CHAPTER 9 DELEGATION OF CLIENT CARE

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CHAPTER 9DELEGATIONOF CLIENT CARE
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Delegation of Client Care
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Definition

• The reassigning of responsibility for the
  performance of a job from one person to another
• (ANA, 1996)

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Concepts of Delegation

• The responsibility of the task is transferred
• Accountability remains with the delegator
• Delegation may be direct or indirect

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Direct Delegation

• Usually verbal direction
• RN decides which staff member is capable of
  performing a specific task

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Indirect Delegation

• Contained in an approved listing of tasks
  established by an institution
• Permitted tasks may vary from institution to
  institution

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Assigning Tasks

• The RN may assign a more skilled individual to
  perform a task
• The RN may not assign an individual to perform an
  activity outside of a job description or the
  scope of practice

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Delegation vs Supervision
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Supervision

• Supervision usually more direct than delegation
• Requires directly overseeing the work or
  performance of others
• Includes checking with individuals during the day
• May entail delegation of tasks and activities
• Nurse manager performs both

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The Nursing Process and Delegation
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Assessment

• Assess client needs
• Set client-specific goals
• Match the personnel with the appropriate skills
  to care for the client

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Planning

• Mentally identify who is best suited for the task
  or activity
• Planning prevents later problems

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Implementation

• Assign the appropriate personnel who have the
  level of expertise necessary to deliver the care
  or carry out the activities

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Evaluation

• Oversee the care or activities
• Determine if client care needs have been met
• Allow for feedback

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Coordinating Assignments
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Methods to Help Organize Care

• Critical pathways
• Computerized information sheets
• Personalized worksheets
• Delegation tree

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Tips for Organizing Care

• Plan time around activities that must be
  performed at a certain time
• Perform high-priority activities first
• Cluster activities that may be performed together
• Consider your peak time when performing optional
  activities

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The Need for Delegation
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Changes in the Health-Care Environment

• Nursing shortage
• Health-care reform
• Increased need for nursing services
• Demographic trends
• Use of unlicensed assistive personnel

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Unlicensed Assistive Personnel (UAPs)

• Individuals trained to function in an assistive
  role to the nurse
• Perform delegated tasks
• Under direct supervision of the RN
• May or may not be certified

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Delegation to UAPs
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Examples of Tasks

• Vital signs
• Skills learned through special training
• Blood drawing
• ECGs
• Measuring intake and output
• Non-nursing duties

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Safe Delegation
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Criteria for Safe Delegation

• Potential for harm
• Complexity of the task
• Problem-solving and innovation necessary to
  complete the task or activity

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Considerations for Safe Delegation

• Ability of the individual
• Fairness of the task

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Task-Related Concerns
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Primary Concern

• Does the individual assigned to the task have
  the ability to perform the task?

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Other Task-Related Concerns

• Ability
• Priorities
• Efficiency
• Appropriateness

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Relationship-Oriented Concerns

• Fairness
• Learning opportunities
• Health
• Compatibility
• Preferences

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Summary of Expectations of Professionals

• Respect of others
• A reasonable workload
• Appropriate wages
• Determining his/her own priorities
• Ask for what he/she wants
• Accountability
• Give and receive information as a professional

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Barriers to Delegation
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Barriers

• Experience
• Licensure
• Quality of care
• Assigning work to others

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The Five Rights of Delegation

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

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Conclusion
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Points to Consider

• Delegation is not new
• The role is essential for good working
  relationships
• Organizational skills are a prerequisite for
  delegation
• Understanding client needs is essential for
  appropriate delegation

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The RN Needs to Understand

• The state nurse practice act
• The capabilities of each staff member
• The tasks that may be delegated
• The concept of accountability in delegation