Chapter 10: Delegation

Question 1

Delegation

Answer 1

giving another staff member the responsibility and authority to complete a task or activity
-through delegation, the RN determines the tasks that should be done, by whom, when, and how

Question 2

What does the nurse have to do before an RN can delegate?

Answer 2

the RN needs to have responsibility and authority, or the power over the activity or task

• an RN cannot delegate something that is outside approved nursing practice as determined by the nurse practice act in the state where the nurse practices
• ex: RN cannot delegate prescriptive authority (prescribing of medications) because an RN typically cannot do this activity

Question 3

Accountability

Answer 3

being responsible and answerable for actions or inactions of self or others in the context of delegation
>the RN is not avoiding work and is still held accountable for the outcomes, but the care is provided in a more efficient manner

Question 4

Supervision

Answer 4

when a nurse is monitoring patient care and work performance

• the RN (delegator) is still responsible for supervising the work (activity, task) that the other staff member (the delegatee) is to do
• the nurse may be in a formal management position, such as nurse manager, a team leader, or an RN staff nurse who has delegated work and then ensures that a task is done effectively

Question 5

Assignment

Answer 5

the process that moves an activity from one person to another, including the responsibility and accountability

• ex: the nurse manager might assign an RN to lead a team or to administer medications to the patients
• an assignment can be given only to staff that have the required qualifications to complete the task and can assume the responsibility and accountability
• the person doing the activity has the accountability for the actual action or activity, whereas the person who made the assignment is responsible for the assignment decision

Question 6

Critical Elements of Delegation

Answer 6

communication and information

Question 7

Mindfulness

Answer 7

staying alert to key information and evaluating and updating that information as necessary

• active process that can improve communication during delegation
• goal is not to share as much information as possible, but rather to share the critical information; information that has meaning in the situation

Question 8

Mindful Communication

Answer 8

recognizing the significance of the facts and how they pertain to the patient situation
-when a nurse engages in mindful communication, information processing is redirected, resulting in a unique set of decisions and actions
>historically, RNs have relied on job descriptions and delegated skills lists to guide delegation practices; overreliance on standards that results in routine interpretations and behaviors may jeopardize patient safety when nurses do not engage in mindful communication about the task at hand

Question 9

NCSNB definition of Delegation

Answer 9

transferring to a competent individual authority to perform a elected nursing task in a selected situation; the nurse retains the accountability for the delegation

Question 10

Transferring

Answer 10

The RN can do something that will be passed on to someone else to do

• the RN cannot delegate something that the RN as no right to do as an RN
• ex: the RN can do the bed bath, but it is more efficient to have the UAP complete the bed bath while the RN assesses the patient’s overall status at the beginning of a shift

Question 11

The RN transfers this activity to a Competent person

Answer 11

someone who can complete the task because that person has the skills and experience to do so
-ex: the UAP has been trained to give bed baths and report to the nurse any problems ecountered)

Question 12

The Delegator or RN

Answer 12

giving the delegatee the authority or power to do the act or task

• RNs have overall responsibility and authority for all nursing care–from basic care, such as a bed bath, to complex care needs
• the RN determines who is the best staff member to complete a task
• in some cases, the RN may decide that b/c of the critical status of the patient and the need for intensive interaction and assessment, the RN should complete the bed bath

Question 13

The Five Rights of Delegation

Answer 13

• Right Task
• Right Circumstances
• Right Person
• Right Direction/Communication
• Right Supervision

Question 14

Right Task

Answer 14

the task must be delegatable for a specific patient or situation
-if the RN or delegator is not clear about what the task is, the RN will not be able to clearly identify what needs to be done and by whom

Question 15

Right Circumstances

Answer 15

the appropriate setting, available resources, and other relevant factors need to be considered
-perhaps the RN needs to tell the delegatee where to complete the task and identify which supplies, equipment, and other resources are needed to complete the task effectively

Question 16

Right Person

Answer 16

the right person delegates the right task to the right person, to be performed by the right person
-the RN must consider the best staff member to complete the task (type of staff, experience and skills, availability of time to complete task w/o negatively impacting other work)

Question 17

Right Direction/Communication

Answer 17

providing a clear, concise description of the task, including its objective, limits, and expectations

• delegator must explain to the delegatee what is to be done, how to do it (if not already clear), the time frame, and outcomes; needs to ask directly if there are questions or concerns and be open to the response
• the delegatee needs to feel comfortable asking questions for clarification or expressing concern about the inability to complete the task; if the delegatee is afraid of speaking up and not saying “I do not know how to do something or would you explain more about what you want done”, then this is an ineffective delegation process that may harm the patient
• the delegatee may need help in organizing work and setting priorities, or the delegatee may need to be told what to report to the RN and when

Question 18

Right Supervision

Answer 18

appropriate monitoring, evaluation, intervention, and feedback

• the RN does not just delegate a task and forget about it, the RN needs to supervise as required
• monitoring methods: observation, written feedback, and review of records in which the delegatee documents what is done

Question 19

Other Factors that cannot be ignored during delegation

Answer 19

• how comfortable the delegator feels in delegating

- how well the delegator knows the delegatee

Question 20

ANA key delegation principles

Answer 20

• the RN takes responsibility and accountability for the provision of nursing practice
• the RN directs care and determines the appropriate utilization of any assistant involved in providing direct patient care
• the RN may delegate components of care but does not delegate the nursing process itself; nursing judgment cannot be delegated
• the decision of whether to delegate or assign is based on the RN’s judgment concerning the condition of the patient, the competence of all members of the nursing team, and the degree of supervision that will be required of the RN if a task is delegated
• the RN delegates only those tasks that the RN believes the other healthcare worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience, and facility/agency policies and procedures
• the RN individualizes communication regarding the delegation to the nursing assistive personnel and the patient situation, and the communication is clear, concise, correct, and complete; the RN verifies comprehension with the nursing assistive personnel and ensures that the assistant accepts the delegation and the responsibility that accompanies it
• communication must be a two-way process; nursing assistive personnel should have the opportunity to ask questions and clarify expectations
• the RN uses critical thinking and professional judgment when following the five rights of delegation
• chief nursing officers are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements in areas r/t delegation

Question 21

Organizational Accountability r/t delegation

Answer 21

r/t to providing sufficient resources

Question 22

What should the nurse do after the delegatee performed the task?

Answer 22

important for the RN to thank the delegatee and recognize the work that the delegatee has done

• RN should provide positive feedback when work is done well and constructive feedback as needed
• RN should not criticize work negatively, but rather discuss the work and outcomes and make recommendations for improvement

Question 23

Will there be times when the RN as a delegator must change a decision about delegation?

Answer 23

• In the monitoring process, the delegatee may ask for help; the RN needs to listen to this request and intervene
• there may be times when the patient’s condition changes, and someone else, including the RN, may be better suited to complete the task
• the RN may realize that the delegatee is not as qualified to complete the task as originally thought; the RN must be aware of the need to avoid being negative, hurting the delegatee’s self confidence, or embarrassing the delegatee in front of others; how the RN communicates and intervenes can make the situation a positive learning experience for the delegatee
• the RN must recognize the impact on the patient

Question 24

ANA definition of Supervision

Answer 24

active process of directing, guiding, and influencing the outcome of an individual’s performance of a task

Question 25

NCSBN definition of Supervision

Answer 25

the provision of guidance or direction, oversight, evaluation and follow-up by the licensed nurse for the accomplishment of a delegated nursing task by assistive personnel

Question 26

How does the RN evaluate delegation?

Answer 26

• were the right tasks delegated, and why were they delegated?
• were the directions clear?
• the RN should consider to whom the task was delegated and the delegatee’s strengths and limitations
• did the delegatee have the resources to complete the task?
• did the delegatee have the time to complete the task?
• what impact did performing the specific task have on other responsibilities that the delegatee may have had?
• did the delegatee have the authority to complete the task?
• were the expected outcomes met?
• was the delegator available to the delegatee if questions arose or problems occurred

Question 27

Characteristics of Effective Delegation

Answer 27

• do not give employees just menial tasks; include tasks that offer opportunities for learning and growth
• distribute tasks with an understanding of each employee’s position description and job status, abilities, and total workload
• delegate when there is sommeone skilled available or when the task can be completed by a subordinate whose time is less expensive
• use benchmarks to monitor progress along the way; having only a final deadline can be overwhelming
• do not micromanage subordinates; experiences employees usually have the skills necessary for managing complex tasks on their own (particularly if the tasks are typically done by the)
• establish what needs to be done, and then provide support to the employee so that the employee can decide how to effectively accomplish the activity or task

Question 28

Unlicensed Assistive Personnel Cannot do the following

Answer 28

• health counseling
• teachings
• activities that require independent, specialized nursing knowledge, skills, or judgment

Question 29

Direct Patient care that UAP’s can perform

Answer 29

• assist the patient in meeting basic human needs
• assisting w/ feeding, drinking, ambulation, grooming, toileting, dressing, and socializing; collection, reporting, and documentation of data r/t to these activities is important

Question 30

Indirect Patient care activities UAP’s can perform

Answer 30

• support the patient and patient’s environment; providing a clean, efficient, and safe patient care milieu
• activities: companion care, simple meal preparation, housekeeping, providing transportation, and clerical, stocking, and maintenance tasks

Question 31

Tasks that can be delegated are those that have the following characteristics:

Answer 31

• frequently occur
• are considered technical by nature
• are considered standards and unchanging
• have predictable results
• have minimal potential for risks

Question 32

Key Aspects of Delegation

Answer 32

• Know your world (practice, organization)
• Know yourself (barriers, benefits)
• Know what needs to be done
• Know your delegatee (competency, motivation)
• Communicate (initial direction, parameters for follow-up)
• Resolve conflict (collaboration, resolution)
• Feedback/Evaluate (who, what, where, when)