Chapter 17: Delegation

What is Delegation Evaluation?

Evaluation is often overlooked in the delegation process. However, it should never be overlooked because it allows time to reflect on delegation decisions. It provides the nurse time to determine whether the delegation was successful and to identify the strengths and challenges related to the delegation decision. Evaluation and constructive reflection allows us to build on the strengths, learn from the challenges, and implement quality measures to improve delegation decision Evaluating how the delegatee and patients are doing throughout the work period is critical to work performance and the outcomes of person-centered care. The nurse reviews if the: • Task/activity was successfully performed • Expected client outcome(s) were successfully achieved • Communication was timely and effective • Strengths/challenges were identified • Strengths/challenges created a platform for a quality improvement plan • Quality improvement plan allowed for addressing concerns/issues and provided constructive feedback for the nurse and UNP • Quality improvement plan allowed for appropriate training and education • Team was acknowledged for contributions to safe and effective patient-centered care

What is organizational accountability?

Strong organizations have relationship-based leadership to build interdisciplinary communication and collaboration The health-care organization is also accountable for delegation and resources available to provide care effectively and safely. (ANA 7 NCSBN, 2006, p. 3) Organizational accountability: When done right promotes a positive culture and work environment that supports person-centered care that is necessary for effective delegation. The Chief Nursing Officers (CNO) are also accountable to assess, monitor, verify , communicate, and evaluate competency requirements related to delegation. (p. 309)

What is individual accountability?

"answerable to oneself and others for one's choices, decisions and actions as measured against standards..." (ANA, 2015a, p. 41) Accountable for decision to delegate and tasks delegated to the right person with the right skillset and experience. Accountable for professional practice and image as well as outcomes of their own and delegated nursing care. (AACN, 2008, p. 9) Comply with state nurse practice act or regulating bodies`

What are the 5 rights of delegation?

5 Rights of Delegation Right Task Right circumstance right person right direction or communication right supervision Mnemonic could be CDS PT or PTS CD

What is delegation?

ANA Definition of Delegation - "transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome" (ANA, 2012, p. 6). NCSBN Definition of Delegation - "allowing a delegatee to perform a specific nursing skill, activity or procedure that is beyond the delegatee traditional role and not routinely performed" (NCSBN, 2016, p. 6). From book However, ANA and NCSNB agree that delegation is a process whereby a nurse directs another individual to perform nursing tasks or activities and the nurse retains accountability for total patient care However, the NCBSN (2016) guidelines reinforce that delegation does not apply to the transfer of responsibility for care of a patient between healthcare providers, such as from an RN to another RN or an LPN/LVN to another LPN/LVN, because this transfer of care for the patient is considered a "handoff " RN Retains Responsibility & Accountability!! COMAR 10.27.11.03.A The nurse may delegate the responsibility to perform a nursing task to an unlicensed individual, a certified nursing assistant, or a medication technician. The delegating nurse retains the accountability for the nursing task. The RN may delegate components of care but does not delegate the nursing process itself. Thepractice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be delegated. Maryland NPA - Delegation (please read this; especially definition and criteria for delegation) NCSBN & ANA Joint statement on Delegation ( please read ana statement regarding delegation)

What is delegation communication? Nurse CNA

Allow for 2-way communication Allows for information sharing Giving direction/asking questions Seeking clarity Seeking advice Clarify the Task, Timeline, & Expectations The Nurse would: Assess the CNA's understanding How is the task accomplished? When & what info is to be reported? (include expected observations to report & record) Specific client concerns that would require prompt reporting Individualize for each CNA Assess the CNA's understanding of expectations, provide clarification Communicate willingness to assist Verify that the receiving person accepts the delegation & responsibility CNA Asks questions & clarifies expectations Informs the nurse if the task is not done Asks for additional training or supervision Affirms understanding of expectations Determines the communication method between the nurse & CNA Communicates their willingness & availability to guide & support Determine the communication & plan of action in emergency situations

Barriers to Effective Delegation underdelegation Overdelegation improper

Barriers to effectiveness Underdelegation (new nurses might do this) RN may lack confidence to delegate Lack the time to delegate Choose to complete the task themselves Lack the confidence in others ability to complete the task Fear a loss of control Overdelegation RN overburdens the delegate Occurs with poor time management skills or when RN lacks the skill themself Improper Delegation Delegating beyond someone's scope of practice

What is assignment?

Is the "routine care, activities and procedures that are within the authorized scope of practice of the RN or LPN/VN or part of the routine function of the UAP" (NCSBN, 2016, p. 6).

What is accountability?

RN License (in most states)= Authority to Delegate LPNS can not delegate tasks and can not ask another tech to do above and beyond Comply with state nurse practice act or regulating bodies Accountable for decision to delegate and tasks delegated to the right person with the right skillset and experience. Accountable for professional practice and image as well as outcomes of their own and delegated nursing care (AACN, 2008, p. 9). The health-care organization is also accountable for delegation and resources available to provide care effectively and safely (ANA 7 NCSBN, 2006, p. 3).

What is Responsibility/Delegate Role?

The obligation and dependability to accomplish work. RN has the responsibility to assess level of competence of delegate & appropriateness of delegation, supervise the delegate, evaluate the performance of the delegate, & manage the results. The delegate is responsible for their actions & accepts only tasks for which they are qualified & provides feedback to the delegator. The RN maintains Accountability

What can CNA, LPN, RN do?

Try to list two for each