What is delegation?
• Giving the employee the appropriate authority to act alone
Scope of practice
• It is the activities that nurses are educated and authorized to perform as established through legislated definitions of nursing practice and complemented by standards, guidelines and policy positions issued by nursing regulatory bodies
Collaborative Practice
• Establishing and maintaining effective working partnerships with other professionals, patients/clients, families, other teams, organizations and individuals to achieve common goals
Distinguish between delegating and assigning (IMPORTANT)
Delegating
• Occurs when the task is outside the role description and training
• Only delegate those things which are not already in the scope of practice
• Importance
o Critical skill for accomplishing care in a timely manner
o Usually saves times in the long run
o Usually cost effective
o Allows professional growth to occur
Assigning
• The work each person is to accomplish in a designated work period
• The transference of both responsibility and accountability
Recognize how the scope of practice of an RN and LPN differ
RN • Higher level of thinking • Broader scope of practice • Higher education for critical thinking • Ability to make clinical judgement LPN • Lower level of thinking • More narrow scope of practice • Less education for critical thinking
Consider responsibility and accountability as it related to delegation and assigning
Accountability
• Nurses are accountable for their actions and related consequences including the initiation and follow through of the nursing process
Responsibility
• Involves reliability, dependability and the obligation to accomplish work
Describe key aspects of successful delegation
- Start with a positive attitude
- Clarify availability
- Consider how directions are given during delegation
- Directions need to be clear
- Be fair about undesirable activities.
- Indicate priorities- should be clear to delegate
- Give and receive feedback
Identify obstacles/issues related to delegation
1. Under-delegation o Do not have trust or confidence in others o Need for control 2. Over-delegation o Reflection of poor time management skills 3. Improper delegation o Wrong time/person/reason o Going beyond capability of person o Not enough info 4. Resistance o Stay with similar patterns 5. Unclear communication
Barriers to delegation
- Lack of interprofessional understanding
a. People around table not all recognized and respected from amount of knowledge they’re bringing to the table - Lack of Resources
a. People can be resources - Inadequate Communication
a. Ineffective problem solving
b. Team members not having same view of pt
i. Mobilization - Level of Responsibility
a. Roles can get blurry at times and can create lack of leadership - Risk for burnout and conflict
a. Fatigue, stress play major roles
b. People tend to retreat into own professional groups when there’s conflict - Stress of shifting healthcare system
“loopy lunatics love raising stress”
In order for collaborative practice to occur you need…
1. Partnership o Teamwork 2. Interdependence o Can have overlapping of competencies 3. Collective ownership and responsibility o Often where the roles get blurred
Describe strategies that facilitate collaborative practice
- Communication skills
- Staff awareness
- Staff decision making
- Coordination
- Negotiation skills
- Assessment skills
Recognize the effect collaborative practice has on nursing teams
• Everyone needs to be knowledgeable about
o Client needs
o Practice environment
o The way care is provided
o Roles and responsibilities of scope of practice
CRNBC conditions to delegation
- Safety and well-being of the patient is not jeopardized
- Agency policies support delegation of certain tasks
- Delegatee must have sufficient direction, education and supervision/support to perform the task properly
- Responsibility and accountability is clear and agreed to by everyone
5 rights of delegation
- Right Task
a. Is the person able and willing to do specific task? - Right Circumstances
a. Would delegation process suggest circumstances are right?
b. Staffing? - Right Person
a. Is it a good fit with that person?
i. If you have an elderly, do not send a male nurse when a female nurse is available
ii. Language barrier
iii. More experience is better - Right Direction and Communication
a. Do you and delegatee have a common language?
b. Need to be clear
c. Do they know what or when to report?
d. Is communication based on good fit with situation and culture?
e. Can you accommodate pieces of a culture in your practice? - Right Supervision
a. Do you know how and when you will interact about pt care with delegetee?
b. How often will you need to provide direct observation?
