Chapter 9: Delegation Of Client Care Flashcards
Before delegating
Assessment
§Before deciding who should care for a particular patient, the nurse must:
§Assess patient needs
§Set patient-specific goals
§Match the personnel with the appropriate skills to care for the patient
Planning
§Mentally identify who is best suited for the task or activity
§Planning prevents later problems
Implementation
§Assign the appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities
Evaluation
§The nurse must then:
§Oversee the care or activities
§Determine if patient care needs have been met
§Allow for feedback this enables personnel to see where they are and where they want to go
Supervision
§Do not confuse delegation with supervision
§Supervision is usually more direct than delegation
§Requires directly overseeing the work or performance of others
§Includes checking with individuals during the day to see what activities have been completed and what may still need to be finished
§Example, CNA assigned to take VS, give morning baths, and two glucose checks on eight patients. By noon she is behind and the RN has responsibility to find out why and reevaluate
§Individuals who supervise others also delegate tasks and activities
§A nurse manager performs both
§Chief nursing officers often delegate tasks to associate directors
§Administrative tasks, such as staff scheduling may be delegated to another staff member
How to organize care
§Plan time around activities that must be performed at a certain time and may be out of one’s control
§Example, medication administration or special preparation for a procedure
§Perform high-priority activities first
§Cluster activities that may be performed together
§Consider your peak time when performing optional activities
§Remember you are responsible for activities delegated to others
UAP
Unlicensed assistive personnel are individuals who are trained to function in an assistive role to the registered nurse in the provision of patient/client care activities as delegated by and under the supervision of the registered professional nurse. Although some of these people may be certified nursing assistant (CAN), it is important to remember that certification differs from licensure. When a task is delegated to an unlicensed person, the professional nurse remains personally responsible for the outcomes of these activities (ANA, 2005).
§Individuals trained to function in an assistive role to the nurse
§Perform delegated tasks
§Under direct supervision of the RN
§May or may not be certified
Tasks for a UAP
§Vital signs §Skills learned through special training §Blood drawing §ECGs §Measuring intake and output §Non-nursing duties
Criteria for safe delegation
§The purpose of delegation is not to assign tasks to others that you do not want to do yourself
§When you delegate to others effectively, the result is you have more time to perform the tasks that only a professional nurse is permitted to do
§In delegating, the nurse must consider both the ability of the person to whom the task is delegated and the fairness of the task to the individual and the team
§Task aspects: Is this a complex task? Is it a professional responsibility? Can this person do it safely?
§Interpersonal aspects: Does the person have the time to do this? Is the work evenly distributed? Is this fair?
Five factors to determine delegation
- Potential for harm to patient
- Complexity of the nursing activity
- Extent of problem-solving and innovation required
- Predictability of outcome
- Extent of interaction
Task related concerns
§Ability: the nurse needs to know the knowledge and skill level, legal definitions, role expectations, and job description for each member of the team, skills, strengths and weaknesses
§Priorities: focus on patient needs, team needs, the organizational and community demands. Use Maslow’s hierarchy
§Efficiency: means that all members of the team know their jobs and responsibilities and work together like gears in a well-built clock
§Float staff interrupts continuity of care, lost time
§Appropriateness: Assigning the correct personnel to the correct unit
Relationship oriented concerns
§Fairness: distribute the workload evenly in terms of both the physical requirements and the emotional investment in providing health care
§Learning opportunities: Assignments stimulate motivation, learning, and assisting team members to learn new tasks and take on new challenges
§Health: Some aspects of caregiving jobs are more stressful than others. Need to rotate team members on difficult jobs, family emergencies or physical problems address
§Compatibility: Getting team members to work together. Personal problems have no place in the work place and you do not have to like everyone you work with, however, it is a plus
§Preferences: Considering the preferences of individual team members is important but should not supersede criteria for delegation
Five rights of delegation
§Right task §Right circumstances §Right person §Right direction/communication §Right supervision/evaluation
Delegation decision-making grid
Level of client acuity.
Level of unlicensed assistive personnel capability.
Level of licensed nurse capability.
Possibility for injury.
Number of times the skills of been performed by the unlicensed assistive personnel.
Level of decision-making needed for the activity.
Clients ability for self-care
Tasks that cannot be delegated
Initial nursing and follow-up assessments if judgment is indicated.
Decisions and judgments about client outcomes.
Determination and approval of a client plan of care.
Interventions that require professional nursing knowledge, decisions, or skills.
Decisions and judgments necessary for the evaluation of client care
Models of care delivery
This includes functional nursing, team nursing, told client care, primary nursing
Functional nursing
Focuses on the task and not holistic client care. The tasks are assigned to the best person for the job. It is efficient and effective, but continuity in client care is lost.
Team nursing
A group of nursing personnel provides care for a cluster of clients. The team leader directs and supervises the team and the whole team knows the condition needs of the client at all times. The team leader must have strong delegation and communication skills
