Delegation & Supervision

Question 1

Issues Affecting Staffing Patterns

Answer 1

Reduced reimbursement from Medicare, Medicaid, and private insurance companies
Growing uninsured population
Focus on safety and quality
Rapid advances in medical technology
Nursing shortage

Question 2

Changes in Staffing Patterns

Answer 2

Increased use of NAP (nursing assistive personnel) forces the RN to delegate more nursing tasks
Roles and responsibilities of care providers (RNs, licensed practical nurses/licensed vocational nurses [LPNs/LVNs], NAP) are significantly overlapping

Question 3

Health Care Errors

Answer 3

Nurses recognized as having a strong effect on improved patient outcomes through patient monitoring, education, therapeutic care, and intercepting healthcare errors
Delegating tasks safely essential to allow nurses time to attend to the most important aspects of professional nursing care

Question 4

What Is Delegation?

Answer 4

Transfer of responsibility for the performance of an activity from one individual to another while accountability for the outcome is retained
Legal and management concept
RN transfers responsibility and authority for the performance of an activity but remains accountable for overall nursing care
Management strategy used to ensure the accomplishment of cost-effective patient care

Question 5

Two-Way Process - RN delegator is responsible for the following:

Answer 5

The act of delegation
Supervising the performance of the delegated task
Assessment and follow-up evaluation
Any intervention or corrective action that may be required to ensure safe and effective care

Question 6

Two-Way Process - Delegatee (LPN/LVN, NAP) is accountable for the following:

Answer 6

His or her own actions
Accepting delegation within the parameters of his or her training and education
Communicating the appropriate information to the delegator
Completing the task

Question 7

What Should and Should Not Be Delegated?

Answer 7

No definitive list of what can and cannot be delegated
Varies among states, organizations, and specific situations
Assessment, evaluation, and nursing judgment cannot be delegated***

Question 8

Patient Needs

Answer 8

RN required to perform a patient assessment and to know the level of care required
Generally the more stable the patient, the more likely delegation is to be safe
Many tasks that can be delegated may be intertwined with a nursing responsibility

Question 9

Job Descriptions

Answer 9

Delineates the tasks, duties, and responsibilities required as a condition of employment
Generally comply with state’s Nurse Practice Act and the health care organization’s standards of care
RN should be aware of the job training required to function as described in the job description
In all cases, legal requirements related to delegation supersede any organizational policy or job description

Question 10

Competencies

Answer 10

Staff member must have the skills and knowledge (competence) necessary to perform a task before it is delegated
Competencies confirm that the individual has demonstrated specific knowledge and skills
Regulatory and accrediting agencies, such as The Joint Commission, require written documentation of staff competencies
RNs should be knowledgeable about the documented competencies of staff members whom they supervise

Question 11

Organizational Policies and Procedures

Answer 11

The specific skill and supervision requirements for various tasks are designated in written policies and procedures
Ensure that the delegatee is trained in and understands the organization’s general standards of care (e.g., infection control)

Question 12

Clinical Situation

Answer 12

Does the NAP/LPN/LVN realistically have time to perform the task?
Is the staff member familiar with characteristics of the patient population?
How complex is the task?
Does individual have the resources (supplies, equipment) to perform the task?
Can RN provide an adequate level of supervision?

Question 13

ANA lists activities that the RN (professional nurse)cannot delegate:

Answer 13

Initial and any subsequent assessment that requires nursing knowledge, judgment, and skill
Determination of nursing diagnoses
Establishment of nursing care goals
Development of nursing plan of care
Evaluation of patient’s progress
Health counseling or teaching
Activities that require specialized nursing knowledge, skill, or judgment

Question 14

Developing Safe Delegation Practices -

Establish a Foundation of Knowledge

Answer 14

Know delegation criteria delineated in the state’s nurse practice act
Know professional standards for nursing practice and specific recommendations on delegation

Question 15

Know The Patient

Answer 15

What is the patient’s physiological status?

Question 16

Know the Staff Member

Answer 16

Know delegatee’s scope of practice, competencies, and job description

Question 17

Know the Task

Answer 17

Know specific skill requirements designated in written policies, procedures, and standards of care

Question 18

Communicate Effectively

Answer 18

Failure to effectively communicate may result in unsatisfactory performance, errors, or patient harm
Clearly explain the task, what must be done, and the expected outcomes
Demonstration and return demonstration may be required

Question 19

Expect Responsible Action

Answer 19

Delegatee becomes responsible for his or her own actions
RN should supervise appropriately
RN should not intervene unless assistance is requested, or an unsafe situation is recognized

Question 20

Assess and Supervise Job Performance

Answer 20

Make frequent rounds, observe, and communicate
Provide the appropriate level of supervision
Be available for questions or unexpected problems
Supervise in a positive and supportive manner
Intervene immediately if the task is not being performed safely and appropriately
Never ignore poor performance—document and report
Use mistakes as learning opportunities
Always evaluate the delegated action by reassessing the patient
Avoid High-Risk delegation

Question 21

Five Rights of Delegation

Answer 21

Right task: delegated tasks must conform to established guidelines
Right circumstances: delegated tasks do not require independent nursing judgment
Right person: one who is qualified and competent
Right direction and communication: clear explanation about the task and outcomes and when the delegatee should report back to the RN
Right supervision and evaluation: feedback and follow-up to assess and improve the process; evaluate patient outcomes

Question 22

Supervision

Answer 22

The active process of directing, guiding, and influencing the outcome of a worker’s performance
On-site supervision: the nurse is physically present or is immediately available while the activity is being performed
Off-site supervision: the nurse has the ability to provide direction through various means of written, verbal, and electronic communication

Question 23

Assignment

Answer 23

Distribution of work that each staff member is responsible for during a given work period
Designates activities consistent with job position and description, legal scope of practice, and educational background
The staff member assumes responsibility and is accountable for completing the assignment
RN responsible for assignments made to nursing personnel and should consider: Patient’s physiologic status and complexity of care
Infection control or cross-contamination issues
Level of supervision required. Staff development opportunities such as assigning a less experienced nurse to a more complex patient with an increased level of supervision

Question 24

Interdisciplinary Health Care Team

Answer 24

Interdisciplinary team members valuable in meeting patient care needs
RNs should know scope of practice and training background of team members

Question 25

Novice Nurses’ Barriers to Effective Delegation

Answer 25

Fear of being disliked, losing control, taking risks, making mistakes
Lack of confidence
Lack of knowledge

Question 26

Create an Environment of Trust and Cooperation

Answer 26

Maintain a nonthreatening and nonjudgmental attitude: problems will be reported more quickly
Avoid blaming and criticizing when mistakes occur: look for root causes such as inadequate training or too heavy workload
Encourage staff members to report and discuss problems