1. Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Chapter 3 Delegation of Nursing Tasks

2. 2 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Delegation  Allows the transfer of responsibility to another person to complete a task or activity while the initial person retains the accountability for the outcome  The person that is entrusted the delegated task must be qualified, competent and able to perform the task

3. 3 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Unlicensed Assistive Personnel (UAP) Also known as:  Non-credentialed assistive personnel  Nursing assistant (NA)  Certified nursing assistant (CNA)  Patient care associate (PCA)  Nursing technician  Unit technician

4. 4 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. RN is responsible for all patient care  The UAP cannot practice nursing  UAP must be directed, supervised and evaluated by the RN  Licensed practical nurse (LPN / LVN) works under direction and supervision of the RN. Their limitations of practice are governed by their state board regulations

5. 5 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Direct Patient Care Activities  Grooming  Feeding  Hygiene care  Vital signs  Ambulation  Electrocardiogram  Measuring Blood sugar levels

6. 6 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Indirect Patient Care Activities  Restocking supplies  Transporting patients  Clerical activities

7. 7 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The Five Rights of Delegation The National Council of State Boards of Nursing (1997) has defined the Five Rights of Delegation, as follows: 1. Right task 2. Right circumstance 3. Right person 4. Right direction / communication 5. Right supervision

8. 8 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Should You Accept a Delegated Assignment?  Is it consistent with your defined scope of practice?  Is there a valid order? Is it in accordance with the agency policies and procedures?  Is the act supported by research data or a position statement?  Are you competent to perform it safely?  Is the act to be performed with the acceptable “standards of care”? Would another nurse with similar education and clinical skills perform similarly?  Are you prepared to assume accountability for the provision of safe care?

9. 9 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Factors to Consider  Your state’s nurse practice act  Hospital policies and procedures  Job descriptions  Staff competencies  Clinical situation  Professional standards  Patient needs

10. 10 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. What can be delegated?  Non-invasive non-sterile treatments such as emptying Foley catheters and providing hot/cold soaks  Vital signs, height, weight, capillary blood sugar results  Bathing, toileting, feeding, assistance with ambulation  Socialization activities

11. 11 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. What cannot be delegated?  Patient assessments  Planning and evaluation of nursing care  Development of a plan of care  Health teaching and health counseling (unless it is reinforcement of previously taught material)

12. 12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Obstacles to Delegation  Lack of training for nurses on how to delegate  Personal qualities, such as poor communication or interpersonal skills  Lack of resources  Insecure delegator  Unwilling to delegate  Nurse unwillingness to trust others

13. 13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Levels of Clinical Experience  Novice  Advanced beginner  Competent nurse  Proficient nurse  Expert

14. 14 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Priority Setting  Identify your priorities  Interact differently with others in order to maintain control over your time, energy and priorities  Identify a time when you will be able to manage a task, set a realistic timeline  Understand the scope, intended outcome and deadline of assignments before accepting the assignment  Ask for help when needed  Delegate where you can – you cannot do it all!!!

15. 15 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Set Realistic Goals  Be SMART  S pecific  M easurable  A ttainable  R elevant  T ime bound