1. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION MODULE 39 Managing Care

2. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Exemplar 39.3 Delegation

3. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Overview Delegation  transference of responsibility, authority to competent individual Delegate  assumes responsibility Delegator  assigns task  Retains accountability Delegator can devote time to other tasks Increases skills, abilities of delegate

4. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Overview, continued Difficult leadership skill  Confusion over who is allowed to do which tasks Critical skill for nurses  Accomplish more by using others' help

5. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Principles of Delegation RNs increasingly delegate components  To other RNs, LPNs  To "nurse extenders"  unlicensed assistive personnel (UAP) Certified nursing aide or assistant (CNA) Home health aide (HHA) Client care technician Orderly Surgical technician

6. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Delegating to Other Nurses RNs may delegate to other RNs and to LPNs Five rights of delegation 1.Right task 2.Right circumstances 3.Right person 4.Right direction and communication 5.Right supervision

7. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Delegating to UAPs  Nurse must assess client first  Client medically stable, or chronic, not fragile  Task must: Be considered routine for this client Not require substantial scientific knowledge, technical skill Be considered safe for this client Have predictable outcome

8. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Delegating to UAPs, continued  Nurse must: Learn agency policies Know scope of practice Be aware of variation in ability Observe if unsure of abilities Clarify reporting expectations Create positive atmosphere

9. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Delegating to UAPs, continued Nurse must clearly communicate to UAP:  Specific tasks to be done for each client  When each task is to be done  Expected outcomes for each task  Who is available as resource if needed  When and in what format a task report will be completed

10. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Tasks That MAY Be Delegated to UAP Taking vital signs Measuring I & O Client transfers Ambulation Postmortem care Bathing Feeding  Gastrostomy feedings in established systems

11. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Tasks That MAY Be Delegated to UAP, continued Attending to safety Weighing Performing simple dressing changes Suctioning of chronic tracheostomies Performing basic life support (e.g., CPR)

12. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Tasks That MAY NOT Be Delegated to UAP Assessment Interpreting data Making a nursing diagnosis Creating a nursing care plan Evaluating care effectiveness

13. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Tasks That MAY NOT Be Delegated to UAP, continued Care of invasive lines Administering parenteral medications Inserting NG tubes Client education Performing triage Giving telephone advice

14. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Differentiating Delegation from Assignment Delegation  transfers responsibility and authority Assignment  no transfer of authority  Reflects job descriptions, client needs  Organizational needs

15. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Factors Affecting Delegation Assignment patterns  Unit-based, pairing, partnering Accepting delegation  Delegate responsible for making sure he/she understands task Inform delegator if skills lacking Accept delegation  accept full responsibility Clarify time frame Keep delegator informed Complete as agreed

16. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Factors Affecting Delegation, continued Obstacles to delegation  Nonsupportive environment  Delegator insecurity Fear of competition, criticism Fear of liability Fear of loss of control Fear of overburdening others Fear of decreased personal job satisfaction  An unwilling delegate

17. Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Liability and Delegation Fear often keeps nurses from delegating Follow state nurse practice acts to determine legal parameters Following guidelines from  ANA  NCSBN