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NR203 Test 3 Delegation


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⬢ Transferring to a competent individual the authority to perform a selected nursing task in a selected situation (NCSBN, 1995, remains the common definition)
- The nurse retains the accountability for the delegation
Who is this "competent individual"?
Who is this "competent individual"?
Nursing Assistive Personnel (NAP)
- Individuals employed within a health care, residential or community support context that includes a component of direct hands-on care and perfonming delegated nursing care tasks
- Certified Nursing Assistant (federal statute)
- Certified Nursing Assistant II
- Certffied Med Aide
- Nurses' aide
- Patient care technician
- Home Health Aide (federal statute)
Sources of Authority for Delegation
Sources of Authority for Delegation
⬢ Federal
⬢ State
- Nurse Practice Act
⬢ Statutes
⬢ Rules and Regulations
Sources of Authority (cont'd)
⬢ Employer policies and standards - Legal implications
- Nursing administrative service role in
delegation policy formation
- Nursing administrative service assurance of adequate structure and resources to support appropriate and effective delegation
Sources of Authority (cont'd)
Professional nursing standards
Sources of Authority (cont'd)
Professional nursing standards
ANA (American Nurses Association)
Code of Ethics for Nurses
The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care
Sources of Authority (cont'd)
⬢ Other standards
Sources of Authority (cont'd)
⬢ Other standards
- Specialty nursing organizations
- JCAHCO (Joint Commission for Accreditation
of Health Care Organizations)
- NCQA (National Committee for Quality Assurance)
State Authority - violations of N P A
State Authority - violations of N P A
⬢ "Unprofessional conduct: inappropriate delegation"
- 2001 11 investigations
- 2002 7 investigations
-2003 9
Making Assignments
Making Assignments
⬢ The distribution of work that each staff member is to accomplish on a given shift or work period (NCSBN, 2005)
- "Work plan" terminology
- Assignments are work plans; the nurse
"assigns" or distributes work and also "delegates" nursing care as she works through others
⬢ How complex is the patients' required care?
⬢ What are the dynamics of clients' status and their stability?
⬢ How complex is the assessment and ongoing
⬢ What kind of infection control is necessary?
⬢ Are there any individual safety precautions?
⬢ Is there special technology involved in the care, and who is skilled in its use?

⬢ How much supervision and oversight will be needed based on the staffs numbers and expertise?
⬢ How available are the supervising RNs?
⬢ How will the physical location of clients affect time and availability of care?
⬢ Can continuity of care be maintained?
⬢ Are there any personal reasons to allocate duties for a particular patient, or are there nurse or patient preferences that should be taken into account?
⬢ Is there an acuity rating system that will help distribute care based on a point or number system?
⬢ The provision of guidance and direction, oversight, evaluation and follow up by the licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel
Delegation and Assignment-
The Five Rights
Delegation and Assignment-
The Five Rights
⬢ Right Circumstances
⬢ Right Task
- Knowledge and skills of the delegate
- Verification of clinical competence by the employer
- Stability of the patient's condition
- Service setting variables
⬢ Available resources (including the nurse's accessibility)
⬢ Methods of communication
⬢ Complexity and frequency of care
⬢ Proximity and numbers of patients to staff

⬢ Right person
- Know their licensure, role and preparation
- Know their strengths and weaknesses
⬢ Right Direction/Communication -Clear
⬢ Right Supervision
- "Second report" - meeting with assistive personnel, outlining the day's plan and the plan for each client, and giving initial direction
- "checkpoint" meetings - before and after breaks and meals and before end of shift
Principles for Prioritization, Delegation and Assignment
Principles for Prioritization, Delegation and Assignment

1. Start with patient/family's preferred outcomes
2. Refer to NPA and job descriptions

3. Provide variable levels of supervision/guidance/support for student nurses, novices, floats, etc.

4. RN accountable for nursing judgment decisions and ongoing supervision
5. RN cannot delegate the Nursing Process or clinical judgment
6. Decisions are specific to the client, the
delegates and the situation

Stable patients with predictable outcomes Activities that involve standard, unchanging procedures
⬢ Remember Maslow
7. Everything is fluid and shifting
The delegation decision-making process
The delegation decision-making process
⬢ After documented/demonstrated evidence of the nurses' competency in use of delegation and the nursing assistant's current competency in receiving delegation
1. Assess and Plan
2. Communication
3. Surveillance and Supervision
4. Evaluation and feedback

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