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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 Making the decision to delegate in the first placey Assessing the clients needsy Planning the desired outcomey Assessing the competency of the delegatey Giving clear directions and obtaining acceptance from the delegatey Following up on the completion of the task, providing feedback to the delegateThe 5 Rights of Clinical Delegation:

1. The right task2. Under the right circumstances3. To the right person4. With the right direction and communication5. Under the right supervision and evaluation

The Right Task

y Look to your states nurse practice act first for reference on what can be delegated, then try yourorganization.

According to nurse-attorney Joanne P. Sheehan, nurses cannot delegate the following:

y Assessments that identify needs and problems and diagnose human responses.y Any aspect of planning, including the development of comprehensive approaches to the total care plan.y Any provision of heal counseling, teaching, or referrals to other heal care providers.y Therapeutic nursing techniques and comprehensive care planning.

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The Right Circumstances

y Assigning tasks on the basis of the strengths of the person will allow the client to experience the very bestcare and allow the delegate to provide the very best care.

y Recognize strengths, and encourage the best client care possible by using them, but challenge delegates togrow too.

What are the causes of performance weakness?

y Employees are not aware of what is expected of themy Lack of performance feedbacky Educational needsy Need for additional supervision and directiony 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 thedelegate 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. CLEAR: Does the team member understand what I am saying?2. CONCISE: Have I confused the direction by giving too much unnecessary information?3. CORRECT: Is the direction according to public policy, procedure, job description, and the law?4. COMPLETE: Does the delegate have all the information necessary to complete the task?

The Right Supervision and Evaluation

Feedback Formula

y Ask for the other individuals input first!y Give credit for effort.y Share your perceptions with each other.y Explore differing points of view, focusing on shared outcomes.y Ask for the other individuals input to determine what steps may be necessary to make certain desired

outcomes are achieved.y Agree on a plan for the future, including timeline for follow-up.y Revisit the plan and results achieved.