Chapter 14 Delegation in the Clinical Setting

Delegation The process for a nurse to direct another person to perform nursing tasks and activities. Assignments Distribution of work that each staff member is responsible for during a given work period. The NCSBN uses the verb assign to describe those situations when a nurse directs an individual to do something the individual is already authorized to do. Supervision Provision of guidance or direction, oversight, evaluation and follow-up by the licensed nurse for accomplishment of a delegated nursing task by assistive personnel.

Who Is Accountable? The nurse is accountable for her delegation, but the delegate is also accountable for accepting the delegation and for their own actions in carrying out the task. The nurse is accountable for the following: y y y y y y Making the decision to delegate in the first place Assessing the client s needs Planning the desired outcome Assessing the competency of the delegate Giving clear directions and obtaining acceptance from the delegate Following up on the completion of the task, providing feedback to the delegate

The 5 Rights of Clinical Delegation: 1. 2. 3. 4. 5. The right task Under the right circumstances To the right person With the right direction and communication Under the right supervision and evaluation

The Right Task y Look to your state s nurse practice act first for reference on what can be delegated, then try your organization.

According to nurse-attorney Joanne P. Sheehan, nurses cannot delegate the following: y y y y Assessments that identify needs and problems and diagnose human responses. Any aspect of planning, including the development of comprehensive approaches to the total care plan. Any provision of heal counseling, teaching, or referrals to other heal care providers. Therapeutic nursing techniques and comprehensive care planning.

The Right Circumstances y y Assigning tasks on the basis of the strengths of the person will allow the client to experience the very best care and allow the delegate to provide the very best care. Recognize strengths, and encourage the best client care possible by using them, but challenge delegates to grow too.

What are the causes of performance weakness? y y y y y Employees are not aware of what is expected of them Lack of performance feedback Educational needs Need for additional supervision and direction Individual characteristics: past experiences, motivational or personal issues

The Right Person y This process includes planning and articulating priority client outcomes, assessing the competency of the delegate to perform the task, determining the potential strengths and weaknesses of the assistive personnel, and planning how much supervision is needed.

The Right Direction and Communication The 4 Cs of Initial Direction: 1. 2. 3. 4. CLEAR: Does the team member understand what I am saying? CONCISE: Have I confused the direction by giving too much unnecessary information? CORRECT: Is the direction according to public policy, procedure, job description, and the law? COMPLETE: Does the delegate have all the information necessary to complete the task?

The Right Supervision and Evaluation Feedback Formula y y y y y y y Ask for the other individual s input first! Give credit for effort. Share your perceptions with each other. Explore differing points of view, focusing on shared outcomes. Ask for the other individual s input to determine what steps may be necessary to make certain desired outcomes are achieved. Agree on a plan for the future, including timeline for follow-up. Revisit the plan and results achieved.