Ch 17: Delegating, Authority,Accountability and responsibility in Delegation Decisions.

Question 1

Delegation

Answer 1

is the “transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome”

Question 2

Responsibility

Answer 2

refers to the obligation and dependability to accomplish work

Question 3

Authority

Answer 3

refers to the ability to perform duties in a specific role

Question 4

Accountability

Answer 4

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

Question 5

Delegator

Answer 5

icensed nurse who delegates nursing responsibilities or allocates a portion of work related to patient care to another individual.
NCBSN (2016) guidelines reinforce that delegation does not apply to the transfer of responsibility for care of a patient between healthcare providers

Question 6

Delegatee

Answer 6

an individual who is delegated a nursing responsibility by a licensed nurse, is competent to perform the task or activity and must verbally accept the responsibility

Question 7

Assignment

Answer 7

defined as 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.
distribution of work that each qualified person is responsible for during a given work period.

Question 8

Delegation

Answer 8

occurs when delegatees are requested to perform a specific nursing task, activity, or procedure outside their traditional role, have completed additional education and training, and have validated competency in the delegated area

Question 9

Important for nursing delegation to remember:

Answer 9

The licensed nurse can never delegate nursing judgment or critical decision making;

Question 10

Communication for delegation

Answer 10

The nurse must provide communication that is clear, concise, timely, and reliable to produce safe and efficient care.
A clear understanding between the delegator and delegatee about a delegated task or activity creates a greater chance of producing a positive outcome.

Question 11

How to improve communication:

Answer 11

Appreciating and valuing each other.
Trusting relationship
Accurate, complete documentation in a timely manner.

Question 12

Giving Information

Answer 12

delegator must provide sufficient information about the patient, situation, delegated tasks, monitoring process and desired outcomes
delegatee must report back to the delegator to indicate any deviations from any of those elements.

Question 13

Giving Direction

Answer 13

Delegator task
delegator is expected to be as specific as possible in what the performance is to entail, how often reports to the delegator are needed, and what constitutes an immediate concern.

Question 14

Seeking clarity

Answer 14

The delegatee is attempting to understand the delegator’s standards for general statements
repeat-back method can be used by both individuals to be sure clarity is present.

Question 15

Seeking advice

Answer 15

Delegatee task
finding alternative ways to solicit information from patients or ways to perform a skill when a patient’s physical condition prevents a typical approach.

Question 16

Assessment: Delegator should

Answer 16

Ensure that laws and rules support delegation
Determine if the task is within the scope of the delegating nurse practice and if he or she is competent to delegate
Assess the client’s needs, stability, health condition, and predictability of the risks and responses
Assess whether the task is appropriate to delegate to a UNP.
Determine if a specific UNP has the experience and educational background to complete the task safely and effectively
Consider the type of healthcare facility related to the delegation task/activity
Determine if the institution’s policies and procedures allows for this type of delegation to a UNP.
Assess whether the nurse can provide appropriate guidance, support, and supervision of the delegated task/activity

Question 17

Delegator Planning:

Answer 17

Identify the delegated task, how it should be accomplished, and the expected outcomes Determine the UNP’s understanding of the task and expectations Alert the UNP to any specific patient conditions, characteristics, or concerns.
Reinforce a willingness to guide and support the delegatee.
Convey expected observations to be reported and recorded. Specify reporting time frames and/or dates expected
Specify any specific concerns or emergency situations that warrant prompt reporting.
Validate the delegatee’s willingness to accept the responsibility for the delegated task. Emphasize the importance of timely, accurate, and complete documentation. Determine any specific patient requirements, characteristics, or concerns to be addressed

Question 18

Delegatee Planning:

Answer 18

Comprehend the delegated task being delegated.
Ask questions and seek clarification regarding the delegation, if needed. Specify any performance limitations regarding the delegation (e.g., never completed the task before, or completed only once or infrequently).
Request additional training or supervision if needed.
Affirm an understanding of expectations.
Review the emergency action/communication plan.
Inform the delegator of the inability to accept the task/activity and discomfort with the delegated task/actively

Question 19

Implementation, The nurse must:

Answer 19

Review the delegated task, how it should be accomplished, and expected outcomes as implementation begins.
Reinforce any specific patient requirements, characteristics, or concerns.
Provide available resources necessary to complete the task/activity.
Intervene based on the patient’s needs and/or complexity of the delegated task on a timely basis. Supervise the UNP’s ability to complete the task/assignment based on education and experience.
Provide appropriate feedback on a timely basis.

Question 20

Implementation, the delegatee should

Answer 20

Complete the delegated task/activity according to established standards.
Ask questions or seek clarification when necessary. Adhere to specified and agreed upon reporting times. Report any specific concerns or emergency situations immediately.

Question 21

Evaluation, the nurse reviews:

Answer 21

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.

Question 22

Organizational Accountability

Answer 22

Highly productive organizations often use a relationship-based leadership model that fosters interdisciplinary communication and collaboration among all members of the healthcare team.
shared governance model, an accountability-based leadership model, fosters structural empowerment, transformational leadership, development of new knowledge, and evidence-based practice improvements and innovations.

Question 23

Chief Nursing officers

Answer 23

accountable for establishing systems to assess, monitor, verify, communicate, and evaluate competency requirements related to delegation.

Question 24

Individual Accountability

Answer 24

refers to individuals’ abilities to explain their actions and results.
The Code’s Provision 4 focuses on the nurse’s authority, accountability and responsibility, for nursing practice and how decisions and actions must be consistent with the obligation to promote health and provide high-quality health care.

Question 25

Five Rights of Delegation

Answer 25

Right Task
Right Circumstance
Right Person
Right Direction and Communication
Right Supervision

Question 26

Situational Leadership Model

Answer 26

Leaders and managers need to behave differently in specific situations.
Nurses must analyze an individual’s knowledge and the work-related task before delegating. Nurses make decisions based on this analysis.
Nurses must analyze an individual’s knowledge and the work-related task before delegating. Nurses make decisions based on this analysis.

Question 27

Situational Leadership Model, Followers readiness:

Answer 27

Ability and Willingness.
The greater the ability and willingness of the delegatee, the more likely the delegator can implement delegation strategies while interacting with individuals in a specific situation.

Question 28

Communicating with a Delegatee: Tell

Answer 28

Delegatee Condition:
Has limited knowledge and ability to perform the task.
Delegator Relevance:
Has limited knowledge and ability to perform the task

Question 29

Communicating with a Delegatee: Sell

Answer 29

Delegatee Condition:
Has ongoing relationship, but a new task is delegated.
Delegator Relevance:
Requires explanation

Question 30

Communicating with a Delegatee: Participate

Answer 30

Delegatee Condition:
Has willingness and ability, but the relationship is new.
Delegator Relevance:
Requires that both individuals create mutual expectations and conditions for performance.

Question 31

Communicating with a Delegatee: Delegate

Answer 31

Delegatee Condition:
Has established relationship and expertise.
Delegator Relevance:
Little guidance is needed

Question 32

Four elements to keep in mind when delegating UNP:

Answer 32

Safety, critical thinking , stability and time.

Question 33

What to remember to keep in mind when delegating UNP

Answer 33

When patients are unsafe for any reason, delegation may not be appropriate. Some exceptions can be monitoring the patient.
Greater the stability of the patient, the more likely the UNP can provide patient care.
Educating UNPs in how to implement delegated tasks is crucial for positive outcomes.

Question 34

Barriers to Effective Delegation.

Answer 34

Underdelegation
Over delegation
Improper delegation

Question 35

Underdelegation

Answer 35

occurs when nurses do not have the confidence to make an effective delegation decision, lack the time to delegate, choose to complete the responsibility themselves, lack the confidence in the delegate’s abilities to complete the task or fear loss of control.

Question 36

Over Delegation

Answer 36

occurs when the nurse overburdens a delegatee with too many tasks and responsibilities.

Question 37

Improper delegation

Answer 37

is delegating tasks or responsibilities beyond the delegatee’s training or education or assigning a task or responsibility without providing adequate information or data to successfully complete the task or activity.

Question 38

Building an effective Nurse delegators and interprofessional team

Answer 38

Nurses must keep current with delegating decisions by continuing education to reinforce what, when and how to effectively delegate.
Understand individual members of their team, their roles and functions and their disciplines.
Creating positive, collaborative partnerships between nursing leaders at healthcare facilities and faculty colleges of nursing.