Delegation & Management

Front 1

Delegation

Back 1

Transferring to a competent individual, the authority to perform a selectd nursing task in a selected situation. The nurse retains accountability for the delegation

Front 2

Accountability

Back 2

Being responsible and answerable for actions or inactions of self or others in the context of delegation

Front 3

Responsibility

Back 3

Each person's obligation to perform at an acceptable level- the level to which the person has been educated.

Front 4

Authority

Back 4

Occurs when a person who has been given the right to delegate, based on the state's nurse practice act, also has the official power from an agency to delegate.

Front 5

Evaluation

Back 5

Final and critical step in the nursing process to review the nursing care provided, to determine the accuracy of the nursing interventions in achieving planned goals and the need to change any aspect of the plan of care in order to better meet client needs.

Front 6

Direct Delegation

Back 6

*Usually verbal direction. * RN decides which staff member is capable of performing a specific task.

Front 7

Indirect Delegation

Back 7

*Contained in an approved listing of tasks established by an institution
* Permitted tasks may vary from institution to institution

Front 8

Assignment

Back 8

Designating nursing activities to be performed by an individual consistent with his/her licensed scope of practice

Front 9

Supervision

Back 9

Provision of guidance, direction, evaluation, and follow-up by the licensed nurse for accomplishment of the work and resultant patient outcomes

Front 10

Supervisor are responsible

Back 10

-Competent & disciplined staff
-Clear directions and communication
-Timely follow-up to ensure prompt execution of delegated activities & order
-Consistent use of active listening skills
-Have thorough scope of knowledge necessary to supervise work
-Demonstrate fairness and respect to all and provide feedback for work well done as well as resolving problems and conflicts.

Front 11

Authority to Delegate

Back 11

-Nurse Practise Act
-State rules/regulations (BON)
-Employer policies & standards
-Professional nursing standards
* NCSBN, ANA, AACN, ENA
* JCAHO

Front 12

Delegation Criteria

Back 12

Nurse Practice Act
(Permits delegation, Authorizes tasks to be delegated/ nurse to decide delegation.)
-Delegator/ Delegatee Qualifications ( Appropriated education, skills, and experience. Documented /demonstrated evidence of current competency. )

Front 13

Assess the situation

Back 13

ID needs of pt, consulting the plan of care
-Consider the circustance/setting
-Assure the availability of adequate resources, including supervision.

Front 14

Plan for the specific task(s) to be delegated

Back 14

-Specify the nature of each task and the knowledge and skills required to perform it.
-Require documentation or demonstration of current competence by the delegatee for each task
-Determine the implication for the pt, other pt's, & significant others.

Front 15

Implementation

Back 15

Assign the appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities.

Front 16

Assure appropriate accountability

Back 16

-As delegator, accept accountability for performance of the task(s).
-Verify that delegatee accepts the delegation and the accountability for carrying out the task correctly.

Front 17

Supervise performance of the task

Back 17

-Provide directions and clear expectations of how the task(s) is to be performed
-Monitor performance of the task(s) to assure compliance to established standards of practice, policies and procedures
-Intervene, if necessary
-Ensure appropriate documentation of the task(s)

Front 18

Evaluate the entire Delegation Process

Back 18

-Evaluate the Pt, the performance of the tasks
-Obtain and provide feedback
Re-evaluate & adjust the overall plan of care as needed.

Front 19

To Delegate or Not: Criteria

Back 19

-Pt condition
-Complexity of assessment
-Intricacy of task
-Repetitiveness of task
-Capabilities of UAP
-Amount of technology required
-Infection control & safety precautions
-Potential for harm
-Level of supervision that RN will need to provide.
-Predictability of outcome
-Extent of pt interaction
-Environment

Front 20

5 Rights of Delegation

Back 20

-Right Task
-Right Circumstances
-Right Person
-Right Direction/Communication
-Right Supervision

Front 21

Inappropriate Delegation 1

Back 21

-Inadequate resources: lack of qualified personnel, equipment, supplies & time.
-Conflict of employer policy & laws or regulation.
- Inappropriate employer directions (coerce nurse to delegate against nurse's best judgement)
-Nurse recognize lack of knowledge, skills and abilities relating to the use of the delegation process.

Front 22

Inappropriate Delegation 2

Back 22

-Nurse fails to accept accountability for nursing care provided
-The UNP does not know how to perform an activity.
-When circumstances have changed significantly (pt condition has changed)
-UNP wking in a new area or w/ a diff type of pt w/out orientation or support.

Front 23

What delegation is NOT

Back 23

- Simple task assignment
-"dumping" problems on someone else
-Abandonment
-Dictating every detail about how the job should be done

Front 24

Decision Making Grid

Back 24

Level of client acuity
-Level of unlicensed assistive personnel capbility
-Level of licensed nurse capability
-Possibility for injury
-Number of times the skill has been performed by the unlicensed assistive personnel
-Level of decision making needed for the activity
-Client's ability for self-care

Front 25

Quality Improvement

Back 25

Systematically testing new ideas to improve something
-Systematic process to improve outcomes based on customers needs

Front 26

Steps in the performance imp. process

Back 26

ID needs most imp 2 consumers of healthcare services
-Assemble multidisciplinary team to review identified needs & services
-Collect data to mea. current status of these services
-Est. meas. outcomes/quality indicators
-Select / implement plan to meet the outcomes
-Collect data to evaluate implementation of the plan / achievement of outcomes.

Front 27

Goals of Performance Improvement

Back 27

-Improve the system, not assign blame
* Providing systems for workers to function efficiently
*Clearly defining goals and missions of organizaition
*Educate entire staff regarding performance improvement strategies
-Enhance Communication
*Transformational leadership style used
*Nurse leadership ensures deliberate, intelligent, shared, and data driven methodology

Front 28

FOCUS-PDCA

Back 28

Find a process improvement opportunity
Organize a team who understands the process
Clarify the current knowledge of the process
Uncover the root cause of the poor outcomes
Start the "plan-do-check act" cycle
Plan the process improvement
Do the improvement, data collection, and analysis
Check the results and lessons learned
Act by adopting, adjusting or abandoning the change.

Front 29

Sources of Improvement

Back 29

Sentinel event reports
Plantiff claim allegations
Congressional inquiries
News media stories

Front 30

Process to improve

Back 30

Is there a clear simple description of the process
What is the process
What are the major process problems
What are the key issues

Front 31

Uncover

Back 31

Current knowledge of process
-Who are the customers
-What are their needs
-Should boundaries be defined
-What is the actual flow of the process
-Is there needless redundancy
-What are the outcomes
Tool: data collection/flow charting

Front 32

Benchmarking

Back 32

Compare one agency's performance against that of similar organizations

Front 33

Regulatory Requirements

Back 33

Joint Commission on Accreditation of Healthcare Organizations

Front 34

Sentinel Event Steps

Back 34

1. ID Sentinel event
2. Report made to JCAHO ( by managerial team w/ legal counsel)
3. Root- cause analysis initiated

Front 35

Root Cause Analysis

Back 35

Determine if an immediate risk to pt/providers exists, and act accordingly.
-Clearly define the role of leaders and facilitators, because an effective RCA requires involvement of a multidis. team of staff at all levels closest to the event & those w/ decision-making authority
-Det. the sequence of event & contributing conditions, & assumptions r/t the critical event.
-Analyze causal factors, those that if eliminated would hv prevented the accurrence or reduced its severity.
-ID changed/ dev action plans 4 rollout across disciplines/ employee levels
-Present the recommended improvements to senior leaders 4 review/ approval of implementation

Front 36

Decision Making

Back 36

purposeful and goal-directed effort that uses systematic process to choose among options
* Effective decision-making predicated on indiv. ability to think critically.

Front 37

Critical Thinking

Back 37

Intellectually disciplined process of actively & skillfully conceptualizing, applying, analyzing, synthesizing, or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning or communication, as guide to belief & action.

Front 38

Steps in Decision Making

Back 38

1. ID the need for a decision
2. Determine the goal / outcome
3. ID alternatives, benefits & consequences
4. Mk the decision
5. Evaluate

Front 39

Poor-Quality Decision

Back 39

likely if objectives not clearly identified or if not consistent w/ values of indiv. organization.

Front 40

Safety/ reducing risk : Setting Priorities

Back 40

What is risk to the patient? Priority given to intervening/responding to situation that poses the greatest risk to patient's physical well-being.

Front 41

Assessment: Setting Priorities

Back 41

Det. if additional assessment findings are needed b4 calling the MD to ask 4 pain meds 4 pt.

Front 42

Survival Potential

Back 42

*Situation in which health resources extremely limited (disaster triage)
- Priority given to pt w/ reasonable chances of survival w/ prompt intervention. Saving the most w/ the fewest resources.

Front 43

Least restrictive

Back 43

Choose interventions w/ least amt of restriction to pt while maintaining pt safety

Front 44

10 Best Practices for Pt safety

Back 44

1.Wash hands & sanitize hands b4 Q direct Pt contact
2. ID Pt correctly
3.Use Meds safely
4. Avoid surgical errors
5.Prevent venous thromboembolism (VTE)
6.Customize hosp. discharges
7. Use good hosp design principles
8. Assemble better teams & rapid respons sys.
9. Share data for quality improvement
10. Foster open-communication culture.