Prioritization and Delegation

1
Prioritization and Delegation
SOAR-RN

• Margaux Johnson RN
• Surgical Unit Team Leader

2
What do you want to know
Discussion Objectives

• Verbalizes appropriate delegation
• Verbalize CURE method utilized in prioritization
  and managing multiple tasks

3
Prioritization

• What words or phrases come to mind when we hear
  the word prioritization?

4
How the experts define prioritization

• Clinical Definition
• Deciding which needs or problems require
  immediate action and which ones could be delayed
  until a later time because they are not urgent.

5
Who do you see first?

• Mr. C., 68-year-old with unstable angina who
  needs teaching for CCL, scheduled this morning.
• Ms. J., a 45-year-old woman experiencing chest
  pain scheduled for a graded exercise test later
  today.
• Mr. R., a 75-year-old with a 2-day-old
  left-sided stroke.
• Mr. L., a 59-year-old man with mild shortness of
  breath and chronic emphysema.

6
What factors influence prioritization for you!

7
Factors that influence prioritization

• Experience expertise of individual nurse
• Patient acuity
• Nurse-patient relationship
• Unit organization
• Models of care
• Individual priority-setting strategies

8
Barriers

• What are some possible barriers to accurate
  prioritization?

9
Pitfalls in Priority Setting

• Inadequate assessment and evaluation
• Failure to differentiate between priority and
  non-priority problems
• Acceptance of others priorities without
  assessing the possibilities
• Performance of tasks
• First identifiedfirst completed approach
• Completion of the easiest task first

10
Strategy for Prioritizing

• CURE
• Critical needs
• Urgent needs
• Routine Responsibilities
• Extras

11
Refocusing--Outcomes vs. Tasks

• What is my goal (outcome)?
• What tasks will lead to fulfillment of the goal?
• What problems do I anticipate if I wait to do the
  tasks?
• What happens if the outcome is not reached?
• What should I do what could I delegate?

12
After hearing shift report which patient will
you see first?

• 1. A 20 year old with possible acute myelogenous
  leukemia who has just arrived on the medical
  unit.
• 2. A 38 year old with aplastic anemia who needs
  teaching about decreasing infection prior to
  discharge.
• 3. A 40 year old with lymphedema who requests
  help to put on compression stockings before
  getting out of bed.
• 4. A 60 year old with non-Hodgkins lymphoma who
  is refusing the ordered chemotherapy regimen.

13
Who will you see first after report?

• 1. A patient who developed tumor lysis
• syndrome around 500 am.
• 2. A patient with frequent reports of
• break-through pain over the past 24
• hours.
• 3. A patient scheduled for exploratory
• laparotomy this morning.
• 4. A patient with anticipatory nausea and
• vomiting for the past 24 hours.

14
Who, What, When..

• Who can help me?
• What do I need to do first?
• When does it need to be done?
• What will be the outcome if I do
• one activity before another one?

15
(No Transcript)
16
What is Delegation?

• ANA defines delegation as
• the transfer of responsibility for the
  performance of an activity from one individual to
  another while retaining accountability for the
  outcome
• Key Concept transfer while retaining
  accountability

17
What is Delegation?

• NCSBN defines delegation
• transferring to a competent individual the
  authority to perform a selected nursing task in a
  selected situation
• Key Terms competent, selected
• task, selected situations

18
Safeguarding the Public Safety

• State Boards of Nursing are responsible for Nurse
  Practice Acts, Scopes of Practice, and clear
  regulations for delegation.
• A licensed nurse has ultimate responsibility
  accountability for management and provision of
  patient care.
• http//adm.idaho.gov/adminrules/rules/idapa23/0101
  .pdf

19
Delegation is an essential nursing skill
20

• Who do you delegate to at
• St. Lukes?

21
What Cannot Be Delegated

• Activities within the scope of nursing practice
• Unstable patients
• Activities requiring assessment, problem-
  solving, judgment, evaluation
• Where outcome is unpredictable
• Sterile technique, med administration,
• IV therapy, invasive procedures.

22
Shift your focus!

• Identify outcomes for your patients at the
  beginning of your shift.

23
Barriers to Delegation

• Concern regarding patient safety
• Unsure of the persons competency to
  whom you are delegating?
• Super nurse mentality
• Unsure about rules and regulations
• What else?

24
Delegation Process

• Knowledge of job descriptions, policies,
  regulations, State Practice Act
• Identify the purpose of delegation
• Ensure the 5 rights of delegation
• Communicate effectively
• Offer and receive feedback
• Retain accountability for outcome

25
Five rights of Delegation

• Right task
• Right person
• Right circumstance
• Right communication
• Right supervision, feedback

26
Right Task

• What can be delegated?
• Tasks that fall within the facility procedures
  and protocols
• Tasks performed on patients who are stable and
  whose outcomes are predictable
• Tasks that require minimal supervision

27
Right Person

• Matching a task to a person
• Select the right task
• Person must be competent
• Right situation
• Focuses on outcomes
• Determine strengths and weaknesses of team members

28
The Right Circumstances

• Appropriate
• Patient
• Setting
• Available resources

29
Right communication

• Initial direction is most important
• Use the Cs of initial direction

30
The Cs of initial direction

• CLEAR
• CONCISE
• CORRECT
• COMPLETE

31
Stop and Reflect

• The nurse asks a CAP who didnt hear shift
• change report to take a patients B/P.
• The CAP measures the BP in the left arm
• which has a arteriovenous shunt. Which
  right of delegation did the nurse violate?
• Right time, right person, right information,
  right task.

32
Red Flags of Delegation

• Refusal to accept delegation
• Incomplete directions
• Failure to confirm expectations
• Failure to communicate

33
Supervision - Defined

• Provision of guidance or direction to perform and
  accomplish a task

34
Right Supervision

• Ask for the other individuals feedback
• first.
• Give credit for effort.
• Share your perceptions with each
• other.
• Explore different points of view.
• Agree on a plan for the future, include
• timeline for follow-up.
• Revisit the plan and results achieved.

35
Reflection

• How do you give feedback?

36
Trade roles and walk in their shoes!

• Trust one another- confidently expect
  fulfillment of patients and each others needs
• Respect for all roles/tasks and their importance
• Admiration- express approval/pride verbally and
  nonverbally
• Define/describe roles clearly (job descriptions).
• Expectations must be upheld for all roles.