Delegation (Nursing)

00:00 Welcome back everyone. Today, we're going to be talking about an incredibly important skill especially for the new nurse. Delegation. Imagine, a brand new nurse coming in to one of her very first shifts at an organization and she has an incredible list that she has to accomplish.

00:18 How is she going to get it all done? Delegation. So delegation in nursing is a transfer of the nurse's responsibility for the performance of a task to another nursing staff member. Well, ultimately, holding accountability for the outcome. So there are several considerations to delegation. You want to think before you delegate a skill or a task to someone else. What is the potential for harm? Can the patient get harmed in the task that you are delegating to another individual? How difficult is the task? What is the amount of problem solving and innovation required? In other words, does it require critical thinking? What is the predictability of the outcome? For example, are you going to delegate a task that could be medication to an unstable patient? You don't know what it is or what the outcome may be for that particular client, or are you delegating a skill such as a bad bath to a stable client? And then, what is the level of patient interaction needed for the skill or the task that you are transferring or delegating to the other individual? The image like we have rights of medication administration, we also have 5 rights of delegation. First, you want to ensure that you are selecting the right staff member whether they are licensed or unlicensed to delegate the task to. You have to make sure that you're delegating the right task based on the circumstances. Thinking of circumstances, what are they? What is the context around why you are delegating the task and what is going on at that particular moment. So for example, if you have a new admission coming in and you know this patient is going to be unstable and they need a full admit and they're probably going to be needing medications, when you're thinking about selecting a staff member you would need to select a registered nurse to be able to admit the new client coming in that is possibly unstable. And so those are all 3 of these are encompassed in this one example to understand how you can select the right person with the right task under the right circumstances for that specific situation. You also want to be able to think about the directions and communication that you are giving the staff member that you're delegating the task to. Communication is clear. You need to make sure that you're giving them very clear directions on exactly what and when to do what you need to be completed.

02:42 And finally, as a registered nurse, you need to be able to ensure that you're able to supervise and evaluate the task that was completed. Now sometimes, there are some barriers to delegation.

02:54 Now why would we have any barriers to delegation? Well first, as registered nurses, we are incredibly busy throughout our shift. So sometimes, time pressures can actually prohibit us from delegating a task. It seems counter intuitive but a lot of times when we're really busy we just think it's easier for us to complete the task rather than to give it to another person.

03:14 Similarly, when we are registered nurse, we're all registered nurses, do documentation. Sometimes when we have a lot to document, again we feel like we don't have the time to delegate. We know that we are going to be ultimately accountable for it so we feel comfortable completing the task ourselves rather than to delegate it to another individual. Sometimes, depending on your organization, there may be lack of education on delegation so even seasoned nurses and new nurses may not know exactly who they can delegate task to or how to evaluate it. So, instead of doing it, they just prefer not to delegate and they just do the skills themselves. And finally, depending on the type of care model that's adopted within your organization depending on which team members you're working with, you may or may not be comfortable with the skills of an unlicensed assistant personnel or even another registered nurse or another licensed practical nurse because you just haven't worked with them that long and until you've had the opportunity to work with certain team members you may not feel comfortable delegating task until a relationship has been established.

04:18 So there are some important aspects to effective delegation. You want to make sure that you identify the tasks for delegation based on the client needs. That's paramount. You need to be sure that what the client needs dictates what type of tasks and to whom you delegate them to. You want to ensure the appropriate education, skills, and experience of the personnel performing the delegated task. You also want to assign and supervise the care provided by others. That is your responsibility as a registered nurse. Terribly important is communicating tasks to be completed and then ensuring that you tell the person that you're delegating to to report any client concerns to you immediately.

05:01 You also want to organize the workload to manage the time effectively and that holds true for you as well as to the person that you're delegating the task to. Make sure that everything is there in regard to workload. You want to evaluate the delegated task to ensure that the correct completion of the activity occurred. This is really important because as a registered nurse you are accountable for the activity that was delegated and this gives you an opportunity to actually make sure that it was completed and to also possibly even give some peer coaching to the person that you delegated the task to in case they need some opportunities for improvement in that area.

05:39 You also want to evaluate the ability of the staff member to perform the assigned tasks for the position. And finally, you also want to evaluate the effectiveness of the staff member's time management skills. Even though you were assessing the situation at the time and you delegated the task and everyone felt that they had enough time to complete the task, that may not have been the case. So this is a great opportunity to evaluate that and to evaluate those time management skills of the staff, again so that you can help with some peer coaching and some professional development there as well. So now we're going to do a really great example to see if you're able to figure out what type of skills someone can do or that you can delegate as a registered nurse. So your hospital patient care unit is full and it's busy with high acuity patients. The shift is somewhat short staffed but Susan, an unlicensed assistive personnel and then Beth, a licensed practical nurse, has been floated in to help the registered nurses. Which of the following tasks might be delegated to Susan, the unlicensed assistive personnel? Can she assist the patient with a bath, perform an IV flush, perform a wound dressing change, collect vital signs, weigh the patient, or apply oxygen to the patient? I'm going to give you just a moment to look through these options and select more than one if possible, select all the correct answers. So if you selected assisting a patient with the bath, collecting the vital signs, and weighing a patient, you are correct. All of these activities do fall under the scope of responsibility of an unlicensed assistive personnel. An IV flush, a wound dressing change, and applying oxygen to a patient all fall under the scope of responsibility for a licensed personnel. So it's incredibly important to remember that the nurse, the registered nurse, is ultimately accountable for the appropriateness and the supervision of the delegated task. So what do we learn today? We learned that the assignment of care to others including nursing assistants, licensed practical nurses and even other registered nurses, well it's perhaps one of the most important daily decisions that a nurse makes everyday.

07:58 Proper and appropriate assignments facilitate quality care. If they're not, if they're improper and they're inappropriate assignments that can actually lead to poor quality of care, disappointing outcomes, and also could possibly jeopardize client's safety leading to possible legal consequences.

08:15 So it's important to remember, responsibility can be delegated but accountability cannot be delegated. The delegating registered nurse does remain accountable for client care despite the fact that some of these aspects of care can and are delegated to others. So I hope you've had a really great time understanding a little bit more about delegation. Thank you so much for watching this video.