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Nursing Delegation

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Simran Sahota

on 1 April 2013

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Transcript of Nursing Delegation

Direct Delegation decision depends on patient's nurse
takes into account best interest of patient
is complex
requires consideration of patient's needs
must be supported by agency policies & procedures
care providers knowledge & skill base to complete delegated task safely (CRNBC, 2005, p. 1) PRINCIPLES OF DELGATION Nursing Delegation LEARNING OBJECTIVES WHAT IS DELEGATION? ACCOUNTABILITY & RESPONSIBILITY RESPONSIBILITIES OF HEALTH CARE TEAM TYPES OF DELEGATION Indirect Delegation Reverse Delegation Inappropriate Delegation Delegating versus Dumping Overwhelmed with workload...??? Does nursing education lack delegation teaching? Who can I delegate too? Over-Delegation CRNBC THE FIVE RIGHTS OF DELEGATION POLICIES & PROCEDURES Regional specific - Health Authority
Agency specific policies - Site
Unit specific policies - unit/ward "Sharing authority with other care providers to provide a particular aspect of care" (CRNBC, 2013, p. 28)

"Working with people to accomplish more than one person can do alone" (Kaernested & Bragadottir, 2012, p. 10) Define nursing delegation
Assigning vs Delegating
RN's role as a delegator
Five rights of delegation
Benefits of delegation
Barriers to delegation 1. Right Task
2. Right Circumstances
3. Right Person
4. Right Direction & Communication
5. Right Supervision Personal qualities
Fear of competition or criticism
Fear of liability
Fear of loss of control
Fear of over burdening
Fear of decreased personal job satifaction
Time consuming - easier to complete task independently
Fear of mistakes
Reluctance to let go of certain aspects of RN work
Lack of trust
Lack of leadership

(ANA Health Care Education System, 2012; Kaernested & Bragadottir, 2012) Barriers to
Delegation Delegation to regulated care providers occurs when an activity is within the scope of the delegating profession and outside the scope of the other profession (CRNBC, 2013, p. 28)

Delegation to unregulated care providers occurs when the required task is performed primarily by nurse and is outside the role description and training of an unregulated care provider (CRNBC, 2005, p. 1) client-specific
in the patient's best interest
delegating nurse is responsible for the decision to delegate and the process of delegation (including ongoing supervision to assess delegate's ability to perform the delegated task)
care provider is accountable to the delegating nurse for the performance of the delegated task
(CRNBC, 2005, p. 1)
paid care providers
neither registered nor licensed by a regulatory body
no legally defined scope of practice
do not have mandatory education or practice standards
(CRNBC, 2005, p. 1) New graduates are often unaware of the level of responsibility required of them as nurses and lack confidence in their ability to make clinical judgments, including delegation
75.5% agreed that they could successfully manage their workload
80.6% felt profiecient in prioritzing care delivery
56.1% felt they would feel confident in delegating aspects of patient care to colleagues upon registration
46.9% felt that there would be open and supportive communication channels in the ward/unit where they worked
96.9% would ask for guidance from their peers
(Doody, Tuohy, & Deasy, 2012) References
Delegation is one of the key factors in effective team work, it could be a great benefit to improve the delegation skills of RNs.
Positive impact on team work & job expectations
Reduces RN turnover rates
Effective delegation has the potential to increase job satisfaction, responsibility & productivity, as well as personal & professional growth of staff

(Kaernested & Bragadottir, 2012) ADVANTAGES OF EFFECTIVE DELEGATION UNREGULATED CARE PROVIDERS CLINICAL IMPORTANCE ANA Health Care Education Services. (2012). Development of Skills, Behavior, and Leadership for Charge Nurse Positions. Retrieved from http://www.rn.com/get pdf.php/1769.pdf?Main_Session=c8f9b8bd9815db1254feb5c52f785318

College of Registered Nurses of British Columbia (CRNBC). (2012). Assigning and Delegating to Unregulated Care Providers. Retrieved from https://www.crnbc.ca/ Standards/Lists/StandardResources/98AssigningDelegatingUCPs.pdf

College of Registered Nurses of British Columbia (CRNBC). (2005). Assignment Between Nurses. Retrieved from https://www.crnbc.ca/Standards/Lists/StandardResources/414AssignbetweenNursesPracStd.pdf

College of Registered Nurses of British Columbia (CRNBC). (2005). Delegating Tasks to Unregulated Care Providers. Retrieved from https://www.crnbc.ca/StandardsOld/Lists/StandardResources/429DelegatingTaskstoUCPPracStd.pdf

College of Registered Nurses of British Columbia (CRNBC). (2013). Scope of Practice for Registered Nurses. Retrieved from https://www.crnbc.ca/StandardsOld/Lists/ StandardResources/433ScopeforRegisteredNurses.pdf

Doody, O., Tuohy, D., & Deasy, C. (2012). Final-year student nurses' perceptions of role transition. British Journal Of Nursing, 21(11), 684-688. Direct Delegation Effective delegation
Effective teamwork by collaboration
Communication
There is no 'I' in 'Team' Decrease your workload by: Research Successful delegationEffective communciation (timely and onging)teamwork & initative - initiative and willingness to collaborate(Potter, Deshields, & Kuhrik, 2010) Liscenced Practical Nurses (LPNs) Scope of Practice
Provision of care to patients with low complexity, low acuity, and a degree of predictability
Work under direct or indirect supervision of RN or Dr
(AMU Orientation Package, 2010?) Registered Nurses (RNs) Scope of Practice
Provision of care to all patients regardless of characteristics
Work as independent practitioners and team members
(AMU Orientation Package, 2010) Let's take a look at what activities can be delegated or shared ... Can delegate some tasks
Can’t delegate away the responsibility
Overall assessment
Determinations of client status
Care planning
Interventions
Care Evaluation
(CRNBC, 2005; CRNBC, 2007) Registered Nurses (Kaernested & Bragadottir, 2012, p. 12) Wrong time
Wrong care provider
Wrong patient
Tasks and responsibilities beyond the staff’s skills

Results in....
Unnecessary duplication
Under-delegation
Reverse delegation
Over-delegation (AMN Healthcare Education Services, 2012; Kaernested & Bragadottir, 2010) When someone with a lower rank delegates to someone with more authority (AMN Healthcare Education Services, 2012; Kaernested & Bragadottir, 2010) Delegator
loses control over a situation by providing the delegate(s) with too many responsibilities
risky position
increases the potential for liability Over-Delegation Ineffective delegation has led to compromised client care - Nurse Clinician

With the growing demand of RNs, effective delegation has become extremely important for RNs to be able to concentrate on their professional nursing activities (Kaernested & Bragadottir, 2012) Assignment Dynamic process in which decisions are evaluated & adjusted as nurses work together to meet the changing needs of clients
The assigned task/care must be within the
Agency policy
Role description
Training
Scope of practice
of both the assigning RN & the nurse accepting the assignment
(CRNBC, 2005, p. 1) When client acuity, complexity, or variability increases, LPNs need support from RNs/RPNs and do not work in isolation.
•Providing consultation
•Sharing part of the client assignment
•Taking the lead role in the client’s care
•Taking full responsibility of the client (CRNBC, 2005, p. 1) Working with Licensed Practical Nurses Paid care providers
Have mandatory education
Registered or licensed by a regulatory body
Legally defined scope of practice
Practice standards Regulated Care Providers The Delegated Task Is: Provision of care to patients with low complexity, low acuity, and a degree of predictability
Work under direct or indirect supervision of RN or Doctor Licensed Practical Nurses Scope of Practice: Registered Nurses Scope of Practice: Provision of care to all patients regardless of characteristics

Work as independent practitioners and team members
(AMU Orientation Package, 2010) Unregulated Care Providers Delegation to unregulated care providers occurs when the required task is performed primarily by nurse and is outside the role description and training of an unregulated care provider (CRNBC, 2005a, p. 1), as defined by the employer (CRNBC, 2007, p. 5) Unregulated Care Providers
Paid care providers
Neither registered nor licensed by a regulatory body
No legally defined scope of practice
Do not have mandatory education or practice standards (CRNBC, 2005a, p. 1) Resident care attendants
Home support workers
Mental health workers
Teaching assistants
Community health representatives
(CRNBC, 2007, p. 5) Unregulated Care Providers Include:
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