Ch 17: Delegating, Authority,Accountability and responsibility in Delegation Decisions. Flashcards
Delegation
is the “transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome”
Responsibility
refers to the obligation and dependability to accomplish work
Authority
refers to the ability to perform duties in a specific role
Accountability
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
Delegator
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
Delegatee
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
Assignment
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.
Delegation
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
Important for nursing delegation to remember:
The licensed nurse can never delegate nursing judgment or critical decision making;
Communication for delegation
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.
How to improve communication:
Appreciating and valuing each other.
Trusting relationship
Accurate, complete documentation in a timely manner.
Giving Information
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.
Giving Direction
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.
Seeking clarity
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.
Seeking advice
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.
Assessment: Delegator should
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
Delegator Planning:
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
Delegatee Planning:
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
Implementation, The nurse must:
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.
Implementation, the delegatee should
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.
Evaluation, the nurse reviews:
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.
Organizational Accountability
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.
Chief Nursing officers
accountable for establishing systems to assess, monitor, verify, communicate, and evaluate competency requirements related to delegation.
Individual Accountability
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.
