Page 130 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch09_115-130.qxd 11/6/09 5:58 PM Page 117
chapter 9 | Delegation of Client Care 117 CikguOnline
Delegation delineated by the National Council that UAP are performing inappropriate functions
of State Boards of Nursing (NCSBN) (Box 9-1). that belong within the legal realm of nursing
■ The RN recognizes that a relational aspect exists (ANA, 2002).
between delegation and communication. Permitted tasks vary from institution to institu-
Communication needs to be culturally appropri- tion. For example, a certified nursing assistant
ate, and the individual receiving the communi- (CNA) performs specific activities designated by the
cation should be treated with respect. job description approved by the particular health-
■ Chief nursing officers are responsible for care institution. Although the institution delineates
creating systems to assess, monitor, verify, and tasks and activities, this does not mean that the RN
communicate continuous competence require- cannot decide to assign other personnel in specific
ments in areas related to delegation. situations.Take the following example:
■ RNs monitor organizational policies, procedures,
Ms. Ross was admitted to the neurological unit
and job descriptions to ensure they are in
from the neuroscience intensive care unit. She suf-
compliance with the nurse practice act, consult-
fered a grade II subarachnoid hemorrhage 2 weeks
ing with the state board of nursing as needed
ago and has a left hemiparesis. She has difficulty
(ANA, 2005, p. 6).
with swallowing and receives tube feedings through
Delegation may be direct or indirect. Direct delega- a percutaneous endoscopic gastrostomy (PEG) tube;
tion is usually “verbal direction by the RN delegator however, she has been advanced to a pureed diet.
regarding an activity or task in a specific nursing She needs assistance with personal care, toileting,
care situation” (ANA, 1996, p. 15). In this case, the and feeding. A physical therapist comes twice a day
RN decides which staff member is capable of per- to get her up for gait training; otherwise, the physi-
forming the specific task or activity. Indirect delega- cian wants her in a chair as much as possible.
tion is “an approved listing of activities or tasks that
Assessing this situation, the RN might consider
have been established in policies and procedures of
assigning an LPN to this client. The swallowing
the health care institution or facility” (ANA, 1996,
problems place the client at risk for aspiration,
p. 15). The ANA also differentiated the delegation
which means that feeding may present a problem.
of a task from the assignment of a task. Although
There is a potential for injury. The LPN is capable
the terms are often used interchangeably, according
of managing the PEG tube feeding. While assist-
to the ANA (1996), assignment is the “downward
ing with bathing, the LPN can perform range-
or lateral transfer of both the responsibility and the
of-motion exercises to all the client’s extremities
accountability of an activity from one person to
and assess her skin for breakdown. The LPN also
another.”When one RN “delegates”to another RN,
knows the appropriate way to assist the client in
that RN, based on knowledge and skill, may be
transferring from the bed to the chair.The RN may
responsible and accountable. UAP may also be
not assign an individual to perform a task or activ-
assigned, rather than “delegated,” a task. For exam-
ity not specified in that person’s job description
ple, UAP have the knowledge and skills required for
or within the scope of practice, such as allowing
some routine tasks (Ellis & Hartley, 2004).
a nursing assistant to administer medications or
The recent changes occurring in the health-care
perform certain types of dressing changes.
environment continue to modify the scope of nurs-
ing practice and the activities delegated to UAP. A Supervision
main concern in almost all health-care settings is
Do not confuse delegation with supervision.
Supervision is more direct and requires directly
overseeing the work or performance of others.
box 9-1 Supervision includes checking with individuals
The Five Rights of Delegation throughout the day to see what activities have been
1. Right task completed and what may still need to be finished.
2. Right circumstances For example, a nursing assistant has been assigned
3. Right person to take all the vital signs on the unit and give the
4. Right direction/communication morning baths to eight clients. Three hours into
5. Right supervision/evaluation
the morning, she is far behind. At this point, it is