Effective Delegation and Supervision

1
Effective Delegation and Supervision
Insert Chapter 18 opening illustration
2
Key Concepts

• Staffing patterns in the current health care
  system
• Principles of delegation and supervision
• Safe delegation practices
• Delegation vs. assignment

3
Effective Delegation and Supervision

• Accomplish patient care safely
• Effectively use a variety of skilled and
  nonskilled workers
• Provide essential skills for the RN in any
  practice role or setting

4
Issues Affecting Staffing Patterns

• Balanced Budget Act of 1997
• Managed care
• Prospective payment system
• Nursing shortage

5
Changes in Staffing Patterns

• Decline in the number and utilization of RNs
• Increased utilization of unlicensed assistive
  personnel (UAP)
• Overlapping of care providers roles

6
Economic Necessity

• Place for competent, appropriately supervised
  UAPs and licensed practical nurses/licensed
  vocational nurses (LPNs/LVNs ) in patient care
• RNs confidence with delegation and supervision
  skills is essential

7
Delegation

• Management strategy to accomplish cost-effective
  health care
• Transfer of responsibility and authority for the
  performance of an activity
• RN remains accountable for outcomes
• Two-way process between RN and delegatee

8
RN Delegator Responsibilities

• The act of delegation
• Supervising the performance of the delegated task
• Assessment and follow-up evaluation
• Any intervention or corrective actions required
  to ensure safe and effective care

9
Delegatee Responsibilities

• Monitoring his or her own actions
• Accepting delegation within the parameters of
  training and education
• Communicating appropriate information to
  delegator
• Completing the task

10
What Can Be Delegated?

• No definitive list
• Varies
• From state to state
• From organization to organization
• From situation to situation
• Assessment, evaluation, and nursing judgment
  cannot be delegated

11
Delegation Guidance

• State nursing practice acts
• Patient needs
• Job descriptions
• Competencies of employees
• Policies and procedures
• Clinical situation
• Professional standards of nursing practice

12
State Nursing Practice Acts

• Provide guidance for legal delegation
• Criteria may be presented in various parts of the
  act
• State Board of Nursing can offer guidance
• Know legal scope of practice for LPN/LVN
• UAP practice generally governed by the health
  care organization

13
Patient Needs

• RN must perform patient assessment
• Stable patients generally mean a safer delegation
  opportunity
• Tasks that can be delegated may be intertwined
  with a nursing responsibility

14
Job Descriptions

• Detail tasks and responsibilities required as a
  condition of employment
• Comply with state laws and organizations
  standards of care
• Training should be related to the job description
  
• Legal requirements supersede organizational
  policies

15
Competencies

• Confirm the staff members specific knowledge and
  skills
• Written competency documentation required by
  regulatory and accrediting agencies
• RN should be knowledgeable of staff members
  competencies

16
Organizational Policies and Procedures

• Designate specific skill level and supervision
  requirements for tasks
• Designate general standards of care such as
  infection control

17
Clinical Situation

• Time to perform the task
• Familiarity with characteristics of the
  population
• Complexity of the task
• Resources to perform the task
• Adequate supervision available

18
Professional Standards of Nursing Practice

• Agreed-upon levels of nursing practice competence
  determined by American Nurses Association (ANA)
  and specialty nursing organizations

19
ANAs Delegation Standard

• When delegating, the RN will consider
• Assessment of the patient condition
• Capabilities of the nursing and assistive staff
• Complexity of the task to be delegated
• Amount of clinical supervision needed
• Staff workload

20
ANAs Delegation Standardcontd

• What can be delegated
• Feeding, drinking, positioning, ambulating,
  grooming, toileting, dressing, and socializing
• Collecting, reporting, and documenting data
  related to these activities
• Maintaining a clean, safe, and efficient
  environment
• Housekeeping, transporting, and record keeping
• Stocking and maintaining supplies

21
ANAs Delegation Standardcontd

• What cannot be delegated
• Initial nursing assessment
• Determination of nursing diagnoses
• Establishment of nursing care goals
• Development of nursing plan of care
• Evaluation of patients progress
• Health counseling or teaching
• Activities that require specialized nursing
  knowledge, skill, or judgment

22
Safe Delegation Practices

• Establish a foundation of knowledge
• Assess patient before delegation
• Know delegatees knowledge and skill level
• Know the task to be delegated
• Comply with skill requirements in written
  policies and procedures

23
Safe Delegation Practicescontd

• Explain task and outcomes
• Expect responsible action
• Assess and supervise job performance
• Provide for positive outcomes
• Evaluate and follow-up

24
Safe Delegation Practicescontd

• Know specific standards of nursing practice
• Be involved in LPN/LVN and UAP training programs
• Help develop LPN/LVN and UAP job descriptions
• Always evaluate the delegated action
• Never ignore poor performance

25
High-Risk Delegation

• Task should be performed only by an RN
• Task could involve substantial risk for the
  patient
• Delegatee has not had the necessary training
• RN fails to provide adequate supervision
• RN fails to evaluate the delegated action

26
Delegation and the Nursing Process

• Assess the patient and plan the care
• Identify tasks that someone else can perform
• Implement the plan of care
• Assign and supervise task performance
• Evaluate performance and client response

27
Five Rights of Delegation

• Right task
• Right circumstances
• Right person
• Right direction and communication
• Right supervision and evaluation

28
Supervision

• Active process of directing, guiding, and
  influencing a workers performance
• On-site supervision
• Physically present or immediately available
• Off-site supervision
• Available through written and verbal
  communication
• Increased use of telecommunications technology is
  raising supervision questions

29
Components of Supervision

• Initial direction
• Periodic inspection
• Levels of supervision
• Unsupervised
• Initial direction and periodic inspection
• Continuous

30
Supervising

• Make frequent rounds, observe, and communicate
• Provide the appropriate level of supervision
• Be available for questions/unexpected problems
• Supervise in a positive, supportive manner

31
Supervisingcontd

• Intervene immediately if the task is not being
  performed safely and appropriately
• Never ignore poor performancedocument and report
• Use mistakes as learning opportunities

32
Assigning vs. Delegating

• Assignment
• Transfer of responsibility and accountability is
  downward or lateral
• Activities designated are consistent with job
  position and qualifications
• Staff member assumes responsibility and is
  accountable

33
Assignment Considerations

• UAP assignments are functions and tasks, not
  patients or groups of patients
• LPN/LVN may be assigned specific clients for whom
  to perform care
• RN remains responsible for nursing practice
  activities

34
Assignment Considerationscontd

• Patients psychologic status
• Patients physiologic status
• Complexity of care
• Infection control or cross-contamination
• Level of supervision required
• Staff development opportunities

35
The Transdisciplinary Team

• Teams valuable in meeting patient care needs
• Team members should know scope of practice and
  training of other team members
• Team members may report to the RN
• Team members may report to supervisors in their
  individual disciplines and work collaboratively
  with the RN

36
Barriers to Effective Delegation

• Fear of being disliked
• Fear of losing control
• Fear of taking risks
• Fear of making mistakes
• Lack of confidence
• Lack of knowledge

37
Effective Delegation and Supervision Skills

• Communicate effectively
• Create an environment of trust and cooperation
• Create an environment of teaching and learning
• Promote patient satisfaction
• Provide feedback and follow-up

38
Appropriate Feedback

• Provide honest feedback about performance
• Praise good performance
• Address poor performance
• Immediately stop inappropriate, unsafe, or
  incompetent performance
• Document and report
• Request additional training or other action