1. Delegation in the Clinical Setting
Chapter 14
Delegation in the Clinical Setting

2. Delegation in the Clinical Setting
Define the operational terms delegation, supervision, and accountability
Delegate tasks successfully based on outcomes
Select the right person for the right task
Apply the four “Cs” of initial direction for clear understanding of your expectations
Provide reciprocal feedback for the effective evaluation of the delegate's performance

3. What Does Delegation Mean?
Delegation: “…the process for a nurse to direct another person to perform nursing tasks and activities. National Council of State Boards of Nursing (NCSBN) describes this as the nurse transferring authority while ANA calls this a transfer of responsibility. Both mean that a registered nurse (RN) can direct another individual to do something that that person would not normally be allowed to do. Both papers stress that the nurse retains accountability for the delegation.” (NCSBN, 2005, p. 1)

4. What Does Supervision Mean?
Supervision: "…the provision of guidance or direction, oversight, evaluation and follow-up by the licensed nurse for accomplishment of a delegated nursing task by assistive personnel" (NCSBN, 2005, p. 1).
Once you delegate, you must supervise

5. Accountability Who is accountable here?
Accountability: "Being answerable for what one has done, and standing behind that decision and/or action" (Hansten & Jackson, 2004)
The delegate is accountable for accepting the delegation and for his/her own actions in carrying out the task (NCSBN, 1995, p. 3)

6. Accountability You are accountable for: Deciding to delegate
Assessment of patient’s needs
Planning desired outcomes
Assessing competency of delegate
Giving clear directions and obtaining acceptance from delegate
Following up and providing feedback

7. The Five Rights of Clinical Delegation
1. The right task
 2. Under the right circumstances
 3. To the right person
 4. With the right directions and communication; and
 5. Under the right supervision and evaluation (NCSBN, 2005, p. 2)

8. The Right Circumstances
First consideration made by the nurse
How can I determine the strengths and weaknesses of team members?
Assign tasks based on strengths
Encourage best care possible
Ask about competency levels

9. The Right Circumstances
What are the causes of performance weaknesses?
Unclear expectations
Lack of performance feedback
Educational needs
Need for additional supervision and direction
Individual characteristics: past experiences, motivational or personal issues

10. The Right Task Check Nurse Practice Act What can I delegate?
Check organization’s job descriptions and skills checklists
Is there anything I can't delegate?
Check the law
What belongs only to the RN’s scope of practice

11. The Right Task Cannot delegate: NURSING PROCESS
Assessments that identify needs, problems, or diagnose human responses
Any aspect of planning
Health counseling, teaching, or referrals to other health care providers
Therapeutic nursing techniques and comprehensive care planning (Sheehan, 2001)

12. The Right Person How can I use outcomes in delegating?
Dependent on plan of care and goals health care team has set (with patient and family)
Outcomes need to be clear and communicated to all team members

13. The Right Communication
How can I get the delegate to understand what I want?
Provide initial direction—Is it:
Clear?
Concise?
Correct?
Complete?

14. The Right Feedback How can I give and receive feedback effectively?
Ask for input
Give credit for effort
Share perceptions
Explore differing points of view
Determine what steps are needed for desired outcomes
Revisit plan and results achieved

15. NCLEX QUESTIONS
Which task could a staff nurse delegate to a certified nursing assistant (CNA)?
a. Evaluating a client’s response to pain
b. Making rounds with a physician
c. Feeding a stroke client who has minimal dysphagia
d. Assessing a client’s central venous line site

16. C. The majority of state boards have addressed the issue of delegation and have developed rules that offer specific guidelines regarding who can do what. The scope of practice for each level-of-care provider usually includes a description of the tasks that may be performed at that level.