is predictable; you can give specific directions -- with no need to alter the standard procedure, and -- the results are predictable

non-complex task

The following are tasks that RNs usually do ______ delegate: -- Accessing any implanted device -- Removal of central lines or peripherally inserted central venous catheters (PICC lines) -- Administration of medications requiring both titration and continuous patient assessment--> This is part of the reason LPNs can't work in critical care because a lot of these patients have titrated drips. *******Know your organization's policies!!This list can vary from organization to organization*******

not

The following are tasks that RNs usually do ______ delegate: -- Administration of IV investigational drugs -- Administration of IV cancer therapeutic drugs -- Administration of medications by IV push (bolus)--> other than those identified by health agency protocol for emergency situations (for example saline bolus) -- Administration of blood and blood products -- Administration of total parenteral nutrition solutions

not

Common tasks generally considered appropriate for delegation to ____ ____ ___ include: --noninvasive and non sterile treatments --collecting, reporting, and documenting data including but not limited to vital signs, height, weight, intake and output, and cagily blood and urine tests --ambulation, positioning, turning --transportation of a client within a facility --personaly hygiene, elimination, including vaginal irrigations and cleansing edema --feeding, cutting up food, placing of meal trays --socialization activities --activites of daily living

nursing assistive personnel

In contrast to under-delegating, which overburdens the manager, some mangers _______, burdening their subordinates. Some managers ____delegate because they are poor mangers of time, spending most of it just trying to get organized. Others _____delegate because they feed insure about their ability to perform a task. It is critical that the manager is sensitive to the workload constraints of his or her staff. Staff should always have the right to refuse a delegated task. The servant leaders always ask the person they want to delegate to if they have time to help instead of just assuming that their needs are greater than those of the staff member. Mangers also must be careful not to ______delegate to expectinally competent employees because they may become overworked and tired, which can decrease their productivity, **delegation error

over-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: · Poor management of time; spending too much time trying to get organized · Insecurity in the ability to perform a task o Should probably ask for guidance or assistance instead of delegating the task all the time

over-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: · Poor management of time; spending too much time trying to get organized · Insecurity in the ability to perform a task o Should probably ask for guidance or assistance instead of delegating the task all the time · Managers who _______-delegate do not become overburdened but burden their subordinates instead. Managers also must be careful not to ________-delegate to exceptionally competent employees because they may become _______worked and tired, which can decrease their productivity.

over-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: · Managers who _______-delegate do not become overburdened but burden their subordinates instead. Managers also must be careful not to ________-delegate to exceptionally competent employees because they may become _______worked and tired, which can decrease their productivity.

over-delegating

There are 5 factors to assess when deciding to delegate nursing tasks: 1. potential for harm, 2. complexity of the task, 3. amount of problem solving and innovation required, 4. unpredictability of outcome, and 5. level of patient interaction. Which of these 5 factors is described below? How much risk does the activity carry for the patient?

potential for harm

Establishing _______: · _______ setting o Using ****decision making***** process regarding the order in which things should be done § Critical thinking o Organizing activities from MOST important to LEAST important § What things do we have to do now and what tings can we do later?

priorities

Establishing _______: · Why? o Nurses continuously set and reset _______ to meet the needs of patients § Sometimes not having our ______ right could possibly mean harming somebody bc we don't get to them in a timely fashion o Nurses are extremely busy and don't have a lot of time to waste so establishing _______ is important

priorities

In ______, the nurse determines the order. o Patients are seen § Which patient is seen first and the order that they see patients § May decide to start with the sickest patient, you may decide to put a patient with a lot of hospital achirid infections as a last patient to be seen o Assessments are completed o Interventions are provided o Steps in a procedure are completed o Components of care are completed § How they are completed · In all of this we are trying to be patient or client centric, we are trying to meet the needs of the patient, sometimes what we feel is a priority and what the patient feels is a priority can be two different things

prioritization

In _______, ask yourself.... · "What are you going to do first? Why?" · "Which is more important? Why?" · "What could happen if you don't do this now?" · "What is most important to the patient?"

prioritization

definition: the organization of activities according to the order in which they should be done. o Not necessarily in the order that you do them but in the order that they should be done

prioritization

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Listen carefully to patients and don't assume o This is important and a lot of nurses overlook this o Listen to the patient!!

prioritization principles

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Recognize and respond to trends · Recognize signs of medical emergencies and complications versus expected patient findings o Sometimes we expect certain things from a particular procedure · Apply clinical knowledge to priority setting

prioritization principles

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Systemic before local · Acute before chronic · Actual problems before potential future problems o At times I would see this when doing care plans, what is the actual problem for this patient right now? If it is not a problem right now, it is probably not a prioriy

prioritization principles

The following is considered important and ______: --medical emergencies --important meetings --project deadlines **prioritizaiton

urgent

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Systemic before local · Acute before chronic · Actual problems before potential future problems o At times I would see this when doing care plans, what is the actual problem for this patient right now? If it is not a problem right now, it is probably not a prioriy · Listen carefully to patients and don't assume o This is important and a lot of nurses overlook this o Listen to the patient!! · Recognize and respond to trends · Recognize signs of medical emergencies and complications versus expected patient findings o Sometimes we expect certain things from a particular procedure · Apply clinical knowledge to priority setting

prioritization principles

Testing Hints: ________ Needs: · Patients exhibiting signs of shock o Shock means patient is hypo perfused, that's a medical emergency, low BP, really low oxygen, low cardiac output · Patients with chest pain · Patients whose status has deteriorated from their normal baseline o If they are declining they are headed in the wrong direction, that's a priority

priority

Testing Hints: ________ Needs: · Patients exhibiting signs of shock o Shock means patient is hypo perfused, that's a medical emergency, low BP, really low oxygen, low cardiac output · Patients with chest pain · Patients whose status has deteriorated from their normal baseline o If they are declining they are headed in the wrong direction, that's a priority · Patients with allergic reactions o These can escalate quickly and turn into a state of shock · Patients who report they have unusual symptoms o If somebody complains of an awful headache, ask if they have headaches a lot § If they say no and that it's the worst headache, they have ever had in their life I get concerned, could be a subarachnoid hemorrhage. Most subarachnoid hemorrhages state it the worst headache they have ever had in their life · Patients with malfunctioning equipment o If your vent isn't working right that is a priority · Patients who are immediate postoperative o Potential airway, breathing, and circulation issues

priority

Testing Hints: ________ Needs: · Patients with allergic reactions o These can escalate quickly and turn into a state of shock · Patients who report they have unusual symptoms o If somebody complains of an awful headache, ask if they have headaches a lot § If they say no and that it's the worst headache, they have ever had in their life I get concerned, could be a subarachnoid hemorrhage. Most subarachnoid hemorrhages state it the worst headache they have ever had in their life

priority

Testing Hints: ________ Needs: · Patients with malfunctioning equipment o If your vent isn't working right that is a priority · Patients who are immediate postoperative o Potential airway, breathing, and circulation issues

priority

Delegation as a Function of ______ Nursing: -- Adequate programs must be developed to foster leadership and delegation. --> Delegation is not just about giving something to someone. It is how you communicate it, manage that expectation, how you follow up, and involves a lot of leadership skills, which is why delegation lands in leadership -- Delegation is not intuitive, it's a learned leadership skill. Delegation errors increase the risk of patient harm and being sued for malpractice.

professional

Delegation as a Function of ______ Nursing: -- 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. -- Delegation is not an inherent skill. We are not born knowing how to delegate -- 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 is not just about giving something to someone. It is how you communicate it, manage that expectation, how you follow up, and involves a lot of leadership skills, which is why delegation lands in leadership -- Delegation is not intuitive, it's a learned leadership skill. Delegation errors increase the risk of patient harm and being sued for malpractice.

professional

With the restricting of care delivery models, RN's at all levels are increasingly being expected to make assignments for and supervise the work of different levels of employees. To increase the likelihood that the increased delegation required in today's restructured healthcare organizations does NOT result in unsafe work environment, organization should have a clearly defined structure where RNs are recognized as leaders of the healthcare team, job description that clearly define the roles and responsibility of all workers, education programs that help personnel learn the roles and responsibility of the corkers and training programs that foster the development of leadership and delegation skills. **Delegation as a function of _____ Nursing

professional

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · "One time I had a patient and they were an open heart patient and I had taken care of them after surgery the day before, I was getting ready to move them out to the floor and the physician assistant came by and pulled out some pacer wires and they had trouble getting the pacer wires out and he pulled pretty firmly to get them out. After he left, I was kind of concerned with what I saw, so I started taking the patients vital signs. His pressure had been running about 130, so I set it to take his blood pressure like every 5 minutes and every five minutes it was trending down 130, 120, 108, 100. So when it got under 100, I called the surgeon and said "you need to come to the hospital, I think your patient is tamponading" and he asked I why I thought that and I told him what happened. I could tell he wasn't going to come to the hospital, so I said " you need to take your patient back to surgery and you need to come to the hospital now." I was firm about it. By the time I got back in the room the patients BP was 70 something, and sure enough he had to go back to surgery. But it's the trend going down that told me that my patient was in trouble." o It's the same thing with labs if you are following labs. Somebody's H&H could be 10 & 30 and you're like "ehh it's not a big deal" but maybe yesterday it was 15 and 45. That is a big deal then. Look at trends, very very important.

recognize and respond to trends

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · Recognize a gradual deterioration or change in level of consciousness or vital signs · Trends can involve anything o Vital signs § BP, HR, O2 sat o Pain scale § Are they suddenly hurting a whole lot or have they been hurting a lot? o Level of consciousness o Glasgow Coma Scale

recognize and respond to trends

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · ____ _____ ____ ____ _____ and complications versus "expected patient findings" o Let's say a patient came back and they had a carotid endarterectomy done, they have the incision on the side of their neck. One expected patient finding is you will find swelling. There is going to be swelling after the surgery bc there is tissue damage there. But if the patient says "oh I feel like my neck is swollen and you write it off and say "oh yeah you just had surgery" and you assess it and it's a large hematoma, that's not an expected finding. That potentially could be a medical emergency. That's a complication, its swelling but it's a significant swelling.

recognize signs of medical emergencies

_______ to Delegation includes: · ________ is a common response by subordinates to delegation. · One of the most common causes of subordinate _________ to, or refusal of, delegated tasks is the failure of the delegator to see the subordinate's perspective. o Overwhelmed with demanding workload o Believe they are incapable of completing task (may just need a little coaching or support) o Inherent resistance to authority o No room for independent thinking, boredom · Ongoing challenge to instill a team spirit between delegators and their subordinates.

resistance

definition: The obligation to complete a task

responsibility

Which of the 5 rights of delegation ( 1. right task, 2. right circumstance, 3. right person, 4. right direction and communication, 5. right level of supervision and evaluation) is described below? o Considering the setting and available resources, should delegation take place? o Is the condition of the patient stable? (if the patient's condition changes, the delegatee must communicate this to the nurse who must then reassess) o The nurse cannot delegate any activity that requires clinical reasoning, nursing judgment or critical decision making o Nurses needs to be able to evaluate the patient and the assistive Personnel (AP) once they have delegated --appropriate patient setting, available resources, and other relevant factors considered

right circumstance

Which of the 5 rights of delegation ( 1. right task, 2. right circumstance, 3. right person, 4. right direction and communication, 5. right level of supervision and evaluation) is described below? o Nurse ensures delegatee understands they cannot make any modifications to the activity without first consulting the nurse (they are not acting independently because you are giving them something from your scope of practice so they need to carry it out in exactly the way that you communicate to them) § This is why communication is so important

right direction and communication

Which of the 5 rights of delegation ( 1. right task, 2. right circumstance, 3. right person, 4. right direction and communication, 5. right level of supervision and evaluation) is described below? o Provide clear, concise instructions, limits, objectives, and expectations o Communication includes data to be collected, the method, time frame for reporting, any pertinent information o As a part of two-way communication, delegatee should ask clarifying questions o Nurse ensures delegatee understands they cannot make any modifications to the activity without first consulting the nurse (they are not acting independently because you are giving them something from your scope of practice so they need to carry it out in exactly the way that you communicate to them) § This is why communication is so important --clear, concise description of the task including the objective, limits, and expectations

right direction and communication

Which of the 5 rights of delegation ( 1. right task, 2. right circumstance, 3. right person, 4. right direction and communication, 5. right level of supervision and evaluation) is described below? o Appropriate monitoring of the delegatee o Evaluate the task implementation, ensure documentation is completed o Maintain proper supervision & provide feedback --appropriate monitoring, evaluation, intervention, as needed, and feedback

right level of supervision and evaluation

Which of the 5 rights of delegation ( 1. right task, 2. right circumstance, 3. right person, 4. right direction and communication, 5. right level of supervision and evaluation) is described below? o The nurse along with the employer and the delegatee is responsible for ensuring that the delgatee possesses the appropriate skills & knowledge to perform the activity o Is it something that your organization has a policy about where you can and cannot delegate to particular people? --right _____ is delegating the right task to the right ______ to be performed on the right ______

right person

Which of the 5 rights of delegation ( 1. right task, 2. right circumstance, 3. right person, 4. right direction and communication, 5. right level of supervision and evaluation) is described below? o Is this a task that can be delegated by the nurse? o Does the activity fall within the delegatee's competency and scope of practice as defined by the facility? --one that is delegable for a specific patient

right task

Elements Affecting Delegation to a Transcultural Work Team: · Communication - especially dialect, volume, use of touch, and eye contact o Every culture is different o Some people speak softy—others speak loudly and with their hands which may come off as aggressive · Space - interpersonal space differs between cultures · ____ _____ - family unit is of primary importance in some cultures (less so in others) · Time - cultures tend to be past, present, or future oriented · Environmental control - cultures have internal or external locus of control · Biologic variations - susceptibility to diseases and physiological differences (some races are more susceptible to diseases than others) · Delegation delivered in a softer tone may be perceived as less important - delegator must recognize the personal space needs of individuals - importance of a unit providing social support in a person's life - past, present or future oriented affects delegation (strategic planning for future oriented) - locus of control (fate or internally driven) - psychosocial differences between racial & ethnic groups

social organization

Elements Affecting Delegation to a Transcultural Work Team: · Communication - especially dialect, volume, use of touch, and eye contact o Every culture is different o Some people speak softy—others speak loudly and with their hands which may come off as aggressive · _____ - interpersonal ______ differs between cultures · Social organization - family unit is of primary importance in some cultures (less so in others) · Time - cultures tend to be past, present, or future oriented · Environmental control - cultures have internal or external locus of control · Biologic variations - susceptibility to diseases and physiological differences (some races are more susceptible to diseases than others) · Delegation delivered in a softer tone may be perceived as less important - delegator must recognize the personal space needs of individuals - importance of a unit providing social support in a person's life - past, present or future oriented affects delegation (strategic planning for future oriented) - locus of control (fate or internally driven) - psychosocial differences between racial & ethnic groups

space

the following are ______ for successful delegation: --ID necessary skill and education levels to complete the delegated task --plan ahead --select and empower capable personnel --communicate goals clearly --empower the delegate --set deadlines and monitor progress --evaluate performance --reward accomplishment

strategies

definition: Directing, guiding and influencing the outcome of an individual's performance of an activity or task o The delegator must supervise along the way

supervision

Which prioritization principle (systemic before local, acute before chronic, actual problems before potential future problems, listen carefully to patients and don't assume, recognize and respond to trends, recognize signs of medical emergencies and complications versus expected patient findings, apply clinical knowledge to priority setting) is described below? · "Life before limb" · Example: o Prioritize interventions for a patient in shock over interventions for a patient with localized limb injury § Yeah somebody's limb could be in jeopardy but if systemically they are not being perfused then they could potentially lose their life

systemic before local

When talking about the delegation process, the first step (#1) is to define the _______. · Ask yourself o Does the ______ involve technical skills or cognitive ability? o Are specific qualifications necessary? o Is performance restricted by practice acts, standards, or job descriptions? o How complex is the _______? o Is training or education required? o Are the steps well defined, or are creativity and problem solving required?—if so, you probably shouldn't delegate it o Would a change in circumstances affect who could perform the ________?

task

When talking about the delegation process, the first step (#1) is to define the _______. · Delegate only an aspect of your own work for which you have responsibility and authority. · These include: o Routine _____s o ______s for which you do not have time o _______s that have moved down in priority

task

When talking about the delegation process, the first step (#1) is to define the _______. · Delegate only an aspect of your own work for which you have responsibility and authority. · These include: o Routine _____s o ______s for which you do not have time o _______s that have moved down in priority · Ask yourself o Does the ______ involve technical skills or cognitive ability? o Are specific qualifications necessary? o Is performance restricted by practice acts, standards, or job descriptions? o How complex is the _______? o Is training or education required? o Are the steps well defined, or are creativity and problem solving required?—if so, you probably shouldn't delegate it o Would a change in circumstances affect who could perform the ________?

task

When talking about the delegation process, the third step (#3) is to determine the ______. · Clearly define your expectations for the delegate · Provide enough time to describe the _______ and your expectations o Cant be in a hurry just barking out orders and walking off · Avoid distractions · Validate understanding of the ______ and your expectations by eliciting questions and providing feedback

task

What is one of the 3 reasons why we delegate?? o Achieves goals o Productivity increases o Provide learning opportunities (delegating can become a teaching moment—helps people learn and grow)

team building

Elements Affecting Delegation to a Transcultural Work Team: · Communication - especially dialect, volume, use of touch, and eye contact o Every culture is different o Some people speak softy—others speak loudly and with their hands which may come off as aggressive · Space - interpersonal space differs between cultures · Social organization - family unit is of primary importance in some cultures (less so in others) · ______ - cultures tend to be past, present, or future oriented · Environmental control - cultures have internal or external locus of control · Biologic variations - susceptibility to diseases and physiological differences (some races are more susceptible to diseases than others) · Delegation delivered in a softer tone may be perceived as less important - delegator must recognize the personal space needs of individuals - importance of a unit providing social support in a person's life - past, present or future oriented affects delegation (strategic planning for future oriented) - locus of control (fate or internally driven) - psychosocial differences between racial & ethnic groups

time

Which framework for priority setting (Maslow's Hierarchy, ABCD - Airway, breathing, circulation, disability, Prioritization Principles, Time Management, and Infection Control Issues) is described below? · Immediately · Within a specific time frame · By the end of the shift · Least amount of time to complete o Sometimes if something doesn't take very long, we have a tendency to want to do it bc we can knock it out and that's fine as long as there isn't something more important that needs to be addressed. If you have a stat drug that needs to be given immediately, that is what you need to focus on. Not whatever is going to take the least amount of time. If you have something that needs to be given within a specific time frame and its getting close to the end of that time frame then that becomes the priority.

time management

What is one of the 3 reasons why we delegate?? o In nursing, the zone of responsibility exceeds one person's ability to complete all the tasks o No one person can do everything

time savings

what are the 3 rreasons why we delegate?

time savings, team building, and cost savings

Set ______ and monitor how the task is being accomplished through informal but regularly scheduled meetings. This shows an interest on the part of the nurse leader, provides for a periodic review of progress and encourages ongoing communication to clarify any questions or misconceptions. In doing so, the leader manager provides staff feedback to increase competency in task performance. In addition this keeps the delegated task before the subordinate and the manager so that both share accountability for its completion. Although the final responsibly belongs to the delegator, the subordinate doing the task accepts responsibility for completing it appropriately and is accountable to the person who delegated the task. **set deadlines and monitor progress

timelines

The following are priority setting ______: · ""Whatever hits first"" o Occurs when an individual simply responds to situations as they happen rather than thinking first and then acting. o Common to new nurses. o So you hit the floor, call bell goes off and your patient says they need a glass of water but you are just out of report. You could delegate this to a CAN, and im not saying you don't address the patients need but there are going to be lots of things that come up and you are going to feel like bc it was first on the list it needs to be addressed first, not necessarily true · ""Path of least resistance"" o The individual makes the assumption that it is easier to do a task by himself or herself and fails to delegate appropriately. § Sometimes we don't want to have to deal with asking somebody else to help us. We think it's easier to do it ourselves and don't want to deal with so and so bc they have an attitude and never want to help me. That is a separate issue that needs to be dealt with but make sure you don't take on more than you should · "Squeaky wheel" o The individual falls prey to those who are most vocal about their requests and then feels a need to respond to the time frame imposed by the "squeaky wheel" rather than his or her own. o We all know that a lot of times the squeaky wheel gets greased. That could be a patient that is just whining about something, they may have a valid concern or they may not. They may be occupying all your time. And you may have a patient in a room that hardly presses the call bell and has very few requests but they are really sick and you probably need to be spending more time with them. "I kind of feel like in order for somebody to be making a lot of noise they have to be feeling pretty good to do that" · "Default" o The individual feels obligated to take on tasks that no one else has come forward to do o Nobody else on the team is doing it so you feel so uncomfortable that nobody is stepping up to the plate that you just volunteer · "Inspiration" o Individuals wait until they become "inspired" to accomplish a task. § Some of us will never be inspired to put somebody on a bedpan or to do a number of things o Some tasks will never be inspiring, and the wise time manager recognizes that the best way to complete these tasks is hard work and appropriate attention to the matter. § " I feel like if there are some things I really don't care to do, as long as I'm not putting other thing that are more important in front of it I just do them first to get them out of the way"

traps

Nurses also ______ because they lack experience in the job or in delegation itself. Other nurses refuse to delegate because they have an excessive need to conrtrol to be perfect. The leader manager who accepts nothing less than perfection limits the opportunities available for subordinate growth and often wastes time redoing delegated tasks. **delegation error

under-delegating

Some individuals ______ because they fail to anticipate the help they will need. In an ideal situation, the best time to delegate is before you become overwhelmed. Although crises happen that require you to reorganize your priorities more often than not you can forsee hectic or challenging times. For example. waiting until the end of your shift to delegate the tasks you did not have time to finish is unfair to the person you are delegating to, and that individual is likely to resent your request. **delegation error

under-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: 1. Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly o 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. o 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. o No one wants to be perceived as incompetent

under-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: 1. Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly o 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. o 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. o No one wants to be perceived as incompetent 2. Desire to complete the job him/herself o 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 o Time spent training another to do a job is repaid in the future (time management). o Delegation (in addition to productivity) provides the opportunity for subordinates to experience feelings of accomplishment and enrichment o Some people are control freaks and want to do everything themselves 3. Fear that staff/subordinates will resent having work delegated to them - want to be liked o Delegated work actually increases employee satisfaction and fosters a cooperative working relationship b/w managers and staff o There is a way to talk to people that they won't feel dumped on § Work on communication o Make sure you follow back in appreciation for what they have done 4. Lack experience in the job or in delegation itself or because they have an excessive need to control or be perfect o Refusal to allow mistakes limits the opportunities available for subordinate growth and results in wasted time as the manager recompletes delegated tasks o 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. 5. Enjoyment of the work/task

under-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: 2. Desire to complete the job him/herself o 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 o Time spent training another to do a job is repaid in the future (time management). o Delegation (in addition to productivity) provides the opportunity for subordinates to experience feelings of accomplishment and enrichment o Some people are control freaks and want to do everything themselves

under-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: 3. Fear that staff/subordinates will resent having work delegated to them - want to be liked o Delegated work actually increases employee satisfaction and fosters a cooperative working relationship b/w managers and staff o There is a way to talk to people that they won't feel dumped on § Work on communication o Make sure you follow back in appreciation for what they have done

under-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? Causes of _______-delegating: 4. Lack experience in the job or in delegation itself or because they have an excessive need to control or be perfect o Refusal to allow mistakes limits the opportunities available for subordinate growth and results in wasted time as the manager recompletes delegated tasks o 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. 5. Enjoyment of the work/task

under-delegating

Which delegation error (under-delegating, over-delegating, and improper delegating) is described below? In fact, delegation can be empowering both to the person delegating and to the person being delegated to. Leaders should delegate some of the most difficult tasks because "reluctance to give ownership of the tuff stuff to your employees indicate a lack of trust toward the people you hired." "If you have hired the right players, you can learn to really trust them to make important decisions fro you. By doing so, you empower them in their roles to go beyond what you probably would have ever done yourself. When people feel trusted, they can innovate and progress in their own thinking as they move forward a decision, which pulls the organization forward as well."

under-delegating

________ frequently stems from the individual's false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely. Delegation does not need to limit the individuals' control, prestige, and power; rather, delegation can extend their influence and capability by increasing what can be accomplished. **delegation error

under-delegating

another cause of ______ is the individual's desire to complete the whole job personally due to a lack of trust in the subordinates; some nurses believe that he or she needs the experience or that he or she can do it better and faster than anyone else and indeed sometimes this is the case. this is especially the case for individuals who are new to delegation because they often feel as through they must give up control. it may be frightening to allow a team member to complete a task for which you are ultimately responsible. Communicating frequently with those to whom you have delegated to check the progress of the task can help decrease this fear and should give the delegator some sense of control. **delegation error

under-delegating

other individuals ______ because there is not enough time to delegate. It takes time to delegate because the delegator must adequately explain the task or teach their team member the skills necessary to complete the delegated task. The problem is paradoxical because one of the main benefits of delegation is saving time. In addition to increased productivity, delegation can also provide the opportunity for subordinates to experience feelings of accomplishment and enrichment. **delgation error

under-delegating

What are the 3 common delegation errors?

under-delegating, over-delegating, and improper delegating

The following is criteria for delegation to an _____ _____ _____: The North Carolina Board of Registerd Nursing suggests that tasks may be delegated to nursing assistive personnel only if they meet ALL of the following criteria: 1. frequently recur in the daily care of a client or group of clients 2. Are performed according to an established (standardized ) sequence of steps 3. Involve little or no modification from one client care situation to another 4. May be performed with a predictable outcome 5. DO not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure itself 6. Do not endanger the health or wellbeing of clients 7. Are allowed by agency policy/procedures

unlicensed assistive personnel

There are 5 factors to assess when deciding to delegate nursing tasks: 1. potential for harm, 2. complexity of the task, 3. amount of problem solving and innovation required, 4. unpredictability of outcome, and 5. level of patient interaction. Which of these 5 factors is described below? Only delegate when a patient's response is predictable.If this is the first time the patient gets a med and there is question to whether they are allergic to it, then that is probably something you shouldn't delegate

unpredictability of outcome