DELEGATION Flashcards
DELEGATION
- Delegation involves the transfer of responsibility for the performance of an activity to another person while retaining accountability for the outcomes.
- RNs may never delegate any element of the nursing process itself
CONSIDERATIONS WHEN DELEGATING NURSING CARE
- Patient’s condition (stable vs unstable)
- Complexity of the activity
- Potential for harm
- Degree of problem solving and innovation necessary
- Level of interaction required with the patient
- Capabilities of the UAP
- Availability of professional staff to accomplish workload
ANA PRINCIPLES FOR DELEGATING CARE
- The nursing profession determines the scope of nursing practice.
- The nursing profession defines and supervises UAPs involved in providing direct nursing care.
- The RN is responsible and accountable for nursing practice.
- The RN supervises any assistant providing direct patient care.
- The purpose of UAP is to work in supportive role to the RN.
Three criteria to be considered by the RN when deciding to delegate care activities (National Council of State Boards of Nursing [NCSBN], 2005):
- `The state Nursing Practice Act must permit delegation and outline the authorized task(s) to be delegated or authorize the RN to decide delegation.
- The person making the delegation has the appropriate qualifications: appropriate education, skills and experience, as well as current competency.
- The person receiving the delegation must have the appropriate qualifications: appropriate education, training, skills and experience, as well as evidence of current competency.
- In addition, according to the ANA and NCSBN (2006), the delegated task(s) must not require critical thinking or professional judgment.
FIVE RIGHTS OF DELEGATION
- Right Task: Is it appropriate to delegate (legally) Is the person willing and able to do the task
- Right Circumstance Does the delegation process suggest that the circumstance is right Is staffing such that delegation is appropriate
- Right Direction/Communication Do you and the delegatee have a common language Is there understanding of what and when to report
- Right Person Is the delegate a willing and able employee Is the patient’s needs a fit for the delegate
- Right Supervision Do you know how and when you will interact with the delegatee about the patient care How often will you need to provide direct observation
*DELEGATION COMMUNICATION TEMPLATE
- State exactly what is being delegated and what is expected outcome
- Identify priorities
- Acknowledge monitoring activities performed
- Specify performance limitations
- Specify timeframes
- Specify report timelines and data expected
- Specify parameters and when immediate action must be taken
- Identify resources, including people
- Be clear about what may not be delegated
DO-NOT-DELEGATE” CARE
Nursing care or tasks that should never be delegated except to another RN include:
- The initial and ongoing nursing assessment of the patient and the patient’s nursing care needs
- The determination of the nursing diagnosis, nursing care plan, evaluation of the patient’s progress in relation to the care plan, and evaluation of the nursing care delivered to the patient
- The supervision and education of nursing personnel; patient teaching that requires an assessment of the patient and the patient’s education needs
- Any other nursing intervention that requires professional nursing knowledge, judgment, and/or skill
LVN SCOPE OF PRACTICE
LVN’s have their own Board for Oversight
https://www.bvnpt.ca.gov/
Official Scope of Practice can be found on site
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The following are rules to follow when delegating to the LVN:
- Assists with implementation of defined plans of care.
- Performs procedures according to protocol.
- Differentiates normal from abnormal.
- Cares for physiologically stable clients with predictable conditions.
- Has knowledge of asepsis and dressing changes.
- Ability to administer medications varies with educational background and state nurse practice act.
UAP
- Can only be delegated standard, unchanging procedures for stable patients .
- Assigned tasks not patients
- CAN DO Daily living activities
— Feeding, bathing ambulating, turning dressing, Etc. - Can Collect Data
— V/S, Weight, height, intake, output, blood sugars - Can Collect simple specimens
— Stool, mid stream urine - Can Transport patients/restocking supplies
— Tasks cannot be complicated or or require nursing process
The Nursing team consisting of one RN, LVN, and one UAP prepare for several new admissions to the unit. The charge nurse needs to reassign care from a current caregiver in order to have the appropriate staff to accommodate the new admissions. The following clients need to be reassigned:
- 1. Adult client with a chest tube with constant bubbling
- 2. Adult client with leg wound requirement a dressing change
- 3. Adult client post-laryngectomy preparing for discharge
- 4. Adult client post-stroke requiring assistance with bathing.
- RN
- LVN
- RN
- UAP
