Question

Delegation

Tom Joserine, a nurse manager of a 36-bed orthopedic unit, has decided that he is too busy to complete all the work that needs to be done. Nurse Joserine has recently read an article on delegation and has decided that delegating tasks to others is an excellent way to accomplish the mound of work that he has to complete. He believes that there are two tasks that take most of his time, disciplinary problems and quality improvement activities. Nurse Joserine calls the nursing coordinator, Janet Jeleen, into the office and informs her that she will now be responsible for all evaluations and handling of incident reports. Nurse Jeleen tells him that she will need some guidance on this new activity. Nurse Joserine informs her that the hospital has managerial classes in which she can enroll to help her with this new duty.

Nurse Joserine also calls Jo Ellen Mae, a clinical nurse specialist for the orthopedic unit, and informs her that she will now be responsible and accountable for the quality improvement activities on the unit. Monthly reports are due on the 10th of each month. He informs Nurse Mae that if she has any questions, she can call the head of the quality improvement committee. When Nurse Joserine leaves the hospital that day, he feels good that he has decreased his workload and happy that he found the article on delegation.

1. Did Nurse Joserine delegate tasks appropriately? Why or why not?
2. Who will be held accountable for the outcomes of the roles/tasks that Nurse Joserine has delegated?

Answer 1

Delegation generally involves assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. The registered nurse cannot delegate responsibilities related to making nursing judgments.

***Nurses responsibilities when delegating tasks***

Ensure appropriate education, skills, and experience of personnel performing delegated tasks. Assign and supervise care provided by others (e.g., LPN/VN, assistive personnel, other RNs) Communicate tasks to be completed and report client concerns immediately. Organize the workload to manage time effectively.

The easiest way to make sure you're delegating properly is to follow the 5 R's.

Right Task. While delegation can be a good tool for teaching someone new skills, patient care and safety always comes first. ...

Right Circumstance. ...

Right Person. ...

Right Directions/Communication. ...

Right Supervision/Evaluation.

(1)Right tasks

First, Joserine needs to determine which tasks are right to delegate. Some questions he may ask at this time would include (1) which tasks are legally appropriate to delegate and (2) can I delegate these tasks based on this organization’s policies and procedures? Correctly answering these questions will require familiarity with institutional and nurse practice act guidance. Generally, registered nurses are responsible for assessment, planning, and evaluation within the nursing process. These actions should not be delegated to someone who is not a registered nurse.

(2)Right circumstances

After determining the right tasks for delegation, Joserine considers the right circumstances of delegation. In so doing,Joserine may ask the following questions: (1) are appropriate equipment and resources available to perform the task, (2) does the delegatee have the right supervision to accomplish the task, and (3) is the environment favorable for delegation in this situation? To appropriately answer these questions, it is imperative that Joserine completes an assessment on each client. Patients who are or may become unstable and cases with unpredictable outcomes are not good candidates for delegation. For example, it may be appropriate for unlicensed assistive personnel to feed patients requiring assistance with the activities of daily living. However, if a patient has a high risk for aspiration and a complicated specialty diet, delegation of feeding to unlicensed assistive personnel may not be safe.

(3)Right person

If a task and circumstance are right for delegation, the next “right” of delegation is the right person. JOSERINE needs to consider if the potential delegatees have the requisite knowledge and experience to complete delegated tasks safely, especially concerning the assessed patient acuity. Before delegating a task, the registered nurse must know the delegatee’s job description and previous training. Joserine may be unsure about his potential delegatee’s qualifications. Therefore, he might ask the following questions before delegating a task: (1) have you received training to perform this task, (2) have you ever performed this task with a patient, (3) have you ever completed this task without supervision, and (4) what problems have you encountered in performing this task in the past?

(4)Right supervision       

The right supervision must be available in all delegation situations. Nurse practice acts require the registered nurse to provide appropriate supervision for all delegated tasks. In the case study, Joserine must be sure that the delegatee will provide feedback after the task is complete. Following task completion, Joserine is responsible for evaluating the outcome of the task with the patient. Registered nurses are accountable for evaluation and the overall patient outcomes.

(5)Right direction and communication      

Finally, the delegator must give the right direction and communication to the delegatee. All delegators must communicate performance expectations precisely and directly.Joserine should not assume that his delegatee knows what to do and how to do it, even for routine tasks. Joserine must consider whether the delegatee understood the assigned task, directions, patient limitations, and expected outcomes before the delegatee assumes responsibility for it. The delegatee also must comprehend what, how, and when to report back after the delegated task is complete. Delegatees also need a deadline for task completion for time-sensitive tasks.

Joserine 's delegation of duty is not appropriate because his delegatees have no adequate knowledge about the process. Joserine should arrange a training program for delegation of duty.Afte that he could

give responsibilities for other registered nurses.