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N471 > Week 14: Delegation > Flashcards

Week 14: Delegation Flashcards

1
Q

Delegation

A

Getting work done through others or as directing the performance of one or more people to accomplish organizational goals

Not an assignment

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2
Q

Assignment

A

involves distributing work to a qualified person or persons for implementation of a specific activity or set of activities within their job description

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3
Q

Delegation v Assignment

A

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

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4
Q

The mark of a great leader is when he/she can…

A

recognize the excellent performance of someone else and allow others to shine for their accomplishments

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5
Q

5 Rights of Delegation

A

Right Task

Right Circumstances

Right Person

Right Direction/Communication

Right Level of Supervision

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6
Q

Strategies for Successful Delegation

A
  1. Identify necessary skill and education levels to complete the delegated task.
  2. Plan ahead.
  3. Select and empower capable personnel.
  4. Communicate goals clearly.
  5. Empower the delegate.
  6. Set deadlines and monitor progress.
  7. Monitor the role and provide guidance.
  8. Evaluate performance.
  9. Reward accomplishment.
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7
Q

In NYS an LPN cannot do what independently

A

perform patient assessments independently

develop a nursing care plan

administer IV Chemotherapy

give any medications by direct IV push

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8
Q

When is the best time to delegate?

A

before you become overwhelmed

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9
Q

While you remain responsible for delivering the results of the tasks you delegate, what can demoralize the employee

A

excessive supervision

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10
Q

Leaders are often measured by …

A

the successes of those on their teams

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11
Q

The number one reason employees leave is…

A

because they feel underappreciated

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12
Q

What is a reflection of the legitimate authority inherent in the management role

A

the right to delegate and the ability to provide formal rewards for successful completion of delegated tasks

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13
Q

Is Delegation intuitive

A

no its a critical leadership skill that must be learned

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14
Q

Breach of Duty

A

failure to meet the expected standard of care

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15
Q

Delegation errors increase the risk of…

A

patient harm and being sued for malpractice

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16
Q

3 Common Delegation Errors

A

Underdelegating

Overdelegating

Improper Delegating

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17
Q

What is the cause of Underdelegating

A
  1. individuals false assumption that delegation may be interpreted as a lack of ability on his/her part to do the job correctly or completely
  2. delegator not having enough time to delegate (such as explaining the task for teaching skills)
  3. lack of trust in subordinates
  4. lack experience in the job/delegating
  5. fail to anticipate the help they will need
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18
Q

What are the causes of over delegating?

A
  1. poor managers of time, spending most of it trying to get organized
  2. feels insecure in their ability to perform a task
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19
Q

Underdelegating overburdens the ____; Overdelegating overburdens the ____

A

manager; subordinate

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20
Q

Staff should always have the right to do what when it comes to delegation

A

right to refuse

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21
Q

What may be a sign you have delegated too much, and left employees feeling abandoned or unmotivated

A

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

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22
Q

Improper Delegation

A

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

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23
Q

What sort of requirements are needed for the increased need for delegation nowadays that will prevent an unsafe work environment as a result

A

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

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24
Q

Nurses must believe they can delegate without fearing…

A

that they will be perceived as lazy or incompetent

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25
Q

In delegation, responsibility for a task can be transferred from the licensed personnel to NAP, but

A

accountability is shared by both

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26
Q

Common Tasks Generally Considered Appropriate for Delegation to NAP (Nursing Assistive Personnel)

A

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

27
Q

Criteria for Delegation to an Unlicensed Assistive Personnel/ NAP

A

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:

  1. Frequently recur in the daily care of a client or group of clients
  2. Are performed according to an established (standardized) sequence of steps
  3. Involve little or no modification from one client-care situation to another
  4. May be performed with a predictable outcome
  5. Do not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure(s) itself
  6. Do not endanger the health or well-being of clients
  7. Are allowed by agency policy/procedures
28
Q

Common Reason for Resistance to Delegation

A
  1. Most Common: Failure of the delegator to see the subordinate’s perspective
  2. Inherent resistance to authority - “testing the water”
  3. Overdelegation in terms of specificity - they need wiggle room to perform task as they would rather than TOO rigid boundaries
  4. Employee believes they are incapable of performing task/lacks confidence
29
Q

If a subordinate resists delegation, the delegator should…

A

ascertain why the delegated task was not accomplished and take appropriate action to eliminate these restraining forces - NOT do it themselves necessarily

30
Q

The leader manager should always attempt to see a delegated task…

A

from the perspective of the individual being delegated to

31
Q

6 Cultural Phenomena to Consider When Delegating to a Transcultural Team

A
  1. Communication
  2. Space
  3. Social Organization
  4. Time
  5. Environmental Control
  6. Biological Variations
32
Q

Cultural Phenomena: Communication

A

Consider dialect, volume, use of touch, and eye contact in a transcultural team

33
Q

Cultural Phenomena: Space

A

Interpersonal space differs between cultures

34
Q

Cultural Phenomena: Social Organization

A

family unit of primary importance in some cultures over the organization

35
Q

Cultural Phenomena: Time

A

Cultures can be past, present, or future oriented

36
Q

Cultural Phenomena: Environmental Control

A

Cultures have either internal or external loci of control

37
Q

Cultural Phenomena: Biological Variations

A

Biopsychosocial differences between groups like susceptibility to diseases and physiologic differences

38
Q

Past Oriented Cultures

A

interested in preserving the past and maintaining tradition

39
Q

Present Oriented Cultures

A

Focuses on maintaining the status quo and on daily operations

40
Q

Future Oriented Cultures

A

focus on goals to be achieved and are more visionary in their approach to problems

41
Q

Benefits for Managers from Delegation

A

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

42
Q

Benefits for Staff from Delegation

A

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

43
Q

Benefits for the Organization from Delegation

A

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

44
Q

Essential Elements of Nurse Practice Acts (NPAs)

A

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)

45
Q

NYS State Practice Act definition of the practice of nursing

A

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

46
Q

Licensed Professional Nurses (LPN)

A

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

47
Q

Unlicensed Assistive Personnel (UAP/NAP)

A

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 responsibility 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

48
Q

What are some exceptions that permit nursing activities or tasks to be performed by non nurses (under specific conditions)

A

family members

nursing students

OMH/OMRDD attendants

Caregivers for self directing individuals in special state authorized home care programs

49
Q

Who can RNs and LPNs delegate to and who can they not

A

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

50
Q

Factors to Consider with Delegation

A
  1. potential for harm
  2. condition / stability of the patient/client
  3. complexity of the task
  4. problem solving and innovation required
  5. unpredictability of outcome
  6. requires coordination and consistency of care
51
Q

Delegation Process

A
  1. Define the Task
  2. Decide on Delegate
  3. Determine the Task
  4. Reach Agreement
  5. Monitor performance and provide feedback
52
Q

Activities that can be assigned to UAP/NAP

A

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

53
Q

Activities that cannot be assigned to UAP/NAP

A

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

54
Q

Tasks that can be delegated by RN to LPN/LVN

A

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)

55
Q

Tasks that can not be delegated by RN to LPN/LVN

A

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

56
Q

10 Steps to Successful Delegation

A

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

57
Q

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.”

A

Underdelegating

58
Q

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
A

Overdelegating

59
Q

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

A

Improper Delegation

60
Q

What is the essence of tasks that CANNOT be delegated

A

Any steps in the nursing process:

Assessment
Diagnosis
Planning
Evaluation
Nursing Judgment
61
Q

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

A

Report to the ICU and identify tasks that can be performed safely

62
Q

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

A

Testing the urine with a reacting strip and recording and reporting the results

63
Q

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

A client awaiting a nursing home bed and a client with one day post-hernia repair

N471 (12 decks)

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