Clinical Delegation. Wanda Rose PhD, RN,BC. Objectives. Define delegation. Describe the role of the RN in terms of delegation. Review model for delegation decision making process. Discuss standing orders. Delegation.
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Wanda Rose PhD, RN,BC
Being accountable means being answerable for what one has done and standing behind that decision and/or action.
It is entrusting and empowering the subordinate and
Sharing of both responsibility and authority. However, even when responsibility and authority are passed on, the
Registered nurse remains totally accountable for
the end results.
"Nursing" means the performance of acts utilizing specialized knowledge, skills, and abilities for people in a variety of settings. The term includes the following acts, which may not be deemed to include acts of medical diagnosis or treatment or the practice of medicine as defined in chapter 43-17:
a. The maintenance of health and prevention of illness.
b. Diagnosing human responses to actual or potential health problems.
c. Providing supportive and restorative care and nursing treatment, medication administration, health counseling and teaching, case finding and referral of individuals who are ill, injured, or experiencing changes in the normal health processes.
d. Administration, teaching, supervision, delegation, and evaluation of health and nursing practices.
e. Collaboration with other health care professionals in the implementation of the total health care regimen and execution of the health care regimen prescribed by a health care practitioner licensed under the laws of this state.
43-12.1-18. Nursing practice standards. The board shall adopt rules establishing standards for nursing practice.
43-12.1 allows the licensed nurse to delegate and supervise nursing interventions to individuals authorized by the board to perform those functions.
54-05-04-01Licensed nurses are directly accountable
and responsible to clients for the nature and quality
of all nursing care rendered. It is not the setting
or the position title that determines a nursing
practice role, but rather the application of nursing
knowledge. Licensed nurses provide care through
a variety of roles including:
How will you know?
Is there access to written instructions?
Does it identify the specific task?
Does it identify the timeline?
Does it identify the outcome you would like?
How are you monitoring performance?
Are you available for follow-up or questions?
What provisions do you have for feedback?
How will you measure client’s response and goal attainment related to delegated interventions?
Do you give feedback based on outcome of the task?
Did you document your findings?
Unlicensed assistive persons who have completed a prescribed training program in medication administration or who have been delegated the delivery of a specific medication for a specific client may perform the intervention of giving or applying routine, regularly scheduled medications to the client. The medication assistant III may perform the intervention of administering medications to the client in an ambulatory health care setting. The licensed nurse must be available to monitor the client’s progress and effectiveness of the prescribed medication regimen. Delegation of medication administration in acute care settings or for individuals with unstable or changing nursing care needs is specifically precluded by these rules.
the intervention of giving medications to another individual, the licensed nurse must be available for direction.
establish in writing the process for providing the supervision in order to provide the recipient of the medication appropriate safeguards.
Delegation is a legal and management concept
and a process that involves assessment, planning,
intervention, and evaluation in which selected
nursing tasks are transferred from one person in
authority to another person, involving trust,
empowerment, and the responsibility and authority
to perform the task. In delegation, communication
is succinct, guidelines are clearly delineated in advance
and progress is constantly monitored in which
the person in authority remains accountable for the
Based on established clinical practice guidelines .
Suited for routine situations.
Enable nurses to assess the care needs of their patients and to initiate appropriate action without delays that may occur when physician contact is required.
Empower nurses to implement certain procedures and activities on behalf of physicians, enabling more immediate interventions, and ultimately improving patient care.
Save valuable time for patients, physicians and nurses.
Increases patient access to treatment.
Provide a safe and effective method of extending the role of the nurse.
Efficient and effective tools for routine situations.
Lack of communication when deviation occurs
Lack of knowledge and skills of health practitioner following the standing orders.
1. Determine a common clinical issue that would benefit from a standing order.
2. Establish a multidisciplinary team.
3. Review national and individual practice guidelines.
4. Complete a literature search for articles centered on evidence based practice.
5. Contact the state board of nursing to review state laws regarding standing orders.
Figure 1. Steps to Initiate a Standing Order
Note. Based on information from Maxwell, 2005.
6. Contact the facility’s continuous quality-improvement committee for facility guidelines.
7. Meet regularly as a work group to review the process.
8. Develop the standing order.
9. Pilot test.
10. Finalize the standing order.
11. Obtain administrative approval.
12. Provide ongoing, focused staff and patient education.
13. Audit and update standing orders on a regular basis
Preprinted order sets.
Must be documented as an order in the patient’s medical record (Centers for Medicare & Medicaid Services, Oct. 24, 2008)
Place copy of the standing orders in the chart.
Signed by the practitioner responsible for the care of the patient after implementation of standing order
Finally, for successful implementation and
long-term adherence, healthcare professionals should develop a plan to educate staff and patients about use of the standing order and audit and update the order regularly.