Fundamentals of Nursing - Chapter 6: Delegation and Supervision - PDF

CHAPTER 6 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT DELEGATION FACTORS SECTION: MANAGEMENT OF CARE Nurses can only delegate tasks appropriate for the skill Del...

CHAPTER 6 UNIT 1 SAFE, EFFECTIVE CARE ENVIRONMENT DELEGATION FACTORS SECTION: MANAGEMENT OF CARE Nurses can only delegate tasks appropriate for the skill Delegation and and education level of the individual who is receiving the CHAPTER 6 assignment (the delegatee). Supervision RNs cannot delegate the nursing process, client education, or tasks that require nursing judgment to PNs or to APs. TASK FACTORS: Prior to delegating client care, nurses should consider the: Delegation is the process of transferring the Predictability of the outcome: Will the completion of performance of a task to another member of the the task have a predictable outcome? ◯ Is it a routine treatment? health care team while retaining accountability ◯ Is it a new treatment for that client? for the outcome. Potential for harm ◯ Is there a chance that something negative could Supervision is the process of directing, happen to the client (bleeding, aspiration)? ◯ Is the client unstable? monitoring, and evaluating the performance Complexity of care of tasks by another team member. Nurses are ◯ Does the client’s care require complex tasks? ◯ Does the state’s practice act or the facility’s policy responsible for supervising the performance of allow the delegatee to perform the task, and does the client care tasks they delegate to others. delegatee have the necessary skills? Need for problem solving and innovation Licensed personnel are nurses who have ◯ Is judgment essential while performing the task? ◯ Does it require nursing assessment or completed a course of study in nursing and data‑collection skills? successfully passed either a PN or RN examination. Level of interaction with the client: Does the delegatee need psychosocial support or education during the Unlicensed personnel are individuals who have performance of the task? had training to function in an assistive role to licensed nurses in providing client care. DELEGATEE FACTORS Education, training, and experience These unlicensed individuals might be nursing Knowledge and skill to perform the task Level of critical thinking the task requires personnel (certified nursing assistants [CNAs], Ability to communicate with others as it pertains to the task certified medication assistants [CMAs]) or Demonstration of competence The facility’s policies and procedures non‑nursing personnel (dialysis technicians, Licensing legislation (state’s nurse practice acts) (6.1) monitor technicians, phlebotomists). Some facilities differentiate between licensed 6.1 Examples of tasks nurses may and unlicensed personnel by using the acronym delegate to PNs and APs NAP for nursing assistive personnel or AP for (provided the facility’s policy and state’s practice guidelines permit) assistive personnel. TO PNS TO APS Monitoring findings Activities of daily DELEGATION (as input to the RN’s ongoing assessment) living (ADLs) Bathing ◯ A licensed nurse is responsible for providing clear Reinforcing client teaching Grooming ◯ from a standard care plan directions when delegating a task initially and for periodic Dressing ◯ Performing reassessment and evaluation of the outcome of the task. tracheostomy care Toileting ◯ RNs can delegate to other RNs, PNs, and AP. Suctioning Ambulating ◯ ◯ RNs must be knowledgeable about their state’s nurse Checking NG Feeding (without ◯ swallowing precautions) practice act and the regulations that guide the use of tube patency Administering Positioning ◯ PNs and AP. enteral feedings Routine tasks ◯ RNs must delegate tasks so that they can complete Inserting a urinary Bed making ◯ higher‑level tasks that only RNs can perform. This catheter Specimen collection ◯ allows more efficient use of all team members. Administering medication Intake and output ◯ PNs can delegate to other PNs and to AP. (excluding IV medication Vital signs (for ◯ in some states) stable clients) FUNDAMENTALS FOR NURSING CHAPTER 6 Delegation and Supervision 27  Online Video: Delegation DELEGATION AND Right person SUPERVISION GUIDELINES Determine and verify the competence of the delegatee. Use the five rights of delegation to decide. (6.2) The task must be within the delegatee’s scope of ◯ Tasks to delegate (right task) practice or job description. ◯ Under what circumstances (right circumstances The delegatee must have the necessary competence and [setting and resources]) training. ◯ To whom (right person) Continually review the performance of the delegatee ◯ What information to communicate (right direction and determine care competence. and communication) Evaluate the delegatee’s performance according to ◯ How to oversee and appraise (right supervision standards, and when necessary, take steps to remediate and evaluation) any failure to meet standards. Use professional judgment and critical thinking skills RIGHT PERSON: Delegate a PN to administer enteral when delegating. feedings to a client who has a head injury. Right task WRONG PERSON: Delegate an AP to administer enteral feedings to a client who has a head injury. Identify which tasks are appropriate to delegate for each specific client. Right direction and communication A right task is repetitive, requires little supervision, and in writing, orally, or both is relatively noninvasive for the client. Delegate activities to appropriate levels of team Communicate what data to collect. members (RN, PN, AP) according to professional Provide a method and timeline for reporting, including standards of practice, legal and facility guidelines, and when to report concerns and assessment findings. available resources. Communicate specific task(s) to perform and client‑specific instructions. RIGHT TASK: Delegate an AP to assist a client Detail expected results, timelines, and expectations for who has pneumonia to use a bedpan. follow‑up communication. WRONG TASK: Delegate an AP to administer a RIGHT DIRECTION AND COMMUNICATION: nebulizer treatment to a client who has pneumonia. Delegate an AP to assist Mr. Martin in room 312 with a shower before 0900. Right circumstances WRONG DIRECTION AND COMMUNICATION: Determine the health status and complexity of care the Delegate an AP to assist Mr. Martin in client requires. room 312 with morning hygiene. Match the complexity of care demands to the skill level of the delegatee. Right supervision and evaluation Consider the workload of the delegatee. Provide supervision, either directly or indirectly RIGHT CIRCUMSTANCE: Delegate an AP to measure the (assigning supervision to another licensed nurse). vital signs of a client who is postoperative and stable. Monitor performance. WRONG CIRCUMSTANCE: Delegate an AP to measure Intervene if necessary (for unsafe clinical practice). the vital signs of a client who is postoperative and Provide feedback: required naloxone to reverse respiratory depression. ◯ Did the delegatee complete the tasks on time? ◯ Was the delegatee’s performance satisfactory? ◯ Did the delegatee document and report unexpected findings? ◯ Did the delegatee need help completing the tasks on time? Evaluate the client and determine the client’s outcome status. 6.2 The five rights of delegation Evaluate task performance and identify needs for performance‑improvement activities and Right task additional resources. RIGHT SUPERVISION: Delegate an AP to Right circumstance assist with ambulating a client after the RN Right person completes the admission assessment. Right direction and communication WRONG SUPERVISION: Delegate an AP to assist with ambulating a client prior to the RN Right supervision and evaluation performing an admission assessment. 28 CHAPTER 6 Delegation and Supervision CONTENT MASTERY SERIES  Application Exercises Active Learning Scenario 1. A nurse on a medical‑surgical unit has received A nurse manager is reviewing the responsibilities of delegation change‑of‑shift report and will care for four with a group of nurses on a medical unit. Use the ATI Active clients. Which of the following tasks should the Learning Template: Basic Concept to complete this item. nurse assign to an assistive personnel (AP)? NURSING INTERVENTIONS: List at least five A. Updating the plan of care for a tasks the delegating nurse must perform when client who is postoperative supervising and evaluating a delegatee. B. Reinforcing teaching with a client who is learning to walk using a quad cane C. Reapplying a condom catheter for a client who has urinary incontinence D. Applying a sterile dressing to a pressure injury 2. A nurse manager is assigning care of a client who is being admitted from the PACU following thoracic surgery. The nurse manager should assign the client to which of the following staff members? A. Charge nurse B. Registered nurse (RN) C. Practical nurse (PN) D. Assistive personnel (AP) 3. A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP. Which of the following information should the nurse share with the AP? (Select all that apply.) A. The roommate ambulates independently. B. The client ambulates wearing slippers over antiembolic stockings. C. The client uses a front‑wheeled walker when ambulating. D. The client had pain medication 30 min ago. E. The client is allergic to codeine. F. The client ate 50% of breakfast this morning. 4. A charge nurse is assigning client care for four clients. Which of the following tasks should the nurse assign to a PN? A. Creating a plan of care for a client who is recovering following a stroke B. Assessing a pressure injury on a client who is on bed rest C. Providing nasopharyngeal suctioning for a client who has pneumonia D. Teaching a client who has asthma to use a metered‑dose inhaler 5. A nurse is preparing an in‑service program about delegation. Which of the following are components of the five rights of delegation? (Select all that apply.) A. Right place B. Right supervision and evaluation C. Right direction and communication D. Right documentation E. Right circumstances FUNDAMENTALS FOR NURSING CHAPTER 6 Delegation and Supervision 29