Delegation...question from a nursing student!!

[kdh_psn]

hi i'm a student nurse and i am doing a presentation about delegation. i thought that it would be fun to ask some working RNs about their perceptions on delegation. what do you think makes delegation successful and what makes it unsuccessful!! :)

[emtb2rn, BSN, RN, EMT-B]

1) delegated task not performed = unsuccessful

2) delegated task performed incorrectly = unsuccessful

3) delegating a task outside the scope of the tech = unsuccessful

4) delegating a task that you could have done yourself in less than time than it took to find a tech = unsuccessful

5) not being clear about what the task is = unsuccessful (see 1 & 2)

6) delegated task performed correctly & within appropriate timeframe = successful

[classicdame, MSN, EdD]

Not knowing your own Nursing Practice Act to know what the RN/LV/CNA's scope of practice.

Not knowing your facility's policies on delegating.

Nurses should know the competency of the party to whom they are delegating.

[kdh_psn]

Thanks for the posts!

[Esme12, ASN, BSN, RN]

https://www.ncsbn.org/323.htm

the delegating nurse is responsible for an individualized assessment of the patient and situational circumstances, and for ascertaining the competence of the delegatee before delegating any task. the practice-pervasive functions of assessment, evaluation and nursing judgment must not be delegated. supervision, monitoring, evaluation and follow-up by the nurse are crucial components of delegation. the delegatee is accountable for accepting the delegation and for his/her own actions in carrying out the task.

the decision to delegate should be consistent with the nursing process (appropriate assessment, planning, implementation and evaluation). this necessarily precludes a list of nursing tasks that can be routinely and uniformly delegated for all patients in all situations. rather, the nursing process and decision to delegate must be based on careful analysis of the patient's needs and circumstances. also critical to delegation decisions are the qualifications of the proposed delegatee, the nature of the nurse's delegation authority set forth in the law of the jurisdiction, and the nurse's personal competence in the area of nursing relevant to the task to be delegated.

managing others is called "delegation" and is defined by the nurse practice act of the state in which the nurse practices. the nurse practice act specifies expectations related to authority, responsibility and accountability. ignorance of these expectations is not an excuse. patient outcomes are at stake and, perhaps, your own nursing license.

delegation is defined as the "transfer of authority to a competent individual" (www.ncsbn.org/314.htm). your authority comes from the nurse's scope of practice as provided by law in your state. the scope of practice differs for apn's, rn's and lvn/lpn's, but at no time can you delegate authority you do not have. likewise, no one can delegate to you any duty that is outside your scope of practice.

nurses are accountable to patients, employers, peers and the state board of nursing. accountability means the nurse must answer for acts of commission or omission that fall within the nurse's responsibility. discipline is frequently tied to accountability and can take many forms, from mere documentation to license suspension or revocation. delegation requires supervision. you are authorizing someone to provide nursing services but are retaining accountability.

unlicensed assistive personnel (uap) are just that - personnel without a license. remember, a license delineates the scope of practice, so without a license the individual has no scope of practice. they have only a job description. uap's have many titles, including certified nursing assistant, patient care tech, and nursing extern. nursing externs present a special challenge because they want to act like nurses, but do not yet have a license. they are uap's and cannot be assigned a patient or given any task that requires a licensed nurse. almost having a license is not enough.

when approaching the subject of delegation in nursing, one must realize that there are ultimately 6 criteria that must be met. in order for delegation to occur, a task must satisfy the six rights that have become well-known consistently from nursing textbook to nursing textbook:

#1)the right task - there a certain tasks, in the clinical arena, that are simply outside of the scope of practice of a licensed practical nurse or a certified nursing assistant. regardless of how comfortable they may feel in performing a particular task, the registered nurse can be held liable if a task is delegated that otherwise shouldn't have been delegated.

#2)the right person - a task must only be delegated to a person who has the knowledge, skills, and ability to perform the task in a safe and effective manner.

#3)the right time - delegation in a crisis is typically frowned upon because of the unstable nature of the situation, however, one of the benefits of being a registered nurse is that, with such a solid foundation in education, that you will make an appropriate nursing judgment regarding this criteria.

#4)the right information - even though a task may be delegated to another, the registered nurse does maintain accountability for the safe and effective deliverance of care. for this reason, it is always imperative that the registered nurse not only provides correct information regarding how a task is to be conducted, but that they also ensure competency and ability and that they maintain this supervision at all times.

#5)the right supervision

#6)the right follow-up - satisfying this particular criterion may take many forms from a verbal to a written follow-up.

http://www.nursetogether.com/career/career-article/itemid/650/nursing-career-learn-how-to-delegate-effectively.aspx

http://www.dora.state.co.us/nursing/scope/scopeofpracticeinfo.pdf

http://www.oregon.gov/dhs/spd/provtools/nursing/study_guides/rn_delegation.pdf?ga=t

i hope this helps......

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[Aurora77]

One more thing to add--don't be a jerk when delegating. Say please and thank you. Just because you have authority doesn't make you almighty.

[Philpster]

Agree as above - simply it's all about conmunication, the one skill that will turn you from a mediocre nurse into a fabulous one.

Being courteous and polite costs nothing. It also works to your advantage as people like to help if they feel their assistance is genuinely needed.

[kdh_psn]

Thanks again for the posts! these are great...especially for me since i will be graduating in december! do any of you ever have problems with techs/UAPs not wanting to be delegated, even though that is what they are there to do...assist the nurse. Also do you ever see nurses not wanting to delegate to UAP...for whatever the reason maybe...example inexperience in delegating, not trusting the uap???

[mamaxmaria]

I'm a Patient Care Tech in an ICU and ETD.... I seem to find the longer the person has been a nurse.... the less likely they are to delegate tasks.... They prefer to do everything themselves. I dont know if this comes from bad experiences with UAP's or just being a veteran nurse...

I would like to add... I know there are UAP's that are lazy and do not like being delegated to. I am not one of them. I know what my job is and I go to work to do it. I was hired to help out the nurses and thats what I do....

But if I'm the only tech in a 16 bed ICU of a level 2.... and you see me running around like a chicken with my head cut off.... Please take into consideration that although I am not yet A nurse.... i get busy too! so please empty your own foley if it has to emptied right this ******* second!

Oh and it might be just me... but if your overwhelmed and come up to me in a panic to go to a pt's room, I'm gonna think it's a emergency by the tone in your voice and treat it as such....

please dont get my adrenaline pumping for a pt that needs a bed pan......

When you need to delegate a tasks... ask in the way you wish the doctor would ask you...ya know treat others the way you wish to be treated. I promise you if you show respect to your UAP's you life will be so much easier. they will be more the willing to help you without even being asked. I've seen nurses be just flat out nasty to techs....lets says they always seemed to have hard time finding the techs when they needed them....

[kdh_psn]

thanks for the post mamaxmaria! it is always good to hear from both sides! so far in nursing school i have worked with great RNs and techs. I agree with you...always treat people the way you would want to be treated!!

[Orange Tree]

I do lots of coordinating with my CNA. And I try to find a time that works well for both of us when there's a task that we need to work on together to complete. We also have a quick "meeting" at the beginning of the shift to verify who's an accucheck (and when), who we need specimens from, out of range vitals to report right away (SPB over 180), etc. I also give them any new information as soon as I get it (admissions coming, ability of new admission to ambulate). In other words, I delegate in advance whenever possible so it's easier for them to plan their day.

[canesdukegirl, BSN, RN]

Delegating is a learned skill. You must first have confidence in yourself in order to instruct another to perform a task. You must have sound leadership qualities to delegate.

Scenario:

I am the OR charge nurse for a busy Level 1 trauma center. I have just received a text on my trauma pager: "Adult red. ATV vs. van. Intubated. GCS 9. HR 120, BP 90/50." From this text, I can surmise that this pt has a bleed. I can also guess that this pt has a significant head injury. I know that I need to set up an OR for a potential craniotomy. I now have to delegate the task of setting up an OR for emergency surgery. I rely upon my strong nurses and techs to carry out this task, because I know that they are capable of not only setting up the surgery, but also performing the surgery under stress.

I delegate to those who I trust. If I do not have staff available who are capable of the tasks that I need to delegate, I will either do it myself or call my supervisor in to take over my job as I complete the needed tasks.

My rationale is that patient safety is FIRST. However I need to achieve that will be implemented.