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Delegation Prezi

Leadership Nursing
by

Michelle Horn

on 5 November 2013

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Transcript of Delegation Prezi

Legal Implications and Application of Situational Leadership Theory
Five Rights
Legal
RNs are accountable for all tasks delegated. It is important to note, as part of the delegation process, “RNs can only delegate nursing tasks; the practice of nursing cannot be delegated
(Sydney, Medina, Bell and Wavra, 2004).”
Right Task
Job description
Policies/procedures

Assess:
Harm potential
Complexity of care
Problem solving
Outcome predictability
Patient's interaction ability
Right Person
Education/training
Evaluate staff
Assess:
Scope of practice
Standards of care
Policies and procedures
Job description
Right Circumstance
Authority given
Sufficient supplies
Assess
Patient's condition
Staff availability
Acuity of patient


Right Direction/Communication
Clear and concise expectations
Correct patient
Follow up
Expected outcome

Right Supervision/Evaluation
Adequate human resources
Evaluate
Progress
Outcome
Effectiveness
Provide/obtain feedback
I think people want to be magnificent. It is the job of the leader to bring out the magnificence in people and to create an environment where they feel safe and supported and ready to do the best job possible in accomplishing key goals. This responsibility is a sacred trust that should not be violated. The opportunity to guide others to their fullest potential is an honor and one that should not be taken lightly. As leaders, we hold the lives of others in our hands. These hands need to be gentle and caring and always available for support.

-- Ken Blanchard

Situational Leadership Theory
Supporting
Low direction
High support
Question competency
Self-critical/insecure
Empower
Control is followers
Delegating
Low direction
Low support
Competent
Inspired/self-assured
Freedom
Control is follower
Coaching
High direction
High support
Novice skills
Overwhelmed/discouraged
Personal attention
Two-way communication
Directing
High direction
Low support
Enthusiastic/excited
Inexperienced/unskilled
Leader defines
Close supervision
One-way communication
Indiana State Board of Nursing
Bears primary
responsibility
and accountability for nursing practiced based on specialized knowledge, judgement and skill derived from the principles of biological, physical and behavioral sciences (State of Indiana, 2013).
Delegation Responsibility
Delegate and supervise only those nursing measures which the nurse knows, or should know, that another person is prepared, qualified or licensed to perform (State of Indiana, 2013).
Delegation Defined
AMERICAN NURSES ASSOCIATION - Reassigning responsibility for the performance of a job from one person to another. RN maintains accountability, but responsibility is transferred (ANA, 2010).
----------------------
NATIONAL COUNCIL OF STATE BOARDS OF NURSING - Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation (NCSBN, 2010).
Indiana University Purdue University Fort Wayne
Nursing 442: Leadership

Delegation is:
Two-way communication/relation
Continuous and dynamic process
Giving authority to another
Giving control to another
Way to encourage initiative and teamwork
Delegation is NOT:
Using authority
Passing one's task to another
Directing
Vertical relationship
Distributing workloads
Code of Ethics
Provision 4 - The nurse is responsible and accountable for individual nursing practice and determines the delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.

Nurses are accountable for quality of nursing care provided. Although an activity may have been delegated, the nurses is still accountable (ANA, 2001).
Unprofessional Conduct
Nursing behaviors (acts, knowledge and practice) failing to meet the minimal standards of acceptable and prevailing nursing practice, which could jeopardize the the health, safety and welfare of the public (ANA, 2001).
Challenges
Delegator
Educational needs
Lack of time
"Do it myself" attitude
Threat to authority
No confidence in team members
Follower
Strapped for time
Lack of confidence
Fear of failure
Perception of others
Administration
Lack of employees
Lack of continuing education
Lack of communication
Delegation
No single best style
Continuum
Followers characteristics
References
American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
American Nurses Association / National Council of State Boards of Nursing (ANA/NCSBN). (2010). Joint statement on delegation. Retrieved from https://www.ncsbn.org/Joint_statement.pdf
Burrell, D.N., Abdul-Malik, O., Rahim, E., Huff, A. and Finklea, K. (2010). An analysis of the application of situational leadership in the post 9/11 evolving public health managerial environments. John Ben Shepperd Journal of Practical Leadership, 5, 45-59.
Davidson, P. & Hansen, B. (2013, October 13). A job engine sputters as hospitals cut staff. USA Today. Retrieved from http://www.usatoday.com/story/money/business/2013/10/13/hospital-job-cuts/2947929/
Inspired!. (2012). Situational leadership II. Retrieved from http://inspiredldg.com/pages/services_programs/services_programs_sitlead.html
Leading and Developing High Performance. (2011) The 8 barriers to delegation. Retrieved from http://www.leadinganddevelopinghighperformance.com/4-step-process/understanding-delegating/the-8-barriers-to-delegation/
Lightfoot, R.J. (2011) Nurse delegation in LTC and assistive living. Picture retrieved from http://www.ltlmagazine.com/article/nurse-delegation-ltc-and-assisted-living
National Council of State Boards of Nursing. (2007). The five rights of delegation. Retrieved from https://www.ncsbn.org/fiverights.pdf
Plawecki, L.H. and Amrhein, D.W. (2010). A question of delegation: Unlicensed assistive personnel and the professional nurse. Journal of Gerontological Nursing, 36(8).
Putnam, B. (2006). Situational leadership. Retrieved from http://wed.siu.edu/faculty/BPutnam/566/Situational_Leadership_Article.pdf
Snyder, D.A., Medina, J., Bell, L., and Wavra, T.A. (2004). AACN delegation handbook. Retrieved from http://www.aacn.org/wd/practice/docs/aacndelegationhandbook.pdf
Whitehead, D.K., Weiss, S.A. and Tappen, R. M. (2007). Essentials of nursing leadership and management, 5 ed. Philadelphia, PA: F.A. Davis Company.
United Nations Office on Drugs and Crime (UNODC). (2010). Legal tools. Picture retrieved from http://www.unodc.org/unodc/en/legal-tools/



Delegation
Group 15: Courtney Cowans,
Michelle Horn & Tiffany Myers

Author Contact Information
Courtney Cowans:
huntcb01@students.ipfw.edu

Michelle Horn: hornml03@students.ipfw.edu

Tiffany Myers:
dimkta01@students.ipfw.edu

NCLEX Questions
Answer & Rationale
ANS: 1 - Observe how well the patient performs pursed-lip breathing

Rationale: Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. Assisting patients with ADLs is more appropriately delegated to a nursing assistant. Planning and consulting require additional education and skills, appropriate to an RN
Question 3
You are responsible for the care of a postoperative patient with a thoracotomy. The patient has been given a nursing diagnosis of Activity Intolerance. Which action should you delegate to the nursing assistant?

1. Instructing the patient to alternate rest and activity
periods
2. Encouraging, monitoring, and recording nutritional
intake
3. Monitoring cardiorespiratory response to activity
4. Planning activities for periods when the patient has
the most energy
Answer & Rationale
ANS: 2 - Encouraging, monitoring, and recording nutritional intake

Rationale: The nursing assistant's training includes how to monitor and record intake and output. After the nurse has taught the patient about the importance of adequate nutritional intake for energy, the nursing assistant can remind and encourage the patient to take in adequate nutrition. Instructing patients and planning activities require more education and skill, and are appropriate to the RN's scope of practice. Monitoring the patient's cardiovascular response to activity is a complex process requiring additional education, training, and skill, and falls within the RN's scope of practice

Question 4
You are initiating a nursing care plan for a patient with pneumonia. Which intervention for cough enhancement should you delegate to a nursing assistant?

1. Teaching the patient about the importance of adequate
of fluid intake and hydration.
2. Assisting the patient to a sitting position with neck
flexed, shoulders relaxed, and knees flexed
3. Reminding the patient to use an incentive spirometer
every 1 to 2 hours while awake
4. Encouraging the patient to take a deep breath, hold it
for 2 seconds, then cough two or three times in
succession.
Answer & Rationale
ANS: 3 - Reminding the patient to use an incentive spirometer every 1 to 2 hours while awake

Rationale: A nursing assistant can remind the patient to perform actions that are already part of the plan of care. Assisting the patient into the best position to facilitate coughing requires specialized knowledge and understanding that is beyond the scope of practice of the basic nursing assistant. However, an experienced nursing assistant could assist the patient with positioning after the nursing assistant and the patient had been taught the proper technique. The nursing assistant would still be under the supervision of the RN. Teaching patients about adequate fluid intake and techniques that facilitate coughing requires additional education and skill, and is within the scope of practice of the RN
Question 1
A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant (PCT)?

1. Assisting the patient to sit up on the side of the bed
2. Instructing the patient to cough effectively
3. Teaching the patient to use incentive spirometry
4. Auscultating breath sounds every 4 hours
Answer & Rationale
ANS: 1 - Assisting the patient to sit up on the side of the bed

Rationale: Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Teaching, instructing, and assessing patients all require additional education and skills and are more appropriate for a licensed nurse
Question 2
The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision?

1. Observe how well the patient performs pursed-lip
breathing
2. Plan a nursing care regiment that gradually increases
activity intolerance
3. Assist the patient with basic activities of daily living
4. Consult with the physical therapy department about
reconditioning exercises
Question 5
You are assigned to provide nursing care for a patient receiving mechanical ventilation. Which action should you delegate to an experienced nursing assistant?

1. Assessing the patient's respiratory status every 4
hours
2. Taking vital signs and pulse oximetry readings
every 4 hours
3. Checking the ventilator settings to make sure they
are as prescribed
4. Observing whether the patient's tube needs
suctioning every 2 hours
Answer & Rationale
ANS: 2 - Taking vital signs and pulse oximetry readings every 4 hours

Rationale: The nursing assistant's educational preparation includes measurement of vital signs, and an experienced nursing assistant would know how to check oxygen saturation by pulse oximetry. Assessing and observing the patient, as well as checking ventilator settings, require the additional education and skills of the RN
Financial
Indiana news
IU Health layoffs
Budget
Objectives
Define delegation
Law definition of delegation
Five rights
Challenges
Applying situational leadership
(NCSBN, 2007)
(NCSBN, 2007)
(NCSBN, 2007)
(NCSBN, 2007)
(NCSBN, 2007)
(Leadership and Developing High Performance, 2011)
(Leadership and Developing High Performance, 2011)
(Leadership and Developing High Performance, 2011)
David & Hansen, 2013
QSEN
Patient-centered care
Teamwork
Collaboration
Herman, 2011
Full transcript