Delegation Chapter 2

Delegation Principles To authorize another person to perform a nursing task in a certain situation Nursing Task: Procedure, activity or work that does not require an RN’s professional knowledge or judgement. Example: MA-C has been administering medications to Mr. Snuffy, however he has recently developed swallowing problems. What do you do? What is the MA-C role?

NACs and MA-Cs cannot delegate Who can delegate? RNs and LPNs can only delegate tasks within their scope of practice The delegating nurse is legally accountable for the nursing task RNs can delegate nursing tasks to LPNs, NACs and MA-Cs. LPNs can delegate nursing tasks to NACs Delegation must protect the patients health and safety. NACs and MA-Cs cannot delegate

Delegation Process The nurse decides whether or not a task can be delegated to you. Each situation or circumstance is an independent….a task that is delegated to you once may not be delegated to you in the future The delegating nurse will decide what is best for the patient at that given time. Patient’s circumstances are central factors in the delegation process

Delegation Process (continued) Assess and Plan: Performed by nurse Nurse must understand patient’s needs as well as the MA-Cs knowledge skills and job description

Delegation Process (continued) Communication: Performed by both the nurse and MA-C Nurse provide the MA-C with clear and complete directions about: How to perform the task What observations to report and record What specific patient & resident concerns to report Priorities for nursing tasks What to do if the patient’s conditions or needs change Before performing a delegated task be sure to discuss the task and ask any questions After completing the task the MA-C must report and record the care given, including any observations

Delegation Process (continued) Surveillance & Supervision: Surveillance: To keep a close watch over someone or something Supervise: To oversee, direct or manage The delegating nurse will oversee the care that the MA-C provides as well as the patient’s condition and their response to the MA-Cs care. Nurses will make observations based upon: Patient’s health status & needs If the patient is stable or unstable If the nurse can predict the patient’s response & risk to care Setting where nursing task occurs Resources & support available Complexity of nursing task

Delegation Process (continued) Evaluation & Feedback Completed by the nurse Determines if the delegation was successful

5 Rights of Delegation Right Task Right Circumstance Right Person Right Directions & Communication Right Supervision

Your Role in Delegation Remember: YOU perform delegated nursing tasks for or on a person. YOU must protect the person from harm YOU have 2 choices….. Accept the delegated task Refuse the delegated task

Accepting the Task When you agree to perform a task, you are responsible for your own actions YOU MUST COMPLETE THE TASK SAFELY What you do or fail to do can harm the person Ask for help when you are unsure or have questions Report to nurse what you did & your observations

Refusing a Task You have the right to say “NO” Sometimes refusing to follow the nurse’s direction is your right and duty Refuse a task when it is: Beyond your legal limits or unethical Not in your job description Not properly trained You could harm the person Directions are against agency policy Directions are unclear or incomplete No nurse supervision Never ignore an order or request, rather communicate your concerns with the nurse

Delegating to MA-Cs The actual task of giving certain drugs may not require a nurse’s judgement, hence nurses are able to delegate the task of giving such drugs. HOWEVER……. The nurse cannot delegate the nursing actions and judgements needed before and after a drug is given.

MA-Cs Role in Medication Administration Process A new or continued drug order is written. The drug is ordered based on the person’s need Drug order is sent to the pharmacy Pharmacy fills the drug order and delivers it to the nursing unit. The drug is stored on the nursing unit Nurse plans to give the drug Nurse delegates giving the drug to the MA-C MA-C gives the drug (Delegating nurse supervises the drug administration process) Nurse monitors the person’s response to the drug Person’s continued need for the drug is evaluated An order is written to discontinue the drug MA-Cs Role in Medication Administration Process

Delegating to MA-Cs (continued) MA-Cs roles is to give the drug This is only one step in the process Nurse cannot delegate any other step in the process Steps that cannot be delegated to the MA-C Assessing patient’s need for a drug Determining the need for PRN drugs Recognizing allergic RXNs Assessing & evaluating side effects Assessing & evaluating immediate desired effects Recognizing when the person no longer needs the drug Recognizing when continued use may be harmful