Page 131 - Essentials of Nursing Leadership and Management, 5th Edition

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118 unit 2 | Working Within the Organization CikguOnline
important that the RN discover why. Perhaps one other staff members with setting priorities, commu-
of the clients required more care than expected, or nicating clearly,clarifying instructions,and reassess-
the nursing assistant needed to do an errand off the ing the situation.
floor. Reevaluation of the assignment may be nec- In 1995 the NCSBN published a paper address-
essary. When one RN works with another, then ing the issue of delegation.The NCSBN developed
supervision is not needed. This is a collaborative a concept called the Five Rights of Delegation (see
relationship and includes consulting and giving Box 9-1), similar to the five rights regarding
advice when needed. medication administration. In 2006 the NCSBN,
Individuals who supervise others also delegate along with the ANA, prepared a joint statement on
tasks and activities. Chief nursing officers often delegation that clarified the profession’s practice
delegate tasks to associate directors. This may guidelines and the legal requisites for delegation.
include record reviews, unit reports, or client Before being able to delegate tasks and activities to
acuities. Certain administrative tasks, such as staff other individuals, however, the nurse must under-
scheduling, may be delegated to another staff stand the needs of each client.
member, such as an associate manager. The chief
nursing officer remains accountable for ensuring Coordinating Assignments
the activities are completed. One of the most difficult tasks for new nurses to
Supervision sometimes entails more direct master is coordinating daily activities. Often, you
evaluation of performance, such as performance have clients for whom you provide direct care, and
evaluations and discussions regarding individual you must supervise the work of others, such as non-
interactions with clients and other staff members. nurse caregivers, LPNs, or vocational nurses.
Regardless of where you work, you cannot Although care plans, critical (or clinical) pathways,
assume that only those in the higher levels of the concept maps,and computer information sheets are
organization delegate work to other people. You, available to help identify client needs, these items
too, will be responsible at times for delegating some do not provide a mechanism for coordinating the
of your work to other nurses, to technical person- delivery of care. To do this, personalized work-
nel, or to another department. Decisions associated sheets can be developed that prioritize tasks to per-
with this responsibility often cause some difficulty form for each client. Using the worksheets helps
for new nurses. Knowing each person’s capabilities the nurse identify tasks that require the knowledge
and job description can help you decide which and skill of an RN and those that can be carried out
personnel can assist with a task. by UAP.
On the worksheet, tasks are prioritized on the
The Nursing Process and Delegation basis of client need, not nursing convenience. For
example, an order states that a client is to receive
Before deciding who should care for a particular continuous tube feedings. Although it may be con-
client, the nurse must assess each client’s particular venient for the nurse to fill the feeding container
needs, set client-specific goals, and match the skills with enough supplement to last 6 hours, it is not
of the person assigned with the tasks that need to good practice and not safe for the client. Instead,
be accomplished (assessment). Thinking this the nurse should plan to check the tube feeding
through before delegating helps prevent problems every 2 hours.
later (plan). Next, the nurse assigns the tasks to the As for Linda at the beginning of the chapter, a
appropriate person (implementation). The nurse worksheet can help her determine who can do
must then oversee the care and determine whether what. First, she needs to decide what particular
client care needs have been met (evaluation). It is tasks she must do. These include receiving and
also important for the nurse to allow time for feed- transcribing orders; contacting physicians with
back during the day. This enables all personnel to information or requests; accessing laboratory
see where they are and where they want to go. reports from the computer, reviewing them, and
Often, the nurse must first coordinate care for giving them to the appropriate staff members; and
groups of clients before being able to delegate tasks checking any new medication orders and placing
to other personnel. The nurse also needs to consider them in the medication administration records.
his or her own responsibilities.This includes assisting Another RN may be able to relieve the monitor