Exemplar 39.C Delegation

Delegation is defined as . . .

The transference of responsibility and authority for an activity to a competent individual.
A tool that allows the delegator more time to tasks that cannot be delegated.

A delegate is defined as . . .

The individual who assumes responsibility for the actual performance of the task or procedure.

A delegator is defined as . . .

The individual who assigns the task and retains accountability for the outcome.

Professional benefits of delegation

Enhances skills and abilities of the delegate, which builds self-esteem, promotes morale, and enhances teamwork and attainment of the organization's goals.

In nursing, delegation refers to . . .

Indirect care
The intended outcome is achieved through the work of someone supervised by the nurse
Defining the task
Describing the expectation
Seeking agreement
Monitoring performance
Providing Feedback

Assignment is defined as . . .

A skill or task that is a fundamental part of an individual's job that the individual is expected to accomplish on a regular basis.

Difference between Delegation and Assignment

Asking an individual to perform a task that is a part of her regular responsibilities and job description is not delegating.
In Delegation, the nurse transfers responsibility for completing the task to the delegate, but not the accountability for the task

Guidelines for Successful Delegation: When delegating . . .

Follow state's NPA, fac. policies and procedures.
Delegate only tasks you have both accountability and responsibility for.
Follow state regulations, job descriptions, and agency policies.
Follow the delegation process and key behaviors.
Accept delegation

Example of delegating certain care activities for a patient to another nurse

RN assigns a float RN to an unstable patient with high temp and BP.
Caring for an unstable patient is within the RN scope of practice.

SAFETY ALERT: Care of unstable patients should never be delegated to an . . .

LPN, LVN, or UAP.
If an RN must delegate all or part of the care of an unstable patient, these tasks must be delegated to another RN as appropriate.

Five Rights of Delegation

Right task
Right Circumstances
Right Person
Right Direction
Right Supervision

Box 39-2 Examples of Tasks that May and May Not Be Delegated

See Box 39-2 on pg 2631

Right Task

Can be delegated according to agency policy and procedures.
Is also appropriate for the pt.

Right Circumstances

Task addresses needs and contributes to a desired outcome.
Supervision is available.

Right Person

Delegate has the necessary skills and experience.
Task is within that individual's scope of practice.

Right Direction

Delegator provides clear and concise description of task, objectives, limits, expectations.
Oral or written.
Ensure delegate understands info communicated.

Right Supervision

Delegator must monitor and evaluate the delegate's performance.
Delegator provides feedback and intervenes if necessary.

Even though UAP lack licensure, nurses may delegate to them as appropriate because they . . .

Are employees of the healthcare provider.
Conversely, a nurse cannot delegate to family or friends because they do not work for the healthcare provider.

Box 39-3 Principles Used by the Nurse to Determine Delegation to UAP

See Box 39-3 on page 2632

Examples of tasks that should NEVER be delegated by the RN

Discipline of other employees.
Highly Technical tasks.
Complex patient care tasks that require Specific levels of licensure, certification, or training.

SAFETY ALERT Each provider, licensed or unlicensed, is responsible for . . .

His or her own actions.
Anyone who feels unqualified to perform a delegated task must decline to perform it until he or she receives appropriate training and is assessed for competency.

Dumping is explained as . . .

Laying an undesirable task on someone else or rewarding a productive employee with more work.

Dumping is not . . .

Delegating routine care.
The nurse should maintain perspective on the tasks that can now be completed in a timely fashion and what tasks could be performed effectively by the delegate.

Benefits of delegation to the Delegate

Allows them to gain new skills and abilities for upward advancement in an org.
Brings trust and support, which builds self-esteem and confidence.
Job satisfaction and motivation with new challenges.
Pride and belonging, ^ awareness of responsibility.

Benefits of delegation to the Manager

Unit functions better.
Able to devote more time to mgmt. functions that cannot be delegated.
Increased opportunity to develop new skills and abilities that facilitate career advancement.

Benefits of delegation to the Organization

Achievement of their goals more efficiently.
Efficiency leads to quality care and patient satisfaction.
Employee overtime and absences decrease.
Productivity increases and financial position may improve.

NCSBN four step process to be followed for every situation involving delegation

Assessment and planning
Communication
Surveillance and supervision
Evaluation and feedback

Details on the Assessment and Planning step

Questions to consider:
Scope? Pt needs? Is the nurse competent to delegate? Is the task appropriate? Is the Delegate trained and current? Are there org. policies for the task? Adequate supervision available?
If "Yes" to all, then nurse may continue to nex

Communication responsibilities that the Delegator has to the Delegate.

Allowing enough time to describe the task.
Answering the delegate's questions
Addressing situations that must be reported to the delegate
And informing delegate of the nurse's Availability in the event the delegate has questions/needs assistance.

Communication responsibilities that the Delegate has to the Delegator.

Affirming Understanding of the task.
Informing if they have Never performed the task before.
Requesting Training if needed.
And describing communication and actions to do in an Emergency situation.

Box 39-4 Key Behaviors When Delegating Tasks

Describe the task using "I" statements. Appropriate nonverbal behaviors. Additional info needed.
Describe importance of task.
Describe outcome and timeline to complete.
Have delegate repeat back task.

Surveillance is necessary to . . .

Validate the task is being delivered in compliance with agency policies and procedures and current standards of practice.
Validates delegate is working within his scope of practice.

The amount of supervision required for a delegate is dependant on . . .

The nature of the task
The delegate's experience
The patient's needs

Balancing surveillance by being accessible can help the delegate build their . . .

Confidence. Reassure the delegate's interest, and negate any concerns of "dumping" undesirable tasks.
But, monitoring too closely may convey distrust.

Example of Surveillance revealing that a delegate needs closer supervision/assistance.

The Delegator notices subtle changes in the pt's S&S or observes that the delegate is having difficulty.
Nurse must intervene with guidance or opting to reassume responsibility personally to complete the task.

If a problem arises in the Evaluation of delegation, the nurse must provide to the delegate an opportunity for . . .

Feedback.
Praise and recognition is equally important.
Then, instruct delegate on how to prevent similar problems in the future.

Box: Transcultural Delegation (6 Broad categories)

Communication (Verbal and Non)
Space
Social organization (Importance of relationships)
Time (Culture may be past, present, or future oriented)
Environmental control (Internal VS External locus)
Biological Variations

Internal locus of control tends to focus on planning and acting proactively. Whereas external locus of control focuses on . . .

Overcoming obstacles and dealing with events as they arise.

Three Assignment patterns that affect delegation

Unit-Based Assignment
Pairing
Partnering

Unit-based approach of delegation is defined as assigning . . .

Assistive personnel, such as UAP, to serve everyone on the unit by working from a task list.
Features the benefit of limited planning between RN's and support staff.
Consequently, there is no teamwork.

Unit-base approach of delegation means that RNs frequently . . .

Ask for assistance as needed.
Requests are made in a vacuum.
Meaning, none of the nurses are aware of the demands placed on the UAP by others (nurses, staff).
Can lead to conflicting requests for the UAP.
This approach is ineffective, and dissatisfies bot

Pairing is defined as the assignment of an . . .

RN, LPN, and/or UAP to work as a team for a shift.
Team compositions vary day to day.
Pairs are able to plan care; the team plans priorities and outcomes for the pt for that shift.
Increases satisfaction among team and facilitates delegation.

Partnering is defined as . . .

The best assignment pattern. [Like House]
A consistent scheduling of a set team (RN, LPN, and/or nursing assistant) who always work together.
Creates healthy interpersonal relationships and trust.
Each partner is able to anticipate others' needs.
Ideal fo

By accepting delegation, the delegate accepts full responsibility for the outcome of the task. But, they also have the option to . . .

Negotiate to perform only those parts of the task for which the delegate has been trained.

Nonsupportive environments to delegation

Rigid and autocratic leadership
Lack of resources/staff
Financial constraints
Education resources (Trainer and proper equipment)
Time

An environment that promotes an atmosphere of distrust, as well as poor tolerance for mistakes, is exampled by . . .

An org. culture of rigid chains of command and autocratic leadership styles where the norm is to do all work oneself because other staff members are not viewed as capable or skilled.

Delegator insecurity can be combated by educating the delegator that . . .

Delegates are not competition.
Success of a delegate reflects well on both of them.
Following the Five Rights of Delegation can minimize fears of liability.
And that organizational skills, time mgmt., and experience reduce this insecurity.

Inexperience and fear of failure can motivate a potential delegate to . . .

Refuse a delegate task. Making them unwilling.
Those that lack confidence need a great deal of reassurance and support.
Following the delegation process and the five rights of delegation means that the delegate should not fail.

Ways to boost a delegate's confidence include . . .

Building on simple tasks (Important)
Reminding them that everyone was once inexperience.
Giving clear guidelines that adhere to organizational policies.
Being available to them.
Recognizing accomplishments.

To combat Unnecessary Duplication of Tasks, the nurse should . . .

Delegate associated tasks to as few people as possible.
Hold a team meeting to develop a plan of who will be performing tasks.
Else, arguing who who has to do what happens.

Underdelegation is defined as . . .

A situation in which efforts at delegation fail because of one or more of the following occur:
The delegator fails to transfer full authority to delegate.
The delegator takes back responsibility for certain aspects of a task.
The delegator fails to approp

As a result of underdelegation, the delegate is unable to . . .

Complete the task.
Now, the delegator must assume full responsibility for its completion.

Reverse delegations is defined as . . .

Someone with a lower rank delegates a task to someone with more authority.
e.g. LPN asks a NP, who has arrived to the burn unit, to assist with dressing changes.
If the NP agrees, then this type of delegation has occurred.

Overdelegation is defined as . . .

The delegator loses control of a situation by providing the delegate with too much authority or responsibility.
This increases the potential for liability to the delegator.

The different levels of authority and how they see delegation.

State NPA determine the legal parameters for practice.
Professional associations set practice standards.
Organizational policy and job descriptions define it.

Figure 39-4 The ANA and NCSBN 2005 decision tree for delegation. A "No" to any of the questions means you do not delegate.

Laws and rules that support it?
Within scope of delegator?
Assessment of pt needs?
Competent delegator?
Task appropriate to UAP?
Competence of UAP?
Agency policy/procedure/protocols for this task?
Supervision?

Example of a license with prescribing privileges

An NP
Staff may then accept appropriate orders from the physician's nurse.
Otherwise, the orders must be also verified by the prescribing physician.