Delegation
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
What does the nurse have to do before an RN can delegate?
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
Accountability
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
Supervision
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
Assignment
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
Critical Elements of Delegation
communication and information
Mindfulness
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
Mindful Communication
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
NCSNB definition of Delegation
transferring to a competent individual authority to perform a elected nursing task in a selected situation; the nurse retains the accountability for the delegation
Transferring
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
The RN transfers this activity to a Competent person
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)
The Delegator or RN
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
The Five Rights of Delegation
- Right Task
- Right Circumstances
- Right Person
- Right Direction/Communication
- Right Supervision
Right Task
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
Right Circumstances
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
Right Person
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)
Right Direction/Communication
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
Right Supervision
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
Other Factors that cannot be ignored during delegation
- how comfortable the delegator feels in delegating
- how well the delegator knows the delegatee
ANA key delegation principles
- 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
Organizational Accountability r/t delegation
r/t to providing sufficient resources
What should the nurse do after the delegatee performed the task?
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
Will there be times when the RN as a delegator must change a decision about delegation?
- 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
ANA definition of Supervision
active process of directing, guiding, and influencing the outcome of an individual’s performance of a task
