Nursing Delegation Principles

Delegation

• Delegation is primarily about entrusting others with responsibility for tasks. Delegates act and initiate independently, assuming responsibility alongside the manager.
• Effective managers understand the strengths and weaknesses of their colleagues.
• Employees are viewed as team members, crucial for achieving goals.
• Authorization granted by a licensed professional to another (licensed or unlicensed) person to perform tasks within the delegator's scope of practice, but not the delegatee's scope, constitutes legal practice.
• Not every nursing task is delegable.
• Nurses must consider legal criteria, professional standards, and individual student needs before delegating tasks.
• A task may be delegable to a student/junior nurse under the supervision of a registered nurse (RN), if the situation permits and it is safe.
• Tasks are specific to the student; a task delegable to one student might not be suitable for another.
• Certain nursing procedures, such as complex tracheotomy suctioning or medication administration requiring dose calculation, are non-delegable and require a registered nurse's direct performance.
• Certain medications (administered by injection) and services requiring nursing assessments are non-delegable.
• Delegation is a complex process where authority is transferred. This is often to assistive personnel within the specific situation.

Principles of Delegation

• The delegator takes responsibility for the care.
• The delegator directs care and determines the suitability of delegation.
• The delegator delegates tasks and clarifies expectations.
• The delegator uses their nursing judgment based on the student/junior nurse's condition, competence, and determined supervision.
• The delegator communicates and validates the comprehension and acceptance of responsibilities.
• The delegator provides opportunities for the student/junior nurse to ask questions.
• The delegator participates in setting up systems to evaluate ongoing competency in delegation.
• The delegator uses critical thinking and professional judgment (five rights of delegation). This ensures the task, circumstances and the delegated individual are all appropriate. The delegator must ensure direction and communication are clear, appropriate and concise.
• The delegator ensures appropriate monitoring, evaluation, intervention, feedback, and documentation.
• The delegator only delegates tasks that the student/junior nurse possesses the knowledge, skills, ability to perform safely, cultural competence, experience, meets institutional policies and procedures.

Five Steps to Successful Delegation

• Step One: Planning involves analyzing tasks, identifying suitable tasks, determining goals, visualizing results, considering resources and timeframes, and choosing the right person.
• Step Two: Engaging involves presenting a clear picture, gaining commitment, communicating goals and expected results. This includes deadlines and relevant pertinent information.
• The speaker provides specific training as needed, which includes demonstrations, explanations and "teach backs". This is completed to ensure the task is well understood.
• Step Three: Collaborating involves reviewing the goal; discussing possible obstacles and solutions. The steps to overcome these include establishing communication barriers and/or scheduling coaching sessions (if needed).
• Milestone meetings are scheduled.
• Step Four: Supporting allows the employee to practice and get up to speed. Progress is monitored, support is given positively, and the need for coaching or further support is evaluated.
• Obstacles and solutions must be discussed, encouragement and support are offered, and a relaxed and efficient work environment is created.
• Realistic time constraints must be considered.

Step Five: Appreciating

• Showing interest in the results, and providing compliments for good work.
• Recognizing and providing credit when deserved.
• Unacceptable work, including unfinished, inaccurate or substandard work must be addressed directly.
• Accountability for unsatisfactory results.
• The delegation process must be revisited and improvements implemented.
• Suggestions and complaints are welcomed.

Performance Appraisal

• Performance appraisals are periodic evaluations of job performance against responsibilities, goals, and assigned tasks.
• It identifies employee strengths and weaknesses, identifies areas that might need potential training or development.
• Performance appraisals are essential for effective staff management, employee development and organizational improvement.
• Annual performance appraisals are important for monitoring standards, agreeing on expectations and objectives, and determining the necessary delegation of responsibilities.
• Staff Performance appraisals are essential for career and succession planning. It also helps with staff motivation, attitude and behavior development.
• Performance appraisals are a regular recorded review of how the individual has performed and a plan for future development.

Objectives of Performance Appraisal

• Improving work performance
• Administering merit pay
• Advising employees of work expectations
• Counseling employees
• Making promotion decisions
• Motivating employees
• Assessing employee potential
• Identifying training needs

Making a Success of Appraisal

• Gaining senior manager commitment
• Consulting relevant stakeholders (managers, employees, trade union representatives)
• Training appraisers to ensure fairness and objectivity.
• Keeping the appraisal scheme simple.
• Maintaining written records to provide feedback and monitor appraisals.
• Focusing on work description for performance and avoiding character assessments.

Appraisal Interview

• Providing adequate notice to employees.
• Using self-assessment forms to help employees prepare.
• Allowing adequate time (at least one hour) for the interview.
• Providing a comfortable and quiet interview setting to avoid interruptions during the appraisal.
• The appraiser should highlight employee strengths, provide methods to improve and discuss future performance goals.
• Both parties review success to date, agree on objectives and discuss development needs.

The Structure of The Interview

• Explaining the purpose and scope of the appraisal and the job responsibilities involved.
• Discussing job requirements, objectives and demands.
• Encouraging the employee to discuss strengths, weaknesses and areas where improvements are needed.
• Discussing how far agreed objectives were met.
• Agreeing on future objectives.
• Discussing development needs (education, training, skills, experience).
• Summarizing agreed upon feedback.
• Establishing an appeal process in case of any disagreement on the appraisal.

Change Management

• Change Management is an alteration in how tasks are completed. It affects organizational purposes, like objectives, strategy, culture, tasks, and activities.
• Change management includes structure, technology, leadership styles, personality, social systems, compensation methods, interpersonal functioning.

Sources of Change

• Internal factors include personnel problems and managerial decisions that cause change.
• External factors include political change, social factors, economic forces and technological change that drive change.

Types of Change

• Reactive (Unplanned) Change: Change occurs in response to threats, problems or opportunities. This change occurs spontaneously or randomly.
• Proactive (Planned) Change: This change results from a process that anticipates future issues, threats, and opportunities. It's driven by a perception of a gap between the desired and actual state of affairs.

Models and Dynamics of Planned Change

• Change impacts key organizational components.
• Change often alters the pattern of interactions/coordination within the organization.
• Leaders need appropriate models/strategies to manage the change.
• Models like Lewin's 3-phase process and Kotter’s 8-steps are helpful.

Assumptions of Change Models

• The change process involves learning something new and altering existing attitudes, behaviors and organizational practices.
• Motivation is essential for change to occur.
• Individuals are central to organizational change.
• Resistance to change may occur despite change aims being desirable.
• Change requires reinforcement of the new attitudes, behaviors, and organizational practices.

Lewin's 3-Phase Change Model

• Unfreezing: The stage where a situation is prepared for change. Existing attitudes/behaviors are challenged to create a need for something new, this is often driven by the recognition of a problem.
• Changing: The modification of existing systems and the introduction of new ones. This stage involves providing new information, developing new behaviors and new perspectives.
• Refreezing: The stage where the change is stabilized and integrated into the norm. The change is solidified by providing opportunities to practice the new behavior and methods and through positive reinforcement.

Kotter's Model

• Kotter's model outlines 8 steps.
• These steps support Lewin's model by first unfreezing behaviors, changing processes and strengthening new processes.
• Step 1 - Establish a sense of urgency
• Step 2 - Create a guiding coalition
• Step 3 - Develop a vision and strategy
• Step 4 - Communicate the change vision
• Step 5 - Empower broad-based action.
• Step 6 - Create short-term wins.
• Step 7 - Consolidate gains and produce more change.
• Step 8 - Anchor new approaches in the culture.

This quiz focuses on the essential principles of delegation in nursing. It covers how to effectively delegate tasks considering legal guidelines and individual competencies. Understand the importance of recognizing team members' strengths and weaknesses in achieving healthcare goals.