Unit 1 The Nurse as Manager Care
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Why delegation?
 The nurse who secures, who scurries haphazardly without a plan unsure what’s the most important lifesaving task to be
done, or which person should to which tasks to do for a group of pts is not fulfilling his/her potential to be a channel for
healing
Determining Care
 Who gets what assignment?
 Knowing the preferred outcome for each patient
 e.g. a young mother who is fighting for her life against breast cancer w/ chemotherapy, she is suffering
uncontrolled emesis that led to dehydration-she’s expecting to gain her health and watch her children graduate
college versus. a 92 y/o man who lost his wife to complications, he has a hx of severe HF and presented with a
heart attack—he would like to die and join his wife, requested a DNR order and waiting transfer to hospice
 Differences in patient outcomes are the driving force
Assignment vs Delegation
 Differentiated by responsibility
 Assignment is distribution of work that each staff member individually responsible for/during a given shirt or work
period
 Delegation is transfer with retained accountability
 Transferring to a competent individual the authority to perform a selected nursing task in a selected situation
 The nurse is still accountable for the delegated work; the RN should know the chosen person can competently
perform the task
 Whenever a nurse delegates, he/she must also supervise
 Supervision is the provision of guidance and direction oversight, evaluation, and follow-up by the
licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel
Delegation
 Supervision
 Communication
 Collaboration
 Conflict negotiation
 The NCSBN drafted a paper articulated the steps of delegation practice
 Assess/plan delegation based on pt’s needs/available resources
 Communicate directions to the delegate including any unique pt requirements and characteristics and clear
expectations regarding what to do, what to report, and when to ask for assistance
 Surveillance and supervision of the delegation including the level of supervision needed for particular situation
and implementation of the situation, include follow-up to the problems or a changing situation
 Evaluation and feedback in order to consider the effectiveness of the delegation including any need to adjust
the plan of care
 The nurse needs to be familiar of each job description and confident about the competency of the work before assigning
a task
 The authority of the worker’s performance still rests w/ the RN
 A person who receives the task or duty is still accountable for accepting the delegation and for their own
actions
The Five Rights of Delegation
 Right task: one that can be delegated for a specific pt
 Right circumstances: appropriate pt setting, available resources, and considering relevant factors, including pt stability
 Right person: delegating the right task to the right person to be perfumed on the right person
 Right directions and communication: clear, concise description of task, including its objective, limits, and expectations
 Right supervision and evaluation: appropriate monitoring, evaluation, intervention, and feedback
Verifying Understanding
 Communicate with the UAP
 Specific tasks
 When each task is to be done
 Expected outcomes for each task including parameters outside the unlicensed person must immediately report
to the nurse and any action that must urgently be taken who is available to serve as a resource if needed when
and in what format (written, verbal) a report on the tasks is expected
 What resources are available
 When and what format to report
The RN also delegates to the LPN = the nurse must know their state’s specific scope of practice in order to delegate
effectively
 In some states, LPNs may perform tasks generally considered he role of the RN w/ special training
 LPNs cannot delegate to others
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The RN can delegate components of care but does NOT delegate the nursing process itself (ADPIE)
 The RN can delegate other RNs—this is part of the daily routine of determining which nurses should care for specific
clients
Which tasks to delegate?
 Stable patients
 Routine tasks
 UAPs can do ADLs and routine vital signs
 Decided by Nurse Practice Act, not just hospital policy
 Legally it’s not the hospital that has the authority on this situation rather than it’s the State Nurse Practice Act
and you have to know what the act allows
 Know also since the RN is responsible for all tasks that are delegated, you cannot delegate a task that
you can’t complete correctly yourself
Typical Delegation Tasks
 LPN – gets chronic, stable pts w/ predictable outcomes
 e.g. COPD, pts who are 24hr postop b/c the LPN cannot do any discharge planning, admission
assessments/admission vs, IVs,
 BUT can give narcotics, have pts 72hrs after an MI, have pts w/ a CVA, pts on vents or w/ glaucoma
scale after 1 week
 can also do sterile procedures, give meds (but no IV push), can complete nursing process under the direction of
an RN, can work w/ contagious pts, can reinforce teaching but RN must do initial teaching
 PCT – works with stable pts
 UAPs make beds, provide H2O, give enemas, stool specimens, monitor I/Os, transport pts from one place to
another, feed chronic Parkinson’s pts, care for chronic CVA pts
 Can: do vs on a stable pt half hour after a blood product has been started; remind/reinforce the pts to do
something (e.g. incentive spirometer); oral hygiene; ambulate; provide skin care hourly turning/TCDB; chart
I/Os, vs, weights; attach suction; remove foley
 Cannot: feed anyone who’s an aspiration risk or pts who can’t swallow well; do admission vs; perform sterile
procedures; provide/give any meds (even OTC topicals); teach; work w/ PT (as providing help or assisting); have
pts who have arterial line, trach, ET tubes, vents, or have any contagious diseases
 Should stay away to show, explain, monitor, teach, check, assess, or demonstrate, these words are outside the
scope of UAP
 Assignment to avoid for New/Float/LPN/Traveling Nurses
 New onset
 Sudden/acute situation
 New admission
 Transfer to a higher level of care or different facility of care
LPNs/UAPs cannot DATE
 D – delegate
 A – assess
 T – teach
 E – evaluate
Prioritization
 Deciding on immediate action and which ones can be delayed b/c they’re not urgent
 Have to have clear idea of desired pt outcome you’re aiming for and the ability to weight possible tasks and
ranking them in order (note how long the tasks will take)
 Difficult for new RNs
 You have to know the purpose for care, current clinical picture, and a picture of the outcome or results in order
to plan priorities
 Framework – the 4 Ps
 Purpose
 Picture
 Plan
 Part
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Evaluate each task
 Is it life threatening or potentially life threatening if the task isn’t done?
 Would another pt be endangered if this task is done now?
 What if it’s left for later?
 Is this task process essential to patient or staff safety?
 Is this task/process essential to the medical or nursing plan of care?
ABCs + V (Airway, Breathing, Cardiac status, and Circulation + Vital signs)