Exam 4 Flashcards
What is considered a core skill to deliver safe and effective care, and allows nurse leaders and managers time to handle more complex activities that require higher levels of expertise
Delegating
What is delegation based on?
Patience needs potential for harm stability of patient’s condition complexity of the task predictability of the outcome
What key principles does delegation require?
Problem-solving skills
Critical thinking skills
Clinical judgment
What can nurses not delegate?
Certain aspects of the nursing process to LPNLVN in UAE example initial assessment
A task that is not in the scope of practice to delegate
Who is the delegator?
Person usually the RN delegating the task must have appropriate qualifications, education and authority to delegate per state nurse practice act
Who is the delegate?
Person to whom the task is being delegated typically other, RN,LPN and UAP
Must also have the appropriate education and skills to carry out the activity
What is professional accountability?
Is an obligation not to abuse trust to be able to justify professional actions
What is organizational accountability?
Involves providing sufficient resources for nurses to effectively and safely provide nursing care
What are nurse leaders and managers accountable for?
Setting the expectations for appropriate delegation
Ensuring that RN LPNs in UAE are aware of individuals roles
Providing safe environment that supports the delegation process
What is authority?
Is the legal rate of an RN to delegate specific task to other RN, or competent LPN or UAP
Is based on the state nurse practice act, and should also be reflected in the nurses description
Using authority, nurse, leaders, and managers must what
Determine how staff resources will be distributed on the unit based on patient needs
Plan implement and evaluate nursing care
What is responsibility
The individuals obligation to perform work competently at the level. The person has been educated.
In responsibility to delegate nurse, leaders, and managers must what
Determine the competence of the delegate and appropriateness of delegation
Supervise and evaluate the performance of the delegate
In responsibility, the delegate must
Except responsibility when he or she agrees to perform a task delegated to them
Is responsible for his own actions
What is supervision?
To provide guidance or direction, oversight evaluation, and follow up
To supervise nurse leaders and managers must
Monitor the delicates performance in a shirt compliance with standards of practice
Adhere to organizational policies and procedures in place to support the nurse delegating the task
What is an assignment?
Distribution of work that each staff member is responsible for during a given period period of time
When assigning task, nurse leaders and managers must
Ensure the activity is within the individual scope of practice
What is prioritization?
Deciding which patient needs or problems require immediate action in which are not urgent and can be addressed at a later time
What can be delegated?
Specified by state, nurse, practice acts regulatory agency guidelines, and institutional policies
Ex.) monitoring patient collecting specimens documenting data.
What cannot be delegated?
Aspects of the nursing process
Performing in assessment
Formulating a nursing diagnosis
Developing and updating a plan of care
Evaluating the patient progress
Communicating with healthcare providers
Implement orders from healthcare providers
Providing teaching to a patient and our family
Evaluating patient status in triage
Who can and cannot be delegated
Erin can delegate to other RNLPN in UAP
LPNs can delegate to a UAP if directed to do so by an RN
LPN cannot assign or delegate to an RN
What can you delegate to a LPN?
Scope of practice, dictated by state nurse, practice act
Can perform all tasks. UAP’s are qualified to do plus other duties.
Duties include monitoring patient’s health status, updating initial assessment performed by RN and reinforcing teaching
What can you delegate to a UAP
Do not hold a license, but maybe be certified
Can provide low risk care that does not require nursing knowledge or nursing judgment
Typically assist patients with activities of daily living, such as bedmaking, bathing, and assisting with dressing
What are the five rights of delegation?
The right task is assigned to the right person under the right circumstance with the RN, providing the right direction/ communication in the right supervision
 what is the right task
A task that can be safely delegated to a specific delegate for a specific patient
Appropriate activities include frequently occur in the daily care of patient patience
Are within the scope of practice of an LPN or UAP
Do not have risks that are predictable or beyond minimal
What is the right circumstance?
Includes the patient setting available resources, and other relevant factors
Nurse leaders and managers must what in the right circumstances
Assess the needs of patient population on the unit/department
Identify collective, nursing care needs priorities and resources
Ensure appropriate staffing and skill mix
Provide sufficient equipment and supplies
What is the right person?
Involves knowing the competency levels of those on the patient care team 
What does the nurse leader and manager do for the right person in delegation?
Establish organizational standards, consistent with the state laws to ensure educational requirements and competencies of RNLPN in UAP
ENSURE COMPETENCY STANDARDS RELATED TO DELEGATION ARE INTEGRATED INTO ORGANIZATIONAL POLICIES
Routinely assess performance of RNLPN in UAE
Initiate steps to remedy any failure to meet standards
What is the right direction/communication?
Clear, concise description of task, including its objective limits and expectations
What is situation specific communication?
Specific data to be collected and timelines for reporting
Specific activities to be performed and any patient specific instructions in limitations
What is the right supervision/evaluation
Includes feedback to the delegate, as well as appropriate monitoring, evaluation and intervention
In the delegation process what is assessment in planning?
Specification of knowledge and skills required to accomplish the task
Development of a plan of care with the patient and his or her family
In the delegation process what is communication?
Provision of clear directions to the delegate, including unique patient information and expectations regarding what to do what to report and when to ask for assistance
Inclusion of mindful communication in which those involved are focused on attending to responding to perceiving information
What is surveillance?
Process of observing and staying a tune to the patient status staff per performance, and following up on any problems
What is supervision?
Monitoring the task and of compliance with standards of practice policies and procedures
What is evaluation?
Assessment of the effectiveness of the delegation the outcome in the potential need to modify the plan of care should occur throughout the delegation process
What is feedback?
Review of whether the task was performed correctly, whether the desired patient outcome was achieved and any areas for improvement
Over delegation occurs whe
The workload is more than the delicate can accomplish in the allotted time frame
The RN feels uncomfortable, performing a certain task
Under delegation occurs when
There is failure to transfer authority for a task, or to provide clear direction to the delegate, because the RN fears losing control or authority, feels insecure believes he, or she can accomplish the task quicker, or is inexperienced
What are some delegate related barriers?
Lacking willingness to do the task
Lacking skill or comfort with the skill required for the task
Feeling overworked or perception of an unfair assignment
Feeling physically, unable to do the work
What is leadership and management related barriers to delegation?

Lack of guidelines, that address who can delegate, and what tasks can be delegated
Lack of policies that protect nurses from inappropriate assignments in delegation of inappropriate nursing activities, or responsibilities
For staffing levels
Absence of processes, for validation of competencies for delegation
How can someone break down the barriers of delegation?
Establishment of guidelines, policies, procedures, that support delegation
Inclusion of delegation in the job descriptions of all nursing personnel
What are nurse leaders and managers must do in breaking down barriers of delegation
Fold all staff accountable to principles addressed in the job description
Provide periodic feedback related to the delegation processes
Focus efforts on creating a supportive environment that promotes effective communication and teamwork
What is a plan change?
Is purposeful calculated in collaborative
Includes the deliberate application of change theories
Is usually well received by staff
What is unplanned change?
Occurs when the need for changes is sudden and necessary to manage. Manage a crisis.
Can cause anxiety and stress among staff
To effectively implement change nurse leaders, and managers must
Develop high functioning empowered teams, that know exactly what is expected
Embrace innovation
Use the right, theoretical framework or model for the situation at hand
What is Lewin’s force field model traditional change theory
 based on the belief that change results from two fields of environment forces
Driving forces (helping forces) that attempt to visit, facilitate the change and move it forward
Restraining forces (hindering forces) that attempt to impede change and maintain the status quo
What are the three steps of Lewins force field model traditional change theory
Unfreezing the status quo
Moving toward the new way
Refreezing or stabilizing the change for sustainability
What is lippitts phase of change model traditional change theory
Uses language similar to the nursing process
Focuses more on the people involved in the change process rather than on the change process itself
Stresses the importance of communication and report with those involved in the process
What are the seven steps of lippitts phases of change, model, traditional change theories
Diagnosing the problem
Assessing the motivation, and capacity for change
Assessing the change agents, motivation, and resources
Selecting, progressive change objectives
Choosing an appropriate role for the change agent
Maintaining the change after it has started
Terminating the helping relationship
What is Rogers innovation decision process traditional change theory
Consist of series of actions and choices overtime that an individual or decision-making unit must follow
Recognizes that the common behavioral responses to change individuals may experience can facilitate change
Requires everyone involved with a change, and or affected by the change to be committed to the change
What are the five stages of Rogers innovation decision process traditional change theory
Knowledge
Persuasion
Decision
Implementation
Confirmation 
What is Cotters eighth stage process of creating major change in traditional change theories
Involves a multi step process that overcomes all sources of resistance, and must be directed by high-quality leadership
What are the eight stages of Cotters eight stage process of creating major change in traditional change change theories
Establishing a sense of urgency
Creating the guiding coalition
Developing a vision in strategy
Communicating the change vision
Empowering broad-based action
Generating short term wins
Consolidating gains and producing more change
In anchoring new approaches in the culture
What are emerging change theories?
Cyclical rather than linear, and require organizations to react with speed and flexibility
Include new theories based on complexity, science, which recognizes that the world is a continual motion, and that a change in one area can result in numerous changes in other areas 
What is chaos theory in emerging change theories
Is non-linear and unpredictable
Explains why a small change in one area can have a large effect across an organization (butterfly effect)
Using the chaos theory, nurse leaders, and managers must
Be aware of the complexity of healthcare of the unit in organization
Understand the decisions made can result in changes that are unintended
What is the learning organization theory in emerging change theories?
Requires all staff to be involved in a problem-solving and implementing change in innovation
What are the five disciplines in the learning organization theory of emerging change theories
Thinking
Personal mastery
Mental models
Building shared vision
Team learning
Using the learning organization theory, nurse leaders, and managers must
Help staff see the larger system to build understanding of complex problems
Enable staff to develop long-term changes and work together to impact the whole system 
Who is the who of change?
The key stakeholder related to the work to be changed
Patients and families employees communities