1. Presented by Connie Chrisman NURS 450
Delegation
Presented by
Connie Chrisman
NURS 450

2. Objectives Students will be able to define delegation.
Students will be able to discuss the registered nurse’s role in delegation.
Students will be able to discuss two delegation theories.
Students will be able to discuss the pro’s and con’s of delegating.
Students will be able to discuss the ANA standards associated with delegation.

3. Introduction
As registered nurses we are all aware of the increased time demands placed on bedside nurses. We have all provided care for numerous patients at a time, depending on clinical specialty, from labor and delivery to long term care.
So how do we manage all the care elements for our patients in a safe and timely manner?

4. What is delegation?
The transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome.
Example: The RN, in delegating a task to an assistive individual, transfers the responsibility for the performance of the task but retains professional accountability for the overall care.
(ANA, pp 64, 2010)

5. What defines a RN?
An individual registered or licensed by a state, commonwealth, territory, government, or other regulatory body to practice as a registered nurse.
This allows:
Critical Thinking
Assess
Plan of Care
Educate
Delegate

6. What is an Unlicensed Assistive Personal?
Medical assistant is an allied health occupation who perform administrative and/or clinical tasks to support the work of physicians and other health professionals.
They perform routine tasks and procedures such as measuring patients' vital signs, administering medications and injections, recording information in medical records- keeping systems, preparing and handling medical instruments and supplies, and collecting and preparing specimens of bodily fluids and tissues for laboratory testing.

7. Five Rights of Delegation
Right person
Right circumstances
Right task
Right Direction/communication
Right supervision/evaluation
(EOHHS, para 1, 2013)
(ANA, pp 67, 2010)
Right person – The RN needs to know the patient, medical history, plan of care, medications, etc…
Right circumstances –
Right task – in assigning a UAP a task its best to know their skill level, experience level, comfort level. This should be individualized not generalized.
Right direction/communication – communicate clearly – example: Telling someone to just go get a set of vitals versus explaining that you need the patients blood pressure because you have to give them antihypertensive medications and you can’t give it if the patients blood pressure is too low.
Right supervision/evaluation – following up on the tasks delegated is essential. Ensuring the UAP placing the blood pressure in the medical records will support why you did or did not give the medication.

8. Theory – Watson & Glaser
Early critical-thinking theorists (Watson & Glaser) identified the attitude of inquiry as one of the components of critical thinking. The attitude of inquiry drives critical thinking. A continuously inquiring approach takes you to higher and higher levels of critical thinking.
They theorized that the attitude of inquiry plays a central role in effective delegation. This employs the critical- thinking skill of analysis by analyzing the NCSBN definition of delegation in search of actions that will make delegating more effective and satisfying for the RN and the UAP.
Non-Nursing Theory
Goodwin Watson (professor) and E. M. Glaser a student at Columbia Teachers College. The Watson-Glaser initial critical thinking theory development was in 1925 and in 1941 the first critical thinking test was published and is still used today in all different aspects of business to help determine leadership qualities/personalities.

9. Maslow’s Theory Maslow’s Motivation–Hierarchy of Needs: Physiological
Safety
Love/belonging
Esteem
Self-actualization
Two hierarchy's to focus on when delegating
1. Belonging
2. Esteem
Belonging (friendship, family, sexual intimacy) – in the work place; we all have a desire to belong. If you feel like you don’t belong, your not part of the team then your performance is affected and errors occur.
Esteem (self-esteem, confidence, achievement, respect of others, respect by others) - Esteem is important in delegation and when done well can stimulate others esteem. A UAP can achieve this level of esteem when having a task assigned to them and then completing the task and reporting is back to the RN.

10. Health Care Assessment – Con’s
Many nurses are reluctant to delegate. This is reflected in NCSBN research findings and the literature review as well as in subjective accounts from nursing students and practicing nurses
Lack of educational opportunities to learn how to delegate others effectively
Not knowing the skill level and abilities of nursing assistive personnel to simplify the work
(National Council of State Boards of Nursing, 2005)

11. Health Care Assessment – Pro’s
Work under the direct supervision of an RN to implement the delegated aspects of nursing care.
Assist the RN in providing patient care through task delegation.
Enable the RN to provide nursing care for the patient through time management.

12. Root Cause Analysis
Example: MA works in family practice office. The MA receives a call from the pharmacy inquiring about new Rx they received from the office and were clarifying it because the patient states it was wrong and it is different from what has historically been ordered. The MA told the pharmacy to increase number of narcotic tablets from 60 to 120 without discussing with the provider.
Do you recognize any problems?
What should the MA have done?
How does this affect patient safety?
How does this affect the provider?
In essence what was the MA doing? She/he was acting as a licensed nurse, placing the patient, and the provider in harm and at risk.

13. Root Cause Analysis Problem Possible causal factors Recommendations
MA practicing outside scope of practice
Possible causal factors
MA - not sure of scope of practice
Provider – not educating on practice expectations
Provider – allowing MA’s to practice outside of scope
Recommendations
Educate MA scope of practice
Educate Provider to MA scope of practice
Prove competency
Do you recognize any problems?
What should the MA done?
How does this affect patient safety?
How does this affect the provider?
In essence what was the MA doing? She/he was acting as a licensed nurse, placing the patient, and the provider in harm and at risk.

14. This is a tool that can be utilized to improve delegation skills
This is a tool that can be utilized to improve delegation skills. This is a delegation flow chart that can be used in an RN’s practice as well as shared with our peers. Additionally, this can be shared with UAP’s to educate them to the practice of delegation.

15. Implications When delegating correctly – No implications
Improves UAP’s skills
Makes the team stronger
Time Management

16. QSEN Six competencies Teamwork and Collaboration Know UAP’s abilities
Collaborate with UAP’s
Safety
Licensed staff responsible safety
Responsible for staff safety
QSEN has identified six competencies that address quality and safety.
The two that I will point out are Teamwork and Collaboration and Safety.
For Teamwork and Collaboration - when working with any UAP you need to know what their education is. If you have not worked with a UAP before and therefore you do not know their practices/experiences you would do well to protect the patient, the UAP, and yourself by taking the time to assess their skills by using the delegation flow chart. Remember they are able to complete tasks only. Collaborating with the UAP’s is teamwork. Find out what tasks the UAP is comfortable doing and well as what your expectations are but do is in a nice manner.
As far as Safety – communication and education are what keep patients and ourselves safe. Communicating clearly with UAP’s and discussing patient safety/care concerns on a regular basis throughout the shift is invaluable. Example: If a patient is a high fall risk, clearly communicating and reviewing fall risk safety measures that are currently in place, planning hourly rounds, planning for bowel & bladder care rounds, etc… must be planned/discussed.

17. ANA Standards Standard 5A – Coordination of Care
Organizes the components of the plan
Standard 8 – Education
Contributes to a work environment conducive to the education of healthcare professionals.
Standard 9 – Evidence-Based Practice and Research
Shares personal or third-party research findings with colleagues and peers
Coordination of Care – Organizes the components of the care plan – This can be done with the UAP’s to work as a team and so all team members know the plan of care and work to coordinate care in reaching improved patient outcomes.
Education – contributes to a work environment conducive to the education of healthcare professionals. Educating UAP’s to the importance of timely rounding & documentation is one way to improve overall patient safety.
Evidence-Based practice and research – shares personal or third-party research findings with colleagues and peers – this information can be shared with UAP’s if it is appropriate to their practice. Example: Annual competency validation. Working data scopes, glucometers, informatics/documentation, etc…

18. Conclusion
The topic of delegation has never been timelier. Delegation is a management tool. Used effectively, it can result in safe and effective nursing care, free the nurse for attending to more complex client care needs, develop the skills of nursing assistive personnel and promote cost containment for the organization. There is no clear consensus as to the best regulatory approach for the regulation of nursing assistive personnel and delegation at this time. However, facing a shortage of epic proportions, the nursing community needs to plan how we can continue to accomplish nursing care while assuring the public access to safe, competent nursing care.
(National Council of State Boards of Nursing, 2005)
For those of you that don’t feel comfortable delegating please remember this picture.

19. References
American Association of Critical Care Nurses, (2004). AACN Delegation Handbook, (2nd ed). Sinai Hospital of Baltimore, Maryland.
Case, B., (2013). Delegation skills. Advance Healthcare Network for Nurses. Retrieved from: skills.aspx
Eisenhardt, M, K. (1989). Agency theory: An assessment and review. Academy of Management Review, 14(1), 57).
Health and Human Services Departments and Divisions. (2013) Five Rights of Delegation. Retrieved from ursing/nursing-practice/advisory-rulings/unlicensed-assistive- personnel/five-rights-of-delegation.html

20. References
Heat Inc., (2013). Nursing negligence: guidelines for care. Retrieved from:
Hunt, D., (2012). QSEN competencies: A bridge to practice. Nursing Made Incredibly Easy: September/October Volume 10 Issue 5 - p 1–3 doi: /01.NME
Lupia, A. (2001). Delegation of Power: Agency Theory. Published in Neil J. Smelser and Paul B. Baltes (eds.) International Encyclopedia of the Social and Behavioral Sciences 5: Oxford, UK.
National Council of State Boards of Nursing, (2005). Working with others: A position paper. Chicago: Author.
Watson, G., (1941). The gold standard of critical thinking test. Pearson Education, Inc.