Delegation Flashcards
Delegation
Getting work done through others or as directing the performance of one or more people to accomplish organizational goals
Not an assignment
Assignment
involves distributing work to a qualified person or persons for implementation of a specific activity or set of activities within their job description
Delegation v Assignment
Delegation - the individual transfers the authority to perform a specific activity from their own practice to an individual qualified to perform the task BUT retains accountability for the delegated task
Assigning - act of handing over a patient to someone else while delegating is handing over a task
The mark of a great leader is when he/she can…
recognize the excellent performance of someone else and allow others to shine for their accomplishments
5 Rights of Delegation
Right Task
Right Circumstances
Right Person
Right Direction/Communication
Right Level of Supervision
Strategies for Successful Delegation
Identify necessary skill and education levels to complete the delegated task.
Plan ahead.
Select and empower capable personnel.
Communicate goals clearly.
Empower the delegate.
Set deadlines and monitor progress.
Monitor the role and provide guidance.
Evaluate performance.
Reward accomplishment.
In NYS an LPN cannot do what independently
perform patient assessments independently
develop a nursing care plan
administer IV Chemotherapy
give any medications by direct IV push
Delegate when
before you become overwhelmed
While you remain responsible for delivering the results of the tasks you delegate, what can demoralize the employee
excessive supervision
Leaders are often measured by …
the successes of those on their teams
The number one reason employees leave is…
because they feel underappreciated
What is a reflection of the legitimate authority inherent in the management role
the right to delegate and the ability to provide formal rewards for successful completion of delegated tasks
Is Delegation intuitive
no its a critical leadership skill that must be learned
Breach of Duty
failure to meet the expected standard of care
Delegation errors increase the risk of…
patient harm and being sued for malpractice
3 Common Delegation Errors
Underdelegating
Overdelegating
Improper Delegating
What is the cause of Underdelegating
stems from individuals false assumption that delegation may be interpreted as a lack of ability on his/her part to do the job correctly or completely - OR - it can come from the delegator not having enough time to delegate (such as explaining the task for teaching skills)
It will likely be unnerving (as least at first) to allow a team member to complete a task for which you are ultimately responsible - but it will not limit your control prestige or power but rather extend it
The time issue is paradoxical because delegation actually saves time
Overdelegating Causes
poor managers of time, spending most of it trying to get organized
potentially because someone feels insecure in their ability to perform a task
Underdelegating overburdens the ____; Overdelegating overburdens the ____
manager; subordinate
Staff should always have the right to do what when it comes to delegation
right to refuse
What may be a sign you have delegated too much, and left employees feeling abandoned or unmotivated
if you find yourself often miscommunicating with your team on deliverables, hearing about issues at the last minute, and misunderstanding how your team set up their priorities
Improper Delegation
Includes things like delegating at the wrong time, to the wrong person, or for the wrong reason
Also includes delegating without providing adequate info - if the manager needs more quality than satisficing it must be made clear
What sort of requirements are needed for the increased need for delegation nowadays that will prevent an unsafe work environment as a result
clearly defined structure where RNs are recognized as leaders of the health care team
job descriptions that clearly define the roles and responsibilities of all workers
education programs that help personnel learn the roles and responsibilities of coworkers
training programs that foster the development of leadership and delegation skills
The RN, while trained well in the role of direct care provider, may not be;…
prepared for the role of delegator
Nurses must believe they can delegate without fearing…
that they will be perceived as lazy or incompetent
In delegation, responsibility for a task can be transferred from the licensed personnel to NAP, but
accountability is shared by both
What does not exist for the NAP
no license to lose for exceeding scope of practice
no nationally established standards for scope of practice
Common Tasks Generally Considered Appropriate for Delegation to NAP (Nursing Assistive Personnel)
Noninvasive and nonsterile treatments
Collecting, reporting, and documenting data including, but not limited to, vital signs, height, weight, intake and output, and capillary blood and urine tests
Ambulation, positioning, turning
Transportation of a client within a facility
Personal hygiene, elimination, including vaginal irrigations and cleansing enemas
Feeding, cutting up of food, placing of meal trays
Socialization activities
Activities of daily living
Criteria for Delegation to an Unlicensed Assistive Personnel/ NAP
The North Carolina Board of Nursing (2014) suggests that tasks may be delegated to nursing assistive personnel only if they meet all of the following criteria:
- Frequently recur in the daily care of a client or group of clients
- Are performed according to an established (standardized) sequence of steps
- Involve little or no modification from one client-care situation to another
- May be performed with a predictable outcome
- Do not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure(s) itself
- Do not endanger the health or well-being of clients
- Are allowed by agency policy/procedures
Unlicensed Medication Administration Personnel
UAP/NAZP that administer medications
also called Med Aides or Med Assistant Techs
Certified Med Aides even work in home and nursing home settings
*Concerns of safe administration - since this is considered a professional nursing practice task
Common Reason for Resistance to Delegation
- Most Common: Failure of the delegator to see the subordinate’s perspective
- Inherent resistance to authority - “testing the water”
- Overdelegation in terms of specificity - they need wiggle room to perform task as they would rather than TOO rigid boundaries
If a subordinate resists delegation, the delegator should…
ascertain why the delegated task was not accomplished and take appropriate action to eliminate these restraining forces - NOT do it themselves necessarily
The leader manager should always attempt to see a delegated task…
from the perspective of the individual being delegated to
6 Cultural Phenomena to Consider When Delegating to a Transcultural Team
- Communication
- Space
- Social Organization
- Time
- Environmental Control
- Biological Variations
Cultural Phenomena: Communication
Consider dialect, volume, use of touch, and eye contact in a transcultural team
Cultural Phenomena: Space
Interpersonal space differs between cultures
Cultural Phenomena: Social Organization
family unit of primary importance in some cultures over the organization
Cultural Phenomena: Time
Cultures can be past, present, or future oriented
Cultural Phenomena: Environmental Control
Cultures have either internal or external loci of control
Cultural Phenomena: Biological Variations
Biopsychosocial differences between groups like susceptibility to diseases and physiologic differences
Past Oriented Cultures
interested in preserving the past and maintaining tradition
Present Oriented Cultures
Focuses on maintaining the status quo and on daily operations
Future Oriented Cultures
focus on goals to be achieved and are more visionary in their approach to problems
Delegation
getting work done through others or directing the performance of one or more people to accomplish organizational goals
an individual transfers AUTHORITY AND RESPONSIBILITY to perform a specific activity from their own practice, to an individual qualified to perform that task, but retains ACCOUNTABILITY for the task
delegation is a skill that must be TAUGHT AND PRACTICED
Delegation is NOT…
assignment - the distribution of work to qualified persons
Benefits for Managers from Delegation
allows time to focus on initiatives
increases flexibility
gain trust in staff performance
earn respect from your staff
improves communication
achieves goals in cooperative group effort
balances workload and time
decreases stress
increased productivity
more ideas/ creativity/ solutions
better use of human resources
builds on leadership skills
Benefits for Staff from Delegation
improves the level of trust and communication
achieves goals that require cooperative group effort
personal and professional development
increased job satisfaction
know-how, experience
increased productivity
Benefits for the Organization from Delegation
saves money
ensures tasks are assigned to the right person at the right level
increases overall productivity and efficiency
makes the best use of organizational resources
more motivated staff and improved retention
Essential Elements of Nurse Practice Acts (NPAs)
States NPA definition of delegation
items that cannot be delegated or items that cannot routinely be delegated
guidelines for RNs about tasks that can be delegated
description of professional nursing practice
description of RN, LPN/LVN, and UAP scope of practice
degree of supervision required to complete a task
guidelines for lowering delegation risks
warnings about inappropriate delegation
if there is a restricted use of the word “Nurse” to licensed staff
(Also differs between states)
NYS State Practice Act definition of the practice of nursing
DIAGNOSING AND TREATING HUMAN RESPONSES TO ACTUAL OR POTENTIAL HEALTH PROBLEMS through such services as case finding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens prescribed by a licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner’s regulations
Nursing Process
Assess –> Diagnose –> Plan –> Implement –> Evaluate
Licensed Professional Nurses (LPN)
Dependent Practitioner - must practice under the supervision of an RN or other licensed health care provider
Must be “Under the direction of a registered nurse”
Degree of supervision should be appropriate to the circumstances - in home care RN should be immediately available by phone - in LTC RN must be on site 8 hours per day
Unlicensed Assistive Personnel (UAP/NAP)
Unlicensed health care provider permitted to perform in a limited manner some activities that fall within the nursing scope of practice
the supervising RN remains responsible for patient assessment, eval, and judgment –> this professional responsibi8lity CANNOT be delegated to an UAP
Can do non nursing functions and health related activities that are direct patient care activities not within the legally protected scope of nursing
What are some exceptions that permit nursing activities or tasks to be performed by non nurses (under specific conditions)
family members
nursing students
OMH/OMRDD attendants
Caregivers for self directing individuals in special state authorized home care programs
Who can RNs and LPNs delegate to and who can they not
RNs can delegate to other RNs and LPNs
LPNs can delegate to other LPNs
RNs and LPNs cannot delegate to UAPs - non nursing tasks can be ASSIGNED!!!! to UAPs
Factors to Consider with Delegation
potential for harm
condition / stability of the patient/client
complexity of the task
problem solving and innovation required
unpredictability of outcome\
requires coordination and consistency of care
Delegation Process
- Define the Task
- Decide on Delegate
- Determine the Task
- Reach Agreement
- Monitor performance and provide feedback
5 Rights of Delegation
Right Task
Right Circumstances
Right Person
Right Direction and Communication
Right Level of Supervision
Activities that can be assigned to UAP/NAP
Feeding (without swallowing precautions), drinking, ambulating/turning, grooming/dressing, toileting
Collecting data such as vital signs, basic intake/output, (glucometer readings- not in NYS)
Applying clean dressings
Performing oral suctioning and mouth care
Taking EKGs
Giving enemas
Doing venipuncture (phlebotomy)
Carrying out non-nursing functions
Reporting to RN or LPN
Activities that cannot be assigned to UAP/NAP
Assessing, evaluating or problem-solving
Determining a nursing diagnosis
Developing the nursing plan of care
Providing patient education or health counseling
Performing sterile or invasive procedures
Feeding through nasogastric tube
Administering oxygen
Performing tracheal suctioning or respiratory care
Administering medications
Tasks that can be delegated by RN to LPN/LVN
Monitoring client findings (as input to the RNs ongoing assessment of clients)
Reinforcement of client teaching from a standard care plan
Routine dressing changes
Tracheostomy care
Suctioning
Checking nasogastric tube patency
Administration of enteral feedings
Ostomy care
Insertion of urinary catheter
Medication administration (excluding IV medications in several states)
Tasks that can not be delegated by RN to LPN/LVN
Assess, evaluate or problem-solve
Independently develop the nursing care plan
Administer chemotherapy (bladder instillation may be okay)
Administer direct IV push medications except for saline and heparin flushes
Administer IV fluid bolus for plasma volume expansion
Access any form of central line or venous chest or arm port line device (except in outpatient chronic hemodialysis)
Do triage, case management, or mental health teaching
Effective Delegation Tips
Plan Ahead
Select and Empower Capable Personnel
Communicate Goals Clearly
Set Deadlines and monitor progress
Be a role model and provide guidance
evaluate performance
Reward accomplishment
10 Steps to Successful Delegation
Define the task
select the individual
assess ability and training needs
explain why
state required results
agree on a schedule
support and communication
provide feedback on results
repeat the process
What delegation error do these statements encapsulate?:
“I like to have things done my way.”
“My staff will resent the additional work.”
“My staff expect me to be the problem solver and decision maker.”
“I can do this better and quicker than my staff.”
“I don’t have confidence in my staff.”
“It’s easier to do it myself than to organize it, explain it, and monitor it.”
Underdelegating
What delegation error do these statements encapsulate?:
Poor time management Unorganized Insecure in ability to do task Do not know laws/regulations Assignment too heavy
Overdelegating
What delegation error do these statements encapsulate?:
Delegating at the wrong time
To the wrong person
For the wrong reason
Delegating tasks and responsibilities beyond the capabilities of the delegate
Delegating without providing adequate information
Improper Delegation
Tasks appropriate to assign to UAP/NAP
Non-invasive and nonsterile treatments
Collecting, reporting, and documenting data including, but not limited to, vital signs, height/weight, intake and output, and capillary blood and urine tests
Ambulation, positioning, turning, transfers
Transportation of a patient within a facility
Personal hygiene, elimination, including vaginal irrigations and cleansing enemas
Feeding, cutting up food, placing of meal trays
Socialization activities
Activities of daily living
What is the essence of tasks that CANNOT be delegated
Any steps in the nursing process:
Assessment Diagnosis Planning Evaluation Nursing Judgment
Reasons for Resistance to Delegation
current workload is overwhelming
believe they are incapable of performing task or lacks confidence
inherent resistance to authority (remember the power authority gap)
tasks are overdelegated in terms of specificity
RN should try to mix routine and boring tasks with more challenging and rewarding assignments
The registered nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first?
Call the hospital lawyer
Refuse to float to the ICU
Call the nursing supervisor
Report to the ICU and identify tasks that can be performed safely
Report to the ICU and identify tasks that can be performed safely
The nurse is supervising a newly trained certified nurse aide (CNA). An adult patient has just arrived on the unit after surgery. Which of the following is the most appropriate task for the nurse to assign to the CNA and under what type of supervision?
Taking the client vital signs while the nurse watches
Suctioning the client’s tracheostomy and reporting back to the nurse.
Changing the client’s post-operative surgical dressing then describing it to the nurse
Testing the urine with a reacting strip, and recording and reporting the results
Testing the urine with a reacting strip and recording and reporting the results
The nurse is making the assignment for the floor. There is one LPN and three RNs. Which of the following clients should be assigned to the LPN?
A client who is intubated and a newly diagnosed diabetic.
A recent ICU transfer and a person with AIDS.
A client awaiting a nursing home bed and a client with one day post-hernia repair
A new admission for cholecystectomy and a client one day post-op mastectomy
A client awaiting a nursing home bed and a client with one day post-hernia repair
