Description

Leadership and Management for Nurses 2nd Edition Finkelman Instructors Manual

ISBN-13: 978-0132137713

ISBN-10: 0132137712

 

 

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Chapter 14: Delegation for Effective Outcomes

 

LEARNING OUTCOME 1

Define delegation.

Concepts for Lecture

1. Delegation is the transfer of responsibility for the performance of a task from one individual (the delegator) to another (the delegatee) while retaining accountability for the outcome.

Lecture Outline in PowerPoint

1. What Is Delegation?

• Transfer of responsibility from delegator to delegatee
• Delegator retains accountability for outcome

LEARNING OUTCOME 2

Critique the benefits of using delegation.

Concepts for Lecture

1. There are many benefits to using delegation. Some of these are cost-effectiveness in the use of resources, professional growth, increased time for other activities, and conveying to the staff that it is valued and trusted.

Lecture Outline in PowerPoint

1. Benefits of Delegation

• Cost-effectiveness in use of resources
• Professional growth
• Increases time for other activities
• Conveys that staff is valued and trusted to do the work

LEARNING OUTCOME 3

Examine key legal issues related to delegation.

Concepts for Lecture

1. State boards of nursing, scope of practice and nurse practice acts, labor unions, and standards of care are critical issues and factors that affect the “who,” “what,” “when,” and “how” of delegation.
2. The state practice act is the legal guide for delegation in the nursing practice, providing the legal framework for practice.
3. In order to properly and lawfully delegate tasks, nurses must know what certified and unlicensed personnel can do and be aware when job descriptions within a health care organization conflict with board regulations.
4. There are a series of questions that registered nurses should ask when learning about their state laws and regulations pertaining to delegation.
5. Using professional judgment through the application of the nursing process and the delegation process, the nurse must act as the patient’s advocate by only delegating action that is appropriate for the patient, even when this means going against a supervisor.
6. The health care organization is responsible for the acts of its employees when they are performing their job and the failure to delegate and supervise within acceptable standards of professional nursing practice may be seen as malpractice.
7. The delegator needs to determine if the staff member has the ability to do the job or task.

Lecture Outline in PowerPoint

1. Critical Issues/Factors That Affect Delegation

• State boards of nursing
• Scope of practice/nurse practice acts
• Labor unions
• Standards of care

2. State Practice Act

• Legal guide for RNs and delegation
• Legal framework of practice

3. Who Is Allowed to Perform Tasks

• Scope of practice
• Legal limits
• Certified vs. unlicensed personnel
• Position descriptions within health care organizations
• Board regulations

4. Questions RNs Should Ask Pertaining to Delegation

• What activities can/cannot be delegated?
• How is delegation defined?
• Does the practice act specify certain tasks for delegation/tasks that cannot be delegated?
• Does it authorize delegation based on certain circumstances?
• Does it describe the UAP role?
• What does supervision mean in the state?
• How much supervision must be given when delegating?
• Does it provide guidelines for reducing delegation risks?

5. Professional Judgment

• Nurse is patient’s advocate
• Delegation only when appropriate to patient
• Conflict with superiors

6. Vicarious Liability/Respondeat Superior

• Health care organization responsible for acts of its employees
• Failure to delegate/supervise within acceptable standards may be considered malpractice

7. Assessment of Competency

• Delegator must determine if delegatee has ability to do the job

 

LEARNING OUTCOME 4

Compare and contrast responsibility, authority, and accountability as they apply to delegation.

Concepts for Lecture

1. Accountability identifies who is answerable for what has been done. The delegator must take accountability in identifying the best person for the task or job to be done, and consider the person’s job description.
2. A staff member who performs a task or job is responsible for his own performance; however, the delegator still is accountable through the decision to delegate.
3. Responsibility is the obligation involved when one accepts an assignment.
4. Authority is the right to act or command the action of others and is determined by job position and the state nurse practice act.

Lecture Outline in PowerPoint

1. Accountability

• Who is answerable for what has been done?
• Delegator: Accountable for identifying the best person to whom to delegate

2. Responsibility vs. Accountability in Delegation

• Delegatee: Responsible for task/job
• Delegator: Accountable for task/job through decision to delegate

3. Responsibility

• Obligation involved when one accepts an assignment

4. Authority

• Right to act/command the action of others
• Determined by job position, state nurse practice act

LEARNING OUTCOME 5

Apply the delegation process in clinical situations when unlicensed assistive personnel are used.

Concepts for Lecture

1. The increased use of unlicensed assistive personnel (UAP) with a variety of titles, functions, and preparations has increased the need for nurses to develop effective delegation competency.
2. The National Council of State Boards of Nursing (NCSBN) guidelines on delegation are important in guiding the delegation process. There are five key questions related to what needs to be done that should be considered, which are described in the five rights of delegation.
3. When staff delegate to UAP, the staff nurse as well as nurse manager need to supervise the work. This may be direct or indirect, but in either case, the nurse must provide clear directions, make sure the UAP understands what needs to be done, and must follow up to monitory outcomes.
4. There are specific types of activities that cannot be delegated to UAP. These include health counseling, teaching, and those activities that require independent, specialized nursing knowledge, skills, or judgment.

Lecture Outline in PowerPoint

1. UAP

• Increased use
• Variety of titles, functions, preparations
• Need to develop effective delegation competency

2. Questions to Ask (NCSBN)

• Right task
• Right circumstances
• Right person
• Right direction/communication
• Right supervision

3. Supervision

• Direct or indirect
• Provide clear directions
• Ensure that UAP understands what needs to be done
• Follow up

4. Types of activities that cannot be delegated to UAP include the following:

• Health counseling
• Teaching
• Activities that require independent, specialized nursing knowledge/skill/judgment

LEARNING OUTCOME 6

Assess methods to monitor and improve delegation to reach effective patient outcomes.

 

Concepts for Lecture

1. The delegation process is similar to the nursing process (assessment, plan, intervention, evaluation).
2. There are eight essential elements for effective delegation. They are emphasizing the professional nursing practice, defining delegation, reviewing specific laws and regulations regarding delegation, emphasizing tasks that cannot be delegated, focusing on RN judgment for delegation decisions, determining the degree of supervision required for delegation, identifying guidelines for lowering risk, and developing feedback mechanisms to ensure that task is completed and to evaluate the outcome.
3. There are barriers to effective delegation. Examples are “I would rather do it myself”; delegating can overburden staff; lacking knowledge about delegating; hesitating to use delegation when first required; not knowing what can be delegated; fearing loss of control, and needing to be overly involved in all details of work.
4. To remove delegation barriers, RNs must fully understand why delegation would be used and the delegation process and accept that delegation is part of the job and that the RN cannot do everything.
5. There are key guidelines that should be followed to ensure consistency in effective delegation. RNs must start with a positive attitude, clarify availability, carefully consider how directions are given during delegation, provide clear directions, be fair about undesirable activities, indicate priorities, and give and receive feedback.

Lecture Outline in PowerPoint

1. The Delegation Process

• Assessment
• Plan
• Intervention
• Evaluation

2. Elements Essential for Effective Delegation

• Emphasis on professional nursing practice
• Definition of delegation, based on the nurse practice act and regulations
• Review of specific sections of the law and regulations regarding delegation, identification of disciplinary actions related to inappropriate delegation
• Emphasis on tasks/functions that cannot be delegated nor routinely delegated
• Focus on RN judgment for task analysis and decision to delegate
• Determination of the degree of supervision required for delegation
• Identification of guidelines for lowering risk related to delegation
• Development of feedback mechanisms to ensure that task is completed and to receive updated data to evaluate the outcome

3. Barriers to Effective Delegation

• “I would rather do it myself”
• Overburdening staff
• Lacking knowledge about delegating
• Hesitating to delegate when there is a need to do so
• Not knowing what to delegate

4. Strategies to Remove Delegation Barriers

• Understand why delegation would be used
• Understand the delegation process
• Accept that delegation is part of the job
• Accept that RN cannot do everything

5. Key Guidelines to Ensure Effective Delegation Consistency

• Start with a positive attitude
• Clarify availability
• Carefully consider how directions are given during delegation
• Directions need to be clear
• Be fair about undesirable activities
• Indicate priorities
• Give and receive feedback