Management of Care - DELEGATION

Lesson 1 : Management of care

1. Concepts of Management and Supervision:

a. Review standards / position statements of the following agencies before delegating any nursing tasks
-State board of nursing
-Interpretations / position statements of specific board or nursing
-Standards of nursing organizations: ANA, NLN, and NCSBN
-Policy of health care institutions
b. Use critical thinking in management situations

2.Delegation
a. Definition of delegation: a process by which responsibility and authority for performing tasks are transferred from one individual to another who accepts that authority and responsibility
b. Delegation involves
-Responsibility: an obligation to accomplish a task
-Accountability: accepting ownership for the results or lack of
-Authority: right to act or empower
c. Principles of delegation
-A nurse can only delegate those tasks for which that nurse is responsible according to the specific state's nurse practice act
-The delegator remains accountable for the task
-Along with responsibility for a task, the nurse who delegates must also transfer the authority necessary to complete the task
-The delegator knows well the task to be delegated
-Delegation is a contractual agreement that is entered into voluntarily
-Consider the scope of practices of nursing personnel :

1. registered nurses:
   baccalaureate prepared nurses are equipped to care for individuals, families, groups and communities in both structured and unstructured health settings
   2.associate degree prepared nurses are equipped to care for individuals in a structured health care environment
   3. RNs cannot delegate to unlicensed personnel:
   a. initial assessment of patients
   b. evaluation of patient data
   c. nursing judgment
   d. patient/family education/evaluation
   e. nursing diagnosis/nursing care planning
2. Licensed practical or vocational nurses (LPN/VN) are equipped to assist in implementing a defined plan of care and to perform procedures according to protocol. Assessment skills are directed at differentiating normal from abnormal. Competence is in caring for physiologically stable patients with predictable conditions.

Unlicensed assistive personnel (UAP) have the most limited scope of practice. They can assist in a variety of direct patient care activities such as bathing, transferring, ambulating, feeding, toileting, obtaining measurements such as vital signs, height, weight and intake and output. They can also perform indirect activities such as housekeeping, transporting and stocking supplies.

d. Steps to delegation
1. Define the task
2. Determine the delegate
is the task within the scope of practice of the delegate?
the scope of practice is define
-nurse practice acts: each state defines what nurses may do
-standards of practice: the American Nurses Association (ANA)
defines standard of practice
Organizational policies and job descriptions
Does the ability of this caregiver match the needs of the task?
3. Communicate clearly about expectations regarding the task
state clearly who will do what by when and how, where and why it will be done
state clearly the outcomes you expect
4. Reach mutual agreement about the task to be completed
the delegator validates with the delegate that an understanding exists regarding what is to be done and the outcomes that are expected
discuss potential problems and solutions
5. Monitor the task and provide guidance as needed
was the task completed according to specifications?
6. Evaluate results
was the desired outcome obtained?
in the desired time?
7. Provide feedback to individual on outcomes performance
review with the delegate what went right as well as what went wrong with the process
e. Five rights of delegation
1. Right task
2. Right circumstances
3. Right person
4. Right direction/communication
5. Right supervision

Client care assignments
Assign the right task
Assign the task to the right person
The PN may assign tasks to the unlicensed assistive personnel or nursing assistants
Unlicensed assistive personnel (UAP) or nursing assistants cannot delegate to other UAPs or nursing assistants
Performance Improvement / Quality Assurance .

• Quality definition: the degree to which client care services increase the probability of desired outcomes and reduce the probability of undesired outcomes given the current state of knowledge
  
• Performance improvement/assurance definition: the process of attaining a new level of performance or quality that is superior to any previous one
  
• Total quality management definition: a management philosophy that emphasizes a commitment to excellence throughout the organization
  
• Six characteristics of total quality management
  Customer/client focus
  Focus on outcomes
  Total organizational involvement
  Multidisciplinary approach
  Use of quality tools and statistics for measurement
  Identification of key areas for improvement