Nursing DELEGAION

Nursing Delegation

Definitions of Delegation:

1- Is the Transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.

2- Delegation is the transfer to a competent individual of the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

3-Sharing responsibility and authority with subordinates and holding them accountable for performance

4- Delegation is primarily about entrusting others . This means that they can act and initiate independently; and that they assume responsibility with you for certain tasks.”(Blair 2005)

5-The reassigning of responsibility for the performance of a job from one person to another.

  • Responsibility transferred
  • Accountability is not

6- Delegation

Asking someone else to perform a task that is one of your responsibilities

 

Accountability:

means that the nurse is legally liable for her actions and is answerable for the overall nursing care of her patients.

Responsibility :

involves reliability, dependability, and the obligation to accomplish work. Responsibility also includes each person’s obligation to perform at an acceptable level.

Authority :

occurs when a person who has been given the right to delegate, based on the state Nurse Practice Act, also has the official power from an agency to delegate.

Assignment

  • Allocation of work load among assigned personnel
  • Assignment making is the process of delegating the duties and all aspects of care for a patient to individual personnel.
  • The assignment includes giving clear, concise directions, and delegating the responsibility and the authority for the performance of the care.

 

Assignment Making

  • The education, skill, knowledge, and judgment levels of the personnel being assigned to a task must be relative to the assignment.
  • The expected outcome of the assignment, time frame for completion, and any limitations on the assignment should be specified when the assignment is made.

 

Responsibilities of Health Team Members

  • Care should be used in delegating or accepting responsibility for any action that:
  • May carry the potential for harm
  • May be highly complex or require advanced skill
  • May require a high level of problem-solving skill
  • Has a greater than average degree of unpredictability
  • Requires a complex level of patient interaction

 

Direct Delegation Versus Indirect Delegation

Direct

Verbal Direction regarding

-Activity

-Task

in a specific nursing care situation.

Indirect

is done using an approved listing of activities or tasks that have been established in the policies and procedures of the health care institution or facility.

 

Underdelegation

  • Usually occurs when a person is in a new job role
  • Potential causes:
  • Trying to avoid resentment from “old guard” staff
  • Not knowing who to delegate to
  • Not knowing scope of staff duties
  • Seeking approval by demonstrating competency

 

The Benefits of Delegation are:

1- Delegation encourages the initiative of subordinates and creates room for them to grow.

2- It frees managers for other priorities, including planning, organizing and directing.

3- Controlling the organization itself.

 

Process of delegation involves

  • Select a capable person.
  • Explain the task and expected outcomes.
  • Give the necessary authority and means for doing the job.
  • Arrange to keep in contact and give feedback.

In making a decision to delegate nursing activities the following five factors can be assessed

1. Potential for harm.

2. Complexity of the nursing activity.

3. Required problem solving and innovation.

4. Predictability of outcomes.

5. Extent of client interaction.

 

What is the most important thing a nurse must understand before delegating patient care?

Five rights of Delegation

1. Right task.

2. Right person.

3. Right circumstance.

4. Right direction/communication.

5. Right supervision.

 

Right task

  • Laws in your state
  • Policy in your institution
  • Needs of your residents
  • Training of nursing assistants

Right Person

Right person should be able to:

1- Communicate effectively,

2- Collect basic subjective and objective data

3- Perform noncomplex activities safely

4- Seek guidance (Hill, 276)

Right Circumstance

  • Setting and patient situation MUST be considered when delegating

Right direction/communication

  • It is not only what you say but how you say it!!!
  • Communication must be specific, objective, clear-cut terms. Realistic, measurable, and time referenced.

Right Supervision, Feedback, and Evaluation

There needs to be

  • Appropriate monitoring, intervention, and evaluation of the nursing assistant
  • How closely do you monitor the nursing assistant?
  • Are you giving appropriate feedback?
  • Are you available if needed?
  • Are tasks being completed on time and correctly?
  • If necessary, intervene

Barriers to delegation in the delegator

  • Lack of confidence and trust in subordinates.
  • The belief that the manager himself can do it only.
  • Low self confidence, insecurity, fear that subordinate might subsequently jeopardize his position.
  • Prestige and power consciousness.
  • Lack of skills in communication.

 

Barrier on the part of delegatee

  • Lack of technical competence and skills required to carry out a task.
  • Lack of willingness to accept responsibility.
  • Lack of initiative.
  • lack of self confidence.
  • Fear of loss of power.
  • Lack of control.
  • Inadequate reward.
  • Have more work than they can do.

 

Barriers in the situation

  • Inadequate support, hurried atmosphere, hostile management

 

Overcoming this barrier

  • The delegator must accept that part of his activity is done by others.
  • The delegator emphasizes that the behavior of people is the key to productivity and success depends on motivated and skilled employee who are committed to organizational objectives.
  • Recognize what is the causes that prevent delegation.

delegation

 

– Delegation always involves two persons, the manager “ delegator” and staff member “ delegatee”.

– The delegator needs to be sufficiently aware of the personal strength, weakness and capabilities of the delegatee

– Delegation require critical thinking and sound clinical decision making, it increase rather than decrease nurses’ responsibilities

 

Rules of Management

  • Do not delegate:
  • Assessment
  • Evaluation
  • Nursing Judgment
  • Responsibility for discipline an immediate subordinate
  • Personal accountability
  • Anything which has legal accountability as termination of an employee
  • Do not make decisions on nursing care based on what you may have observed others do
  • Tasks that an employee does not have the skills to complete.
    • This is also called Punishment.
  • Tasks that are busy work.
    • This is also called Dumping.
  • Tasks which you are constantly detailing out instructions for.
    • This is also called Puppetering.
  • Tasks should not be constantly delegated to the same individual,
  • Tasks that involve personnel issues. (Nahavandi, 2006)l
  •  

    Do Delegate:

    • Tasks that are non-management tasks. (Fracaro, 2006)
    • Tasks with which you can pass on authority. (Protch, 2006)
    • Tasks that boost an employee’s skills and challenges them.
    • This is also called Trivial Pursuit.
    • Tasks that are paired with training, or are skill appropriate. (Nahavandi, 2006).

    – Delegate activities for stable patients with predictable outcomes

    – Delegate activities that involve standard, unchanged procedures

    – Remember Priorities

     

    Markers to Examine for Inadequate Delegation Should Include

    • increase of incidents (i.e. medication errors/falls),
    • increase of mortality rates,
    • increased length of stay,
    • increased readmissions within 24 hrs/3 days/1 month,
    • increased clinical complication rates,
    • decreased client/caregiver satisfaction reports,
    • decreased client knowledge of disease & treatments
    • increased stress levels of clients/staff,
    • increased No. of sick days by staff,
    • increased No.of staff switching areas, &
    • increased No. of staff resigning.

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