SOAR Prioritization & Delegation

1. SOARPrioritization & Delegation Jan Appel, RN

2. Defining Prioritization • What are the defining characteristics of prioritization? • What words or phrases come to mind when we hear the word prioritization?

3. How do the experts define it? Generic definition: “sorting items or groups of items using a set criteria” Clinical Definition: “Deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent”

4. Factors that influence prioritization • Experience & expertise of individual nurse • Patient acuity • Nurse-patient relationship • Models of care

5. Pitfalls in Priority Setting • Inadequate Assessment and Evaluation • Failure to differentiate between priority and non-priority problems • Acceptance of other’s priorities without assessing possibilities • First identified, first completed approach • Tackling the easiest problem first, or completion of the easiest task first

6. Strategy for Prioritizing CURE • Critical needs • Urgent needs • Routine Responsibilities • Extras

7. Refocusing- Outcomes vs. Tasks • What is my goal (outcome)? • What tasks will lead to fulfillment of the goal? • What problems do I anticipate if I wait to do the tasks? • What happens if the outcome is not reached? • What should I do; what could I delegate?

8. PRACTICE SCENARIO - 0715 • Your assignment today on the Inpatient unit is: • Rm 9: 28yr G 1/P 1. Delivered 2hrs ago. Uncomplicated pregnancy & delivery. Her VS are due 15 min. after report. • Rm 8: 85 yr FTT admitted 2 days ago for rehydration and PT. Confused and demanding • Rm 7: 48 yr 24hr post op lap appendectomy. Anticipate DC today • New Admit: Rm 6: 10 yr old with SOB. ER is ready to bring her to the floor. • Using the CURE method, prioritize your assignment!

9. Practice Scenario - 0730 • How do you organize your day? • Rm 8’s call bell is ringing. • ER is still waiting • You do the PostPartum VS: • Her fundus is 2cm above the umbilicus, deviated to the right & boggy. Lochia is a large amount rubra with small clots,. T: 98.6, P 110, R 20, BP 80/50. LR with 10 Units Pit is running at 125/hr. She c/o 8/10 pain in the perineum. • Do your priorities change?

10. Delegation is…

11. Delegation is… Delegation as “transferring to a competent individual the authority to perform a selected nursing task in a selected situation.” (NCSBN, 1995) Delegation as “the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.” (ANA, 1994)

12. Delegation’s Historical Perspective • Pre-’70’s: Delegation was how nurses worked: few RN’s on floors, Team Nursing • ’70’s – ’80’s: Huge technology advances in nursing care and hospitals… More RN’s, fewer assistive staff. • Mid ’90’s: Shift from all professional staff to multi- level nursing staff, Cost containment strategies coupled with nursing shortages

13. Delegation requires… • Management skills • Mentorship skills • Knowledge of the chain of command • Knowledge of scope of practice • Understanding of nursing task vs. professional responsibility • Knowledge & understanding of liabilities

14. Delegation • …promotes teamwork • …reinforces organizational harmony • …increases productivity • …empowers others • …enhances communication • …develops skills • …builds trust • …builds leadership skills

15. Delegation benefits… • Allows the nurse more freedom within her span of control • Others can do task-oriented items • Nurse can do the crucial things: > assessment > judgment & decisions > coordinate patient care • Allows the delegatee to learn new skills

16. Practice Scenario - 0730 • How do you organize your day? • Rm 8’s call bell is ringing. • ER is still waiting and: • You do the PostPartum VS: • Her fundus is 2cm above the umbilicus, deviated to the right & boggy. Lochia is a large amount rubra with small clots,. T: 98.6, P 110, R 20, BP 80/50. LR with 10 Units Pit is running at 125/hr. She c/o 8/10 pain in the perineum. • Do your priorities change? • Can you delegate something?

17. Effective Delegation • Understand delegation concepts • Master delegation skills • Practice the art of working with people • Implement delegation as an ongoing process

18. Delegation Process • Identify the purpose • Identify the competencies of the delegatee • Understand the job descriptions and policies in the area

19. Five Rights • Right Task • Right Person • Right Communication • Right Circumstance • Right Supervision

20. 1. Right Task

21. 2. Right Person

22. 3. Right Communication

23. 4. Right Circumstance

24. 5. Right Supervision

25. Decision Making Tree • State Rules, Regs, Practice Act • Facility Policies • Assessment Prior to Delegation • Assess the Delegatee • Adequate RN Supervision • Reasonable & Prudent • Clear Communication

26. Golden Rule • Do not delegate… • …assessment • …planning • …evaluation

27. Decision Making Grid Tools to assist nurses in making delegation decisions

28. Practice Scenario - 0730 • How do you organize your day? • Rm 8’s call bell is ringing. • ER is still waiting and: • You do the PostPartum VS: • Her fundus is 2cm above the umbilicus, deviated to the right & boggy. Lochia is a large amount rubra with small clots,. T: 98.6, P 110, R 20, BP 80/50. LR with 10 Units Pit is running at 125/hr. She c/o 8/10 pain in the perineum. • Do your priorities change? • Can you delegate something? • Who can you delegate to and what can you delegate?

29. Delegation as Team Work • Trust one another • Respect all roles & tasks • Admiration for co-workers • Define roles clearly • Expectations upheld for all

30. Practice Scenario - 0830 • Your PP patient in now stable • Now you sit down to organize your day, check meds due, etc. • The Dr. is making rounds and writing discharge orders • You are reminded of your ER admit, who is has been in the room for 30 min. • Priorities? Delegation?

31. Practice Scenario - 0845 • ER Admit: Shauna, a 10yo, presented to the ER today with productive cough of thick, white, mucous & temp of 101.6, rapid/shallow breathing & chills. It has been three hours since her presentation to ER, she is now admitted & in her room awaiting initiation of orders. Shauna begins to cry & say. “I don’t want an IV, they hurt too much”. Her mother reports that she has a history of asthma and she is upset that Shauna must be hospitalized. She states, “it is Shauna’s fourth admission. I’m afraid I’m going to lose my job if I miss anymore work. Can’t you do something to prevent her from hurting?” Her physical exam reveals diminished breath sounds on the right side in the lower quadrant of her posterior lung fields and rhonchi scattered throughout the remaining lung fields. A chest x-ray confirms the diagnosis of pneumonia. When assisting Shauna to the bathroom, the nurse notes weakness with ambulation. • Prioritize this patient’s care, your assignment and delegate as indicated!