Continuing Education Presentation

2008

Delegation

Objectives

Define delegation and its component parts.Discuss the need for delegation.Discuss the five rights of delegation.Explain the process of delegation.Identify a delegation model to select the

appropriate delegatee Identify the legal authority for an RN to delegate.Identify challenges with delegation.

Definitions of Delegation

National Council of State Boards of Nursing (1995)Transferring to a competent individual the authority to

perform a selected nursing task in a selected situation.

American Nurses Association (1996)Transfer of responsibility for the performance of a task

from one individual to another.

Definition of Delegation

Achieving performance of care outcomes for which you are accountable and responsible by sharing activities with other individuals who have the appropriate authority to accomplish the work (Yoder-Wise, 2008).

Four Components of Delegation

care outcomes - patient care is safely provided

accountable and responsible - both RN and delegatee have an obligation to care for that patient and ensure the task is completed

sharing activities – both the RN and delegatee work together to accomplish care

appropriate authority – the RN selects the appropriate person to delegate the task

Need for Delegation

Increased acuity of patientsIncreased use of Unlicensed Assistive Personnel

(UAPs) and Practical Nurses (PN)Increased RN responsibilities in the management of

the nursing unit/organizationAccelerated pace and changing health care

environment.

Five Rights of Delegation

Right Task

Right Circumstance

Right Person

Right Communication

Right Supervision

Right TaskQuestions to ask when determining the right task

Is there potential for harm – if there is a great potential for harm if the task is done incorrectly, be careful with delegation

How complex is the task – if the task is very complex, be careful with delegation

What problem-solving is required to carry out the task – if significant problem-solving is require while performing the task, be careful with delegation

What is the predictability of the outcome – if in completing the task there is potential for many different outcomes, be careful with delegation

Patient interaction/ability – if the patient has limited ability to assist or respond to the task, be careful with delegation

Right Circumstances

Delegating a task under the right circumstances

includes

Considering the condition and acuity of the patient

An awareness of the staff mix – distribution of Practical Nurses(PNs) and Unlicensed Assistive Personnel(UAPs)

Organization documents – the job descriptions, policies, and procedures within the organization will guide to whom and what can be delegated.

Right Person

Nurse Practice Act – each state has a nurse practice act that will define and determine what task can be delegated to what level of personnel.

Determines the scope of practice for each position Issues standards of care that guide practice Renders official opinions which guide practice

Organization guidelines – each organization has statements that guide practice.

Mission statement Policies and procedures (determine what can be done and what

level of personnel can carry out the task) Job descriptions – identifies job responsibilities

Right Communication

Clear and concise communication is imperative from the RN to the delegatee. This communication should include the :Task with clear expectations of what is to be done, why

it is being done, and when the task should be completed

Correct patient Information that should be reported back to the nurse

and when that information should be given to the nurseExpected outcome of the task

Right Supervision

The RN must provide sufficient follow up including:Checking on the progress of the taskChecking on the outcomes once the task is

performedObtaining feedback about the completed task from

the delegateeEvaluate the effectiveness of the delegation with the

delegatee

Right SupervisionGiving feedback to the delegatee is important. To create

an environment where feedback is seen as constructive, consider the following.Timing of the feedback – the RN should give the delegatee

feedback as soon as possible after the task is completedFocus on the behavior/performance of the taskProvide clear feedback addressing the completion of the taskUse assertive “I” statementsAsk for a restatement of the feedback from the delegatee so there

is clear understanding of what was saidProvide feedback privately with the delegateeAsk for feedback from the delegatee to clarify any concerns that

person may have as well

Five Rights of Delegation

Please go to this web site for further information on the five rights of delegation.

https://www.ncsbn.org/fiverights.pdf

Delegator

As the delegator, the RN must Have a view of the big picture in the care of the

assigned patientsSelect the appropriate activities to delegateSelect the appropriate staff to carry out the activitiesClearly communicate the expectations and required

follow upFollow up periodically while the task is being completedEvaluate and provide feedback on the effectiveness of

the delegation to staff

Delegatee

The delegatee also has responsibilities including

Accepting the delegated activities as directed by the RN

Give report to RN as requested on the delegated task

Give feedback to delegator on the effectiveness of the

delegation process

Delegation Model

The National Council of State Boards of Nursing have a decision model to assist the RN to correctly delegate the task to the correct delegatee. Please go to this web site to view this decision model.

http://www.ncsbn.org/pdfs/delegationtree.pdf

Legal Authority to Delegation

Legal responsibility for the RN to delegate a task to the PN or UAP is determined by Nurse Practice ActEmployer’s statements including job descriptions,

policies, and proceduresNational standards of care

American Nurses Association (ANA)Other national organizations

ANA Standard of Care

According to the ANA Standards of Care, RNs can not delegate the following tasksInitial nursing assessment and additional

assessments that require nursing judgmentNursing diagnosis related decisionsDecisions about patients outcomesApproval of plan of careTasks that require nursing judgment Evaluation of nursing care

Additional Legal Principles

RN remains legally responsible for delegated activities RN is accountable for appropriateness of delegated

activities and its accurate completionUAPs can not supervise other UAPsUAP or PN can not redelegate activities.UAP can not complete a pain assessmentPN can not complete discharge teaching

Challenges with Delegation

Delegatee refuses to accept the delegated task.Delegator – go rapidly through the 5 rightsAsk the delegatee why the request is being refusedMay be due to

Fear – afraid can not complete the task correctly and safelyTold not to do by others – other RNs have told the delegatee

never to carry out this taskLack confidence – the delegatee may be new or lack the

confidence to complete the taskOverwhelmed – may be concerned about the workload

already assigned

Challenges with Delegation

Some additional challenges with delegation include

“I have to do it myself” belief system – the RN feels that because of the responsibility of care, the tasks need to be completed by the RN

Lack of confidence in PN/UAP – the RN may not know the PN or UAP and therefore is not comfortable with delegation

Conclusion

Delegation is a powerful tool when used correctly can create an effective and safe environment in which staff and patients work together to achieve positive outcomes.

References

National Council of State Boards of Nursing (http://www.ncsbn.org)

Yoder-Wise, P. (2007). Leading and Managing in Nursing (4th ed.).

Sullivan, E. & Decker, P. (2005). Effective Leadership & Management in Nursing.

Huber, D. (2006). Leadership and Nursing Care Management.