3Andrea Raines and Karen Hardin Show
“I attribute my success to this: I never gave nor took any excuse.”- Florence NightingaleThe Role of The Nurse Leader Part 2
Everyone delegates, whether you realize it or not, you delegate. Maybe you ask your younger sibling to put the dirty dishes in the dishwasher, or to help fold the laundry; you are delegating. It requires you to understand the person you are delegating to and what they are capable of completing (you would not ask a toddler to help you fold clothes). Nursing is similar in this role, as nurses there will always be delegation. You might need a colleague to grab a medication for you out of the medication dispenser or you might ask environmental services to help you clean up a certain area. Delegation is not just delegation to unlicensed personnel; delegation occurs frequently throughout the shift. This chapter offers guidance regarding delegation in nursing. Many different legalities must be followed and it may seem confusing at times to a novice nurse. It is a skill that has to be learned and practiced to be fair and consistent. However, given exposure and time, you will find yourself delegating without even realizing it. Delegation in Nursing
a. DelegationAccording to a joint statement by the American Nurses Association (ANA) and the National Council for State Boards of Nursing (NCSBN) (2019), delegation is allowing the delegatee to complete or perform a certain nursing activity, skill, or procedure, which is normally outside of the normal scope for the delegate and is not routinely practiced. Registered Nurses (RN) use delegation as a tool to ensure the completion of all tasks related to patient care. Ensuring each patient receives competent care through the use of the nursing assistant, allows the RN to prioritize and safely assign each task. Delegation allows the independently practicing nurse, to be accountable for the quality of care provided to the patient (Lanier & Morris, 2017) and is a skill of critical competency, essential for nursing. This chapter will discuss the role of the Registered Nurse when delegating to Licensed Practical Nurses, Vocational Nurses, and Assistive Personnel. b. Delegated ResponsibilityAny nursing skill, activity, or procedure that is transferred from the RN to the delegatee becomes delegated responsibility (NCSBON & ANA, 2019). The employer holds specific responsibilities related to delegation such as the following: Identification of the nurse leader who is responsible for the oversight of responsibilities which are delegated for the facility. This nurse leader will work with a committee to determine the responsibilities which may be delegated, as well as the circumstances for delegation within each facility. Policies and procedures should be developed followed by clear communication to all licensed nurses regarding which responsibilities can be delegated. The employer/nurse leader is then responsible for ensuring that all delegates demonstrate knowledge and competency regarding delegated responsibilities. (NCSBON & ANA, 2019). The licensed nurse is responsible for determining when and what should be delegated in the practice setting. Clear communication with the delegatee regarding the delegated responsibility should follow. The licensed nurse must be available to answer questions and offer guidance as needed while understanding the possibility of performing the task him/herself might be necessary depending on the circumstances. Follow-up between the delegator and delegatee is required after task completion. Any feedback regarding competence or issues should be reported to the nurse leader especially related to judgment and decision making (NCSBN & ANA, 2019). The Delegatee should only accept the responsibilities for which appropriate training has been received. The delegatee must feel comfortable performing the delegated responsibility given the healthcare setting and or patient condition. Competency must be maintained regarding employer-approved delegated responsibilities and clear communication between the delegatee and licensed nurse should be maintained. Once accepted by the delegatee, the delegated responsibility becomes accountable to the delegatee once accepted. c. SupervisionSupervision of the delegatee includes monitoring the delegated activity, following up after the activity, and evaluating the outcomes. The licensed nurse should be ready to intervene and provide any follow-up education as deemed necessary. Accuracy of documentation is the responsibility of the licensed nurse. Three A’s
Who is the…
The principles for delegation
Five rights of delegationThe establishment of a clear delegation plan with executed delegated tasks promotes safe care (Wagner, 2018). Utilization of the five rights of delegation is the first step in the promotion of safe delegation practices. 1. Right taskDoes the activity fall within the delegatee job description? Is it included in the established policies and procedures of the facility? 2. Right circumstanceIs the condition of the patient stable? If the patient condition changes during the performance of the delegated responsibility, the delegatee must immediately report/communicate the change to the licensed nurse for a reassessment of the patient. 3. Right personNot only is the employer or leadership responsible for ensuring the delegates possess the appropriate skill set, but the licensed nurse must ensure the delegatee is capable of completing the delegated responsibility. 4. Right direction/communicationThe assignment must be clear and concise. It should include the procedure, time, and completion of the task with two-way communication occurring to close the feedback loop. 5. Right supervision and evaluationSupervision of the delegated activity should occur by the Registered Nurse. Benefits of good delegation
Ineffective delegation
Tasks that may be delegatedA clear explanation of tasks that must be delegated is listed in the documents listed below. The student should click on the link below to access the joint statement from the American Nurses Association statement and National Council Board of Nursing statement. The joint statement provides a clear review of the guidelines for task delegation. Each licensed nurse must have access to the established laws and guidelines within their practicing state. Access to the laws of the South Carolina Nurse Practice Act is provided below. ANA and NCSBN have created a joint statement regarding delegation: Please review the statement by accessing this link: https://www.ncsbn.org/NGND-PosPaper_06.pdf State BON statement: Each state BON provides a position statement regarding the legal rules and guidelines for nursing. The SCBON Nurse Practice Act offers the legal practice guidelines for nursing delegation to unlicensed assistive personnel. Please review Section 40-33-42: Delegation of tasks to unlicensed assistive personnel using the following link: https://www.scstatehouse.gov/code/t40c033.php SupervisionThe role of supervision is not to inspect the completed work by the LPN/UAP but to assist in the development of the individual completing the task (Hughes, 2018). Nurses should have a clear understanding of the differences between the responsibilities outlined in the LPN/UAP job description and delegated tasks. This knowledge helps to build rapport between the nurse and LPN/UAP. Having a good rapport with assistive personnel promotes safe care. Safe delegation practices equal safe care (Wagner, 2018). The RN is responsible for ensuring the delegatee has a clear understanding of the assigned task. If help is needed then the RN is responsible for providing instruction for task completion. SMART objectivesSupervised delegation of a task is writing a Specific Measurable Achievable Realistic and Timely (SMART) objective. When delegating an activity, the registered nurse must make sure the assignment is clear. The task should be measurable, meaning the nurse should know whether or not the delegatee accomplishes the task within the specific time frame. Understand the delegate job descriptionInstitutional and state differences in the job description for unlicensed personnel should be reviewed and understood by the registered nurse. Again, the joint statement by the BON and ANA should be reviewed as well as the state nurse practice act and the facility policies (Burke, 2020). Does the delegate need clarification, help, or review of the process to be delegatedIt is the responsibility of the RN to ensure the Unlicensed Assistive Personnel has a clear understanding of the task. If this is a task that is new to the UAP, then the nurse is responsible for providing education to the UAP to ensure accuracy and patient safety.
Instructions for Class Exercises: The following are exercises that may be completed by the student as practice in class or on their own. Delegation Exercise: Delegating Assignments Karen is a Registered Nurse (RN) in charge of a patient assignment. There are 10 clients on a medical-surgical unit in an acute care setting. Total staffing includes 2 RNs, 1 LPN, and 1 UAP on the unit. 10 patient beds: 3 patients are post-op:
1 patient with Pneumonia: resolving pneumonia being discharged back to the nursing home later this evening requiring turning, feeding, and bathing. 1 patient with asthma: having respiratory difficulty, receiving an Aminophylline drip 1 patient with hypertension and resolved stroke; discharge information and teaching complete. Ready to roll out when transportation arrives 1 newly admitted female with anemia and possible GI Bleed has not been assessed and will be receiving a transfusion of packed red blood cells ASAP. 1 type II diabetic who has met with the diabetic educator but requires reinforced education regarding insulin administration. 1 diabetic foot ulcer with last BG reading of 400mg/dl with food continually brought by the family from outside fast food. Dr. needs to be called for new insulin order.
NCLEX style practice questions The measurement and documentation of vital signs occur in the acute care setting based on provider orders for the patient. 5 south is a renal unit that is currently fully staffed for the shift. Who does the charge delegate the task of taking and documenting vital signs?
Which one of these tasks can be safely delegated to a Licensed practical nurse (LPN)?
You are acting as a preceptor for a newly graduated RN during her 2nd week of orientation. You would assign the new RN, under your supervision, to provide care to which patients?
Answers to NCLEX Questions with Rationale
When caring for a group of patients which task can the nurse delegate to the nursing assistive personnel AP )?The nurse can safely delegate the care of stable clients, such as the client admitted with dehydration, the client admitted with a urinary tract infection, or the client with chronic renal failure. Any client who is very ill or who requires complex decision making should be cared for by a registered nurse.
Which of the following tasks might be delegated to nursing assistive personnel nap?Tasks that can be delegated to NAPs include: Bathing. Providing personal hygiene. Collecting urine samples.
Which task could a staff nurse delegate to a UAP?Routine tasks, such as taking vital signs, supervising ambulation, bed making, assisting with hygiene, and activities of daily living, can be delegated to an experienced UAP.
Which of the following tasks should the RN delegate to the LPN?Which of the following should the nurse delegate to the LPN? obtain vital signs, administer a tap-water enema to a client who is postop, catheterize a client who has not voided in 8 hr. (others: provide discharge teaching, initiate a plan of care...)
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