Delegation in Nursing PDF

DELEGATION MANAGING CARE COURSE OUTCOME Explain management of care concepts COMPETENCY Describe the delegation process used by the nurse.  CONCEPTS Managing Care: Efficient and effective delivery of quality nursing care that maximizes limited human,...

DELEGATION MANAGING CARE COURSE OUTCOME Explain management of care concepts COMPETENCY Describe the delegation process used by the nurse.  CONCEPTS Managing Care: Efficient and effective delivery of quality nursing care that maximizes limited human, economic, and physical resources Focuses on decreased costs and improving patient outcomes Clinical Decision Making: A process used to examine and determine the best actions to meet desired goals requires anticipating, recognizing and organizing patient problems to respond with urgency and/or importance in a preferential order to avoid or minimize adverse changes in a patient’s condition  UNIT OUTCOMES Define delegation of patient care by the nurse. Discuss nursing care delivery models.  What is delegation? SCOPE OF PRACTICE Unlicensed Assistance Personnel LPN’s are unable to: Administer IV push medications Teaching the “practice of nursing” Supervising and evaluating “nursing practice” Assessing health status Must work under an RN Can delegate tasks to another LPN or UAP RN SCOPE OF PRACTICE RN’s Nursing process Assessing health status Health teaching and counseling Evaluate IV medications Blood and chemo Delegate to RN, LPN, UAP DELEGATION Transference of responsibility and authority for an activity to a competent individual Nursing assignment of a task to another person that is not a part of their regular job responsibilities Important component of a registered nurse’s responsibility DEFINITION: ASSIGNMENT Refers to the skill or task that is a fundamental part of one’s job, that an individual is expected to accomplish on a regular basis (NCSB) Asking/expecting an individual to perform a task that is in the person’s regular job description is NOT delegation DELEGATION IN NURSING Transfers specific task responsibility from RN to unlicensed staff or licensed practical nurse RN remains accountable for outcomes DELEGATION IS A CRITICAL AND IMPORTANT LEGAL CONSIDERATION American Nurses Association (ANA) National Council of State Boards of Nursing (NCSB) Both have issued a joint statement on delegation JOINT STATEMENT The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure the delegation or assignment is: 1. The right task. 2. Under the right circumstances. 3. To the right person 4. With the right directions and communication; 5. Under the right supervision and evaluation.  DELEGATION Can be difficult Many mitigating factors What are some of these factors or variables? EFFECTIVE DELEGATION RN assess the patient FIRST Determine the knowledge and skills of the person you want to delegate to. (UNLICENSED STAFF or LPN) Match tasks to the unlicensed staff or LPN’s individual skills. Communicate clearly: What is the Task? What is the outcome intended?, What is the time frame for completion? Listen attentively to clarify Set specific time for unlicensed staff or LPN to report back to you. Provide feedback POSITIVE or DEVELOPMENTAL feedback. DELEGATION The RN is a professional and is held accountable for outcomes The unlicensed staff and the LPN are held responsible for task DELEGATION Another RN LPN UAP Follow state nurse practice act Delegate only those tasks that you are responsible or accountable for Only accept delegation, when you have a clear understanding of the task, time frame, reporting requirements and other expectations Seek clarification if unclear DELEGATIO Unstable patients should not be N delegated to an LPN or UAP DELEGATION VS DUMPING Delegate to help manage time and the needs of patients Delegations should always be practiced in a way that provides the greatest benefit for patients and the best use of staff time.  Assignment Patterns Team/Paired or Partnered assignments Delegates (person receiving the delegation) must fully understand the task before accepting. OTHER DELEGATION If the delegate does not possess the CONSIDERATION necessary skills or abilities, must inform S: the delegator Communication between the delegator/delegate is essential. Accepting delegation means accepting full responsibility for outcome of the task OBSTACLES Environment Finances Leadership style Lack of resources Educational resources Time resources DELEGATOR INSECURITY Insecure because accountability is retained Fear of liability Fear of blame Fear of staff Poor time management Inexpereince UNWILLING DELEGATE INEXPERIENCE FEAR OF AVOIDING D FAILURE RESPONSIBILI TY MANAGING PATIENT CARE DELIVERY MODELS HOW AGENCIES ORGANIZE THEIR CARE ON THEIR UNITS TO DO THE WORK NURSING CARE DELIVERY MODELS Team Nursing Patient Focused Care Case Management Functional Method  Members of the nursing TEAM work with and help the other members to provide patient care. charge nurse RN TEAM team leader RN NURSING team members LPN, UNP, Secretary RN retains responsibility and authority, delegates to other team members  PATIENT FOCUSED CARE Registered nurse works directly with patients, families. Care is considered personalized Patients/families integral component of decision making The RN does not typically have additional nursing team members. The unit may have 1 unlicensed staff to maintain the patient care environment. The unlicensed staff member does not have a direct patient care assignment. CASE MANAGEMENT The Coordinator (RN, Case Management goal Social Worker) links is to streamline costs and health care services to is charged with patients and their maintaining quality. families. Organizes care over time Best for patients with using a combination of complex or chronic nursing and social health care needs services Interprofessional teams responsible for planning and assessing needs of patients from preadmission through discharge  Focuses on jobs Task oriented Production and that need to be efficiency completed model FUNCTION AL METHOD Economical Nonquantifiable aspects of care may be overlooked PRIMARY NURSING One RN responsible for overseeing the total care of a number of patients 24 hours a day, 7 days a week Even if nurse is not delivering the care personally Comprehensive, individualized, and consistent care All aspects of professional role Teaching Advocacy Decision making Continuity of care OHIO HOUSE BILL 163 https://www.legislature.ohio.gov/legislation/134/ hb163 https://search-prod.lis.state.oh.us/solarapi/v1/g eneral_assembly_134/bills/hb163/PH/02/hb163_ 02_PH?format=pdf WHICH DELIVERY OF CARE MODEL IS ON YOUR UNIT? NURSING DIRECTOR, JUAN CASTRO IS THE DIRECTOR OF A SKILLED NURSING UNIT WITHIN A LONG TERM CARE FACILITY. THERE HAVE BEEN MULTIPLE COMPLAINTS FROM PATIENTS, AND FAMILIES REGARDING INCONSISTENT CARE. EX. MEAL TRAYS NOT BROUGHT TO THE ROOM, NO ONE TO HELP FEED PATIENTS, BATHS NOT ALWAYS PROVIDED. WHAT TYPE OF NURSING MODEL MAY WORK BEST FOR THIS UNIT? WHY? WHAT DO YOU NEED TO CONSIDER? STRETCH QUESTION….WHAT NEEDS TO BE CONSIDERED IF A NEW NURSING MODEL IS USED? HOW WOULD YOU KNOW THE NEW MODEL IS WORKING?