Delegation Rules & Responsibilities

1. Delegation Rules & Responsibilities Karysa Caster, Deidre Miller, Amber Shutter

2. Principles Of Delegation • The RN should refer to the applicable state nursing practice statue and rules as well as the organizations job descriptions for current information about roles and responsibilities. • Student nurses, novices, and float nurses require variable levels of supervision, guidance, and support. • The RN is accountable for nursing judgment decision and for ongoing supervision of any care that is delegated. • The RN cannot delegate the nursing process. Particularly assessment, planning, and evaluations. • The RN must know as much as practical about the patients and their conditions, as well as the skills and competency of team members to prioritize, delegate, and assign.

3. Delegation is transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains the accountability for the delegation.

4. Five Rights of Delegation • Right Circumstances • Right Task • Right Person • Right Direction/Communication • Right Supervision

5. Right Circumstance Right circumstance is based on - The specific area of practice (I.e., Acute care, home health care, long-term care). - Patient conditions and preferred results - Available resources

6. Right Task • Right task is a task that ,in the nurse’s best judgment, is one that can be safely delegated. • In ordered to delegate the right task the RN must know who is on their team and specifically what is in their job description at this specific agency.

7. Right Person • Knowing the licensure, role description and preparation of each team member is the first step in determining competency. • To effectively assign or delegate, the RN, must know the role description of team members as well as his or her own. • Know you facilities Policy and Procedure

8. Right Direction/Communication • When delegating communication is key in order to provide the best quality care. • Use the 4 C’s of communication ClearConciseCorrectComplete

9. Right Supervision • The provision of guidance, direction, oversight, evaluation and follow up by the licensed nurse for accomplishment of nursing tasks • Second Reports • Check Points • Feedback

10. Why Proper Delegation Is Important • Nurses spend 10-25% of their shift looking for other staff members. Decreasing time spent caring for patients. • Ineffective delegation was a significant source of missed care, such as lack of turning or ambulation, delayed or missed nutrition, and lack of hygiene. • 14% of task errors or care omissions related to teamwork were due to lack of RN direction or communication. And approximately 12% of the issues stemmed from lack of supervision/follow up.

11. Delegation Don'ts • Nursing Process Assessing Planning Evaluating Teaching These are the sole responsibility of the RN and can never be handed off to unlicensed personnel

12. Evidence Based Practice

13. Developing Delegation Skills • SettingThree different scenarios including an RNs, LPNs and nursing assistants. The scenarios were Unit based, Pairing,& Partnering • Purposewas to show how delegation and patient care improved from the 1st scenario to 3rd scenario. Improve communication and delegation. • OutcomesUnit basedRelationship issues would frequently arise. Attention was not given to patient assignments ultimately affecting continuity of care.PairingIncreased interaction with RN,LPN, Nursing assistant. Delegation increased. Patient care still not getting full attention. Partnered Increased commitment to each other and ability to deal with more complex situations. Increased efficiency in getting work done. Attention is given to patient assignments ultimately improving patient care. • ConclusionDelegation and patient care improves when RN’s understand concepts of responsibility, accountability, and authority. Also with sharing the process of patient care with other responsible members of the nursing team.

14. 2014 National Patient Safety Goals • Improve staff communication NPSG.02.03.01- Get important test results to the right staff member on time. Communication is necessary for safe care of patients. Delegation is accomplished and completed correctly with proper skills of communication.

15. Resources Bittner, N., & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. The Journal Of Nursing Administration, 39(3), 142-146. doi:10.1097/NNA.0b013e31819894b7 Lacharity, L.A., Kumagai, C.K., & Bartz, B. (2006). Prioritization, delegation, assignment: Practical exercises for medical surgical nursing. St louis, MO: Mosby Elsevier The Joint Commission.(n.d.). National Patient Safety Goals. Retrieved January 27, 2014, From http://www.jointcommission.org/standards Weydt , A., ( May 31,2010) “ Developing Delegation Skills” OJIN: The Online Journal of Issues in Nursing Vol. 15, No.2, doi:10.3912/OJIN.Vol15No02Man01