Delegation & supervision
Delegation: is the process of transferring the performance of a
task to another member of the health care team while
retaining accountability for the outcome.
Supervision: is the process of directing, monitoring, and
evaluating the performance of tasks by another team member.
Nurses are responsible for supervising the performance of client
care tasks they delegate to others.
You are RN and even if you delegate care for PN or NA YOU ARE
RESPONSIBLE for all care.
Example of right directions and communications: Delegate an AP
to assist Mr. Martin in room 312 with a shower before 0900,
come back to me if you need help or have some questions.
Remember: If patient is in pain he does not care about
important nursing education.
Do not delegate what you can eat: Evaluation, Assessments,
Teaching
Examples of tasks nurses may delegate to PNs and Aps
Delegate to Practical nurse: Monitoring findings (as input to the
RN ’s ongoing assessment), Reinforcing client teaching from a
standard care plan, Performing tracheostomy care, Suctioning,
Checking NG tube patency, Administering enteral feedings,
Inserting a urinary catheter, Administering medication
(excluding IV medication in some states)
Delegate to nursing assistant: Activities of daily living (ADLs)
Bathing Grooming Dressing Toileting Ambulating Positioning,
Routine tasks, Bed making, Specimen collection, Intake and
output, Vital signs (for stable clients), Feeding (without
swallowing precautions)
Maslow’s Hierarchy of Needs which puts forward that people
are motivated by five basic categories of needs: physiological,
safety, love, esteem, and self-actualization.
Prioritization rules:
rule #1 for prioritization Acute beats chronic: in other words
an acute ill person is higher priority than a chronic ill patient.
rule #2 for prioritization FRESH POST OP (i.e 12 hours or less)
beats medical or other surgical.
rule #3 UNSTABLE beats Stable. Meaning unstable people are a
higher priority than stable patients.
rule #4 for prioritization Tie breaker for stable vs unstable The
more vital the organ, the higher the priority - Most vital is the
brain - Next is the lungs – Heart – Liver – Kidneys - Pancreas
Remember: Black Lipstick Has Left Kisses Passionately
These 4 are always UNSTABLE, as these can all lead to brain death:
1)Hypoglycemia 2) HEMORRHAGE 3) Pulseless or breathless 4) High
fever over 105 F because patient can go into seizure.
Do not delegate these to the family: Safety responsibilities!!: the
family can only do what you teach them to do. Document your
teachings!!!!!!!
When you get a staff question ask yourself Is what they are
doing illegal? If so, tell the supervisor. If not, next question
When you get a staff question ask yourself ask yourself Is what
they are doing physically or psychologically dangerous to staff or
pt? If yes then, confront and take over, if not, next question
When you get a staff question ask yourself Is this behavior legal,
harmless, but still inappropriate? If so, counsel them later
The five rights of delegation
Task
Direction Circumstances
Supervision Person