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Effective Delegation and Supervision. Insert Chapter 18 opening illustration. Key Concepts. Staffing patterns in the current health care system Principles of delegation and supervision Safe delegation practices Delegation vs. assignment. Effective Delegation and Supervision.

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Effective Delegation and Supervision

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    Presentation Transcript
    1. Effective Delegation and Supervision Insert Chapter 18 opening illustration

    2. Key Concepts • Staffing patterns in the current health care system • Principles of delegation and supervision • Safe delegation practices • Delegation vs. assignment

    3. Effective Delegation and Supervision • Accomplish patient care safely • Effectively use a variety of skilled and nonskilled workers • Provide essential skills for the RN in any practice role or setting

    4. Issues Affecting Staffing Patterns • Balanced Budget Act of 1997 • Managed care • Prospective payment system • Nursing shortage

    5. Changes in Staffing Patterns • Decline in the number and utilization of RNs • Increased utilization of unlicensed assistive personnel (UAP) • Overlapping of care providers’ roles

    6. Economic Necessity • Place for competent, appropriately supervised UAPs and licensed practical nurses/licensed vocational nurses (LPNs/LVNs ) in patient care • RNs’ confidence with delegation and supervision skills is essential

    7. Delegation • Management strategy to accomplish cost-effective health care • Transfer of responsibility and authority for the performance of an activity • RN remains accountable for outcomes • Two-way process between RN and delegatee

    8. RN Delegator Responsibilities • The act of delegation • Supervising the performance of the delegated task • Assessment and follow-up evaluation • Any intervention or corrective actions required to ensure safe and effective care

    9. Delegatee Responsibilities • Monitoring his or her own actions • Accepting delegation within the parameters of training and education • Communicating appropriate information to delegator • Completing the task

    10. What Can Be Delegated? • No definitive list • Varies: • From state to state • From organization to organization • From situation to situation • Assessment, evaluation, and nursing judgment cannot be delegated

    11. Delegation Guidance • State nursing practice acts • Patient needs • Job descriptions • Competencies of employees • Policies and procedures • Clinical situation • Professional standards of nursing practice

    12. State Nursing Practice Acts • Provide guidance for legal delegation • Criteria may be presented in various parts of the act • State Board of Nursing can offer guidance • Know legal scope of practice for LPN/LVN • UAP practice generally governed by the health care organization

    13. Patient Needs • RN must perform patient assessment • Stable patients generally mean a safer delegation opportunity • Tasks that can be delegated may be intertwined with a nursing responsibility

    14. Job Descriptions • Detail tasks and responsibilities required as a condition of employment • Comply with state laws and organization’s standards of care • Training should be related to the job description • Legal requirements supersede organizational policies

    15. Competencies • Confirm the staff member’s specific knowledge and skills • Written competency documentation required by regulatory and accrediting agencies • RN should be knowledgeable of staff members’ competencies

    16. Organizational Policies and Procedures • Designate specific skill level and supervision requirements for tasks • Designate general standards of care such as infection control

    17. Clinical Situation • Time to perform the task • Familiarity with characteristics of the population • Complexity of the task • Resources to perform the task • Adequate supervision available

    18. Professional Standards of Nursing Practice • Agreed-upon levels of nursing practice competence determined by American Nurses Association (ANA) and specialty nursing organizations

    19. ANA’s Delegation Standard • When delegating, the RN will consider: • Assessment of the patient condition • Capabilities of the nursing and assistive staff • Complexity of the task to be delegated • Amount of clinical supervision needed • Staff workload

    20. ANA’s Delegation Standard—cont’d • What can be delegated: • Feeding, drinking, positioning, ambulating, grooming, toileting, dressing, and socializing • Collecting, reporting, and documenting data related to these activities • Maintaining a clean, safe, and efficient environment • Housekeeping, transporting, and record keeping • Stocking and maintaining supplies

    21. ANA’s Delegation Standard—cont’d • What cannot be delegated: • Initial nursing assessment • Determination of nursing diagnoses • Establishment of nursing care goals • Development of nursing plan of care • Evaluation of patient’s progress • Health counseling or teaching • Activities that require specialized nursing knowledge, skill, or judgment

    22. Safe Delegation Practices • Establish a foundation of knowledge • Assess patient before delegation • Know delegatee’s knowledge and skill level • Know the task to be delegated • Comply with skill requirements in written policies and procedures

    23. Safe Delegation Practices—cont’d • Explain task and outcomes • Expect responsible action • Assess and supervise job performance • Provide for positive outcomes • Evaluate and follow-up

    24. Safe Delegation Practices—cont’d • Know specific standards of nursing practice • Be involved in LPN/LVN and UAP training programs • Help develop LPN/LVN and UAP job descriptions • Always evaluate the delegated action • Never ignore poor performance

    25. High-Risk Delegation • Task should be performed only by an RN • Task could involve substantial risk for the patient • Delegatee has not had the necessary training • RN fails to provide adequate supervision • RN fails to evaluate the delegated action

    26. Delegation and the Nursing Process • Assess the patient and plan the care • Identify tasks that someone else can perform • Implement the plan of care • Assign and supervise task performance • Evaluate performance and client response

    27. Five Rights of Delegation • Right task • Right circumstances • Right person • Right direction and communication • Right supervision and evaluation

    28. Supervision • Active process of directing, guiding, and influencing a worker’s performance • On-site supervision • Physically present or immediately available • Off-site supervision • Available through written and verbal communication • Increased use of telecommunications technology is raising supervision questions

    29. Components of Supervision • Initial direction • Periodic inspection • Levels of supervision • Unsupervised • Initial direction and periodic inspection • Continuous

    30. Supervising • Make frequent rounds, observe, and communicate • Provide the appropriate level of supervision • Be available for questions/unexpected problems • Supervise in a positive, supportive manner

    31. Supervising—cont’d • Intervene immediately if the task is not being performed safely and appropriately • Never ignore poor performance—document and report • Use mistakes as learning opportunities

    32. Assigning vs. Delegating • Assignment • Transfer of responsibility and accountability is downward or lateral • Activities designated are consistent with job position and qualifications • Staff member assumes responsibility and is accountable

    33. Assignment Considerations • UAP assignments are functions and tasks, not patients or groups of patients • LPN/LVN may be assigned specific clients for whom to perform care • RN remains responsible for nursing practice activities

    34. Assignment Considerations—cont’d • Patient’s psychologic status • Patient’s physiologic status • Complexity of care • Infection control or cross-contamination • Level of supervision required • Staff development opportunities

    35. The Transdisciplinary Team • Teams valuable in meeting patient care needs • Team members should know scope of practice and training of other team members • Team members may report to the RN • Team members may report to supervisors in their individual disciplines and work collaboratively with the RN

    36. Barriers to Effective Delegation • Fear of being disliked • Fear of losing control • Fear of taking risks • Fear of making mistakes • Lack of confidence • Lack of knowledge

    37. Effective Delegation and Supervision Skills • Communicate effectively • Create an environment of trust and cooperation • Create an environment of teaching and learning • Promote patient satisfaction • Provide feedback and follow-up

    38. Appropriate Feedback • Provide honest feedback about performance • Praise good performance • Address poor performance • Immediately stop inappropriate, unsafe, or incompetent performance • Document and report • Request additional training or other action