Personal Growth...
©
A Newsletter for All Staff
Volume 4, Issue 5
KEYS TO DELEGATION
September 2009
Editor-in-Chief: Mary Myers Dunlap, MAEd, RN
BEHAVIORAL OBJECTIVES
AFTER
READING THIS NEWSLETTER THE
LEARNER WILL BE ABLE TO:
1.
Define delegation.
2.
Describe the responsibility of delegation and what to
Trust others on your team to be capable of achieving it.
A simple delegation rule is the acronym SMART. It's a
quick checklist for proper delegation. Delegated tasks must
be Specific, Measurable, Agreed, Realistic, and
Timebound. If these points can’t be checked off, don't
delegate the task.
Delegated Tasks Should Be S-M-A-R-T
delegate, as well as keys and barriers to delegating.
Derived from Latin, delegate means "to send from."
When delegating, you are sending the work from you to
someone else. Delegation is the downward transfer of
formal authority from a superior to subordinate, such as,
in healthcare settings, from an RN to a nursing assistant.
Delegation occurs in all types of businesses and is not a
sign of weakness to need help keeping up with
workloads. For example, at a home improvement store,
a manager may delegate an employee to hang ceiling
fans for display in the electrical department. However, if
that person is not knowledgeable or trained in electrical
products, customer satisfaction may suffer, as well as
the person’s safety. Nowhere is delegation more critical
than in the healthcare setting when direct patient care is
involved. Not only is a patient’s life potentially at risk,
but, if the RN delegates inappropriately, so is his or her
license, and possible career. The ability to delegate
patient care and assign tasks is a vital skill for RNs.
Many health care facilities have assistive personnel,
such as nursing assistants, often at different skill levels.
This newsletter will define delegation, focusing
primarily on delegation from RNs to non-licensed
healthcare providers. The responsibility of delegating,
what to delegate, keys to delegating
and barriers will be described.
Specific Measurable Agreed
Realistic Timebound
DELEGATING RESPONSIBILITY
Only RNs have the formal authority to practice nursing,
as determined by each state’s Nurse Practice Act, and to
delegate direct patient care tasks. Policies and job
descriptions require licensed and non-licensed healthcare
workers to perform certain responsibilities. It’s important
that all employees understand, specifically, what theirs is.
And before you delegate, you must understand which tasks
are and are not within a team member’s scope of practice.
One study found that nearly one fifth of the RNs didn’t know
what training the nursing assistants on their own unit had
completed. This awareness can prevent
you from delegating to a nursing
assistant something outside of his or her
role. And, job descriptions, not
experience, dictate appropriate
delegation. A senior nursing student,
working as a nursing assistant on
weekends, follows the tasks and duties
of the assistant, even though his or her skill level may be
higher. RNs not only retain ultimate responsibility,
accountability, and legal liability for delegation, but also for
any associated problems. Even though you have delegated
a task to someone else, you are still responsible for making
sure the task is done on time and correctly.
ACCEPTING RESPONSIBILITY:
WHAT IS DELEGATION?
Delegation isn't just a matter of
asking or telling someone else what
to do. Instead, when you delegate
you are asking a subordinate to accept responsibility for
completing a specific task or project. Effective delegation
will not only give you more time, but you will also help
others on your team learn new skills. If you are always
behind in your work, consider delegating. Remember, you
are not the only one that can accomplish an end result.
Non-licensed healthcare providers have the right and
should say “No, I’m not allowed to do that”, if something is
delegated to them outside of the tasks they are permitted to
perform. Likewise, even if it is within your job description,
make sure you feel comfortable performing a specific
request. That is, do you have experience with it or do you
need supervision? Are the directions clear? If not, ask
questions and clarify what you need to know. And, if the
patient’s condition changes during a task you’ve been
delegated to do, get help.
Copyright © 2009 Growing Up With Us, Inc. All rights reserved.
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WHAT TO DELEGATE?
There is always the question of what to do yourself and
what to delegate. Nurses can usually safely delegate
supportive and non-nursing tasks, such as transporting
specimens, cleaning up after procedures and making beds.
However, the delegation of direct
patient care is not as clear. More
sophisticated tasks, such as taking vital
signs and suctioning, may be
appropriate for a trained healthcare
provider, such as a nursing assistant.
Each patient situation needs to be
assessed individually. For example, a nursing assistant
may easily handle the task of taking vital signs of a stable
patient two days after surgery, but not of a hemorrhaging
newly, post-operative patient. Likewise, the nursing
assistant may be able to suction a stable comatose patient,
but not a patient with a head injury.
RNs are responsible for evaluating the outcome of a
delegated task. For example, the nursing assistant may
measure intake and output, but the RN needs to interpret
the findings. Similarly, some techs have been trained to
apply a plaster mold cast to a broken ankle, but the nurse
remains responsible for assessment of the application,
capillary refill, and cast care teaching.
KEYS TO SUCCESSFUL DELEGATION
Consistency in delegation is important. For example,
consider the confusion that may occur on a unit if one RN
expects nursing assistants to discontinue IVs and another
becomes upset when they do. Consistency and successful
delegation can be achieved by following a systematic
process.
Start with a positive attitude. People like to be respected
for their contributions at work, and your words and actions
can communicate the appreciation you have for the nursing
assistant with whom you work. Acknowledge a job well
done. Public praise builds a sense of team effort.
Establish good working relationships with effective twoway communication. Be sure to listen attentively, and
remain attentive to details. And don’t forget common
courtesies, like saying “please” and “thank you”.
Delegation generally works best when an assistant is
assigned to a specific nurse. However, due to staffing
shortages, that is not always possible. Therefore, assistants
may receive multiple requests from different people at the
same time. You can help assistants through conflicts in
delegation by checking with other RNs to coordinate
utilization and by assigning tasks within a structured time
period.
Be careful how you delegate. Avoid barking orders. A
more effective style is to frame your request, for example,
by asking, “Could you please give the patient a bedpan?”
However, avoid presenting an option when there isn’t one.
Asking, “Would you like to pick up meal trays?” sends a
mixed, incorrect message. Distribute what are perceived to
be undesirable tasks equally among nursing assistants.
And if there is time, participate as well.
Define what needs to be done, by whom, how, and
when. For complex tasks, include what needs to reported
back to you.
Don’t leave after giving only vague directions, such as “Let
me know if you need anything” or “Check on the patients
and see how they’re doing”. Instead, ask for specific
feedback, such as, “How much output has Mr. Smith had
since surgery?”
Clearly indicate priorities. Without
adequate direction, assistants may
not recognize or react appropriately
to emergencies. Find a common
language to identify true emergencies
– “stat” is often overused. Instead,
communicate a phrase - “This must be done right away” in
a clear tone that conveys urgency. And, verify
comprehension, such as asking “Do you understand?”,
rather than saying a general “Ok?”
BARRIERS TO DELEGATING
No one is born knowing how to delegate. Many people
have difficulty delegating because they feel they can do a
task faster. Or, they may be perfectionists, believing they
can do the job better. As a result, if they do delegate, they
feel they must keep track of every detail.
When a job is delegated to another, you have given
them the authority to complete it, without hovering over his
or her shoulder. Some people may not delegate because it
is easier not to bother someone else and just go on and
perform the task. Not appropriately delegating means you
are not relying on your team of healthcare providers. This
does not help team morale and will cause undo work for
you.
Delegate tasks you have experience with. You, thus,
use your experience to ensure that the task is done well,
rather than actually performing the task yourself. This is
delegation. Consider the first time you learned to mow a
lawn or make a cake. Of course, your parent could do it
faster and better. But, with time and experience, these
tasks could be delegated to you. And, as a child, you were
likely thrilled with the opportunity of performing the task and
the trust others had bestowed in you. This is also true as
adults.
Some people are insecure and may fear their position.
This is a "What if the subordinate does too well?"
syndrome. There may also be a lack of confidence in
subordinates which prevents delegating. This syndrome is
best described as "What happens if something goes
wrong?" Fearing unsatisfactory results, a superior may
question a subordinate's judgment or ability to follow
through.
Activities that rely on the nursing process or require
specialized skill, expert knowledge, or professional
judgment cannot be delegated. Properly utilized, nonlicensed personnel are real assets in providing effective
patient care in today’s hectic healthcare environment.
Growing Up With Us, Inc.
PO Box 481810 • Charlotte, NC • 28269
Phone: (919) 489-1238 Fax: (919) 321-0789
Editor-in-Chief: Mary M. Dunlap MAEd, RN
E-mail: [email protected]
Website: www.growingupwithus.com
GUWU Testing Center
www.growingupwithus.com/quiztaker/
Copyright © 2009 Growing Up With Us, Inc. All rights reserved.
Page 2 of 4
Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
Personal Growth…
A Newsletter for All Staff
September 2009
Competency: Demonstrates Age-Specific Competency by correctly answering
9 out of 10 questions related to Keys to Delegation.
KEYS TO DELEGATION
1. Delegation is best defined as:
a.
b.
c.
d.
doing a co-worker a favor.
the downward transfer of formal authority.
shirking your duties to lighten your workload.
shifting legal accountability of a task to a peer with equal qualifications.
2. When delegation occurs, responsibility is transferred, but not legal accountability for completing
the task.
a. True
b. False
3. Before delegating, each patient situation should be assessed individually.
a. True
b. False
4. A key characteristic to consider when determining the appropriateness of delegating a specific
task is the:
a.
b.
c.
d.
attitude of the assistant.
desirability of the work.
the job description of the assistant.
the assistant’s usual work assignment.
5. An example of a task that could be appropriately delegated to a nursing assistant by an RN would
be:
a.
b.
c.
d.
assessing breath sounds.
obtaining a urine specimen.
teaching a newly diagnosed diabetic.
evaluating blood glucose results.
Copyright © 2009 Growing Up With Us, Inc. All rights reserved.
Page 3 of 4
Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
Personal Growth…
Page 2
KEYS TO DELEGATION
6. The best way for a nurse to communicate a delegated task to a nursing assistant would be to say:
a.
b.
c.
d.
“Watch the post-op patient and let me know if anything changes.”
“Is Mr. Smith’s intake adequate since surgery?”
“Please empty Mrs. Jones’ Foley in four hours and let me know if it is less than 100 cc.”
“Let me know if you observe any signs of hypoglycemia in the diabetic patient.”
7. A culture must be taken to the lab right away. Which of the following best communicates to the
nursing assistant this urgency?
a.
b.
c.
d.
“Take this to the lab stat. Okay?”
“When you get a chance would you please take this to the lab?”
“Carry this to the lab immediately. This must be done now. Do you understand?”
“This needs to go to the lab so we can start any necessary antibiotics as soon as possible.”
8. A nursing assistant, who is not certified in medication administration, is asked to give a patient a
medication when the patient wakes up. The RN says, “It’s only aspirin.” The nursing assistant
should:
a.
b.
c.
d.
do as he or she is told.
say “No, that isn’t a task I’m allowed to perform.”
go on and give it to the patient since it is only aspirin.
ask another nursing assistant to do it.
9. Many people have difficulty delegating for all of the following reasons EXCEPT they:
a.
b.
c.
d.
would rather not bother others.
are the most skilled to do the job.
feel they can do the task faster.
want to directly hurt team morale.
10. When delegating, which of the following is NOT appropriate?
a.
b.
c.
d.
Offer praise for a job well done.
Have a positive attitude.
Remember common courtesies, like “please” and “thank you”.
Always directly supervise the task.
Copyright © 2009 Growing Up With Us, Inc. All rights reserved.
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