Review Chapter 9 slide in module Activity: Examine the five factors to be assessed before delegating (potential for harm, etc.) for a particular
Discussion 2
Review Chapter 9 slide in module
Activity:
Examine the five factors to be assessed before delegating (potential for harm, etc.) for a particular task.
In making a decision to delegate a nursing task, the following five factors should be assessed:
1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient.
2. Complexity of the task: The more complex the activity, the less desirable it is to delegate.
3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated.
4. Unpredictability of outcome: When a patient’s response to the activity is unknown or unpredictable it is not advisable to delegate that activity.
5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient. (AACN, 2004Links to an external site., p.10)
Explain why or why not a task would be delegated depending on each factor.
using an example you can share, and/or face at your current practice setting? (I work at a needle exchange program where understaff and delegation has become a big problem as more work has to be divided when staff is already burnout).
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Chapter 9
Delegation in Nursing
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- Delegation is a fundamental aspect of a nurse’s role
- Florence Nightingale viewed delegation as a critical skill
- Delegation issues
Overview of Delegation
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- Accountability
- Assignment
- Authority
- Client care activities
- Delegate/delegation
- Nursing activities
- Scope of practice
- Supervision
- Unlicensed assistive personnel (UAP)
Definitions
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- Working With Others: A Position Paper: Tools created by NCSBN relating to delegation and the roles of licensed nurses and assistive personnel
Data from NCSBN (2005).
Standards and Guidelines for Delegation
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- Assess and plan
- Communicate
- Surveillance and supervision
- Evaluation and feedback
Data from NCSBN (2005).
NCSBN Model for Delegation Decision Making
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Potential for harm
Complexity of task
Problem solving and innovation required
Unpredictability of the outcome
Level of patient interaction
Data from American Association of Critical-Care Nurses (2004).
Five Factors to Assess When Making a Decision About Delegating Nursing Tasks
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Right task
Right circumstance
Right person
Right direction and communication
Right supervision and evaluation
Five Rights of Delegation
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- Prepared to receive delegation
- Participate in communication/information exchange
- Accept the delegated task
- Seek clarification
- Request additional training/supervision (if needed)
- Confirm expectations/plan of care
UAP’s Role in Delegation
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- Organizational and legal guidelines and policies
- Patient safety and accountability
- Knowledge and education
Three Organizational Principles of Delegation
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- Nurses use ongoing assessment to prioritize patient needs
- Prioritization is a non-sequential decision-making process that is ongoing
Prioritization
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- Addressing imminent clinical concerns
- High uncertainty activities
- Significant, core clinical caregiving and managing pain
- Relationship management
- Documenting
- Helping others and patient support
- System improvement and cleaning/preparing supplies
- Personal breaks and social interactions
Prioritization Hierarchy
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- Status
- Risk to patient and organization
- Lack of time
- Lack of trust in UAP
- Compromised self-esteem
- Lack of understanding of delegation
- Leadership style
Delegation Barriers
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Data from Keogh, K. (2014). Lecturer says delegation should be a part of preregistration courses. Nursing Standard, 29(1), 9. doi:10.7748/ns.29.1.9.s7)
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- Mutual respect
- Feedback
- Supervision
- Communication
Solutions to Delegation Barriers
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- Nurse must know state’s nurse practice act/organization’s policies/procedures/competencies
- Practice acts defines activities only nurse can perform
- Nurse monitors UAP to ensure not acting beyond scope of practice
Scope of Practice
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- Under law, nurses are not permitted to passively observe substandard care
- Safety and ethical concerns must be reported to management
Substandard Care
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- Budget constraints versus safe staffing
- Inadequate staffing is not a legal defense for inappropriate delegation
Cost Containment
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- When UAP accepts task then they shoulder some responsibility, but nurse is still held accountable
- Nurse is obligated to answer for own actions, including supervision
Accountability
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- Direct versus indirect delegation
- Communication
- What to do when in doubt
Other Delegation Issues
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- Provide delegation education to staff
- Coach staff in use of delegation
- Use TeamSTEPPS to mitigate problems
Nurse Leadership and Delegation
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- Delegation is result of expanded nurse role versus expanded role is result of delegation
- Changing health care environments: community-based and ambulatory
- Escalating shortages of nurses, greater acuity of patient illnesses, technological advances, and increased complexity of therapies contribute to today’s current chaotic and multifaceted health care
Current Issues and Trends
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The five rights of delegation include all of the following except:
Right task
Right circumstance
Right person
Right time
Question #1
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Correct answer: d
Rationale: The five rights of delegation include right task (element of care), right circumstance, right person, right direction/communication, and right supervision and evaluation. The right time is not included in the five rights of delegation.
Level: Comprehension
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