Page 136 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch09_115-130.qxd 11/6/09 5:59 PM Page 123
chapter 9 | Delegation of Client Care 123 CikguOnline
box 9-3 criticized, for seeking guidance (Tappen, Weiss, &
Whitehead, 2004).
Five Factors for Determining if Client
Care Activity Should Be Delegated
Priorities
• Potential for harm to the patient
The work of a busy unit rarely ends up going as
• Complexity of the nursing activity
• Extent of problem solving and innovation required expected. Dealing with sick people, their families,
• Predictability of outcome physicians, and other team members all at the same
• Extent of interaction
time is a difficult task. Setting priorities for the day
Adapted from American Association of Critical Care Nurses (AACN). (1990). should be based on client needs, team needs, and
Delegation of Nursing and Non-Nursing Activities in Critical Care: A
Framework for Decision-Making. Irvine, CA: AACN. organizational and community demands. The val-
ues of each may be very different, even opposed.
These differences should be discussed with team
caregivers within each discipline because ability members so that decisions can be made based on
differs with each level of education. Additionally, team priorities.
individuals within each level of skill possess their One way to determine patient priorities is to base
own strengths and weaknesses. Prior assessment decisions on Maslow’s hierarchy of needs. Maslow’s
of the strengths of each member of the team will hierarchy is frequently used in nursing to provide a
assist in providing safe and efficient care to framework for prioritizing care to meet client needs.
clients. Figure 9.3 outlines the skills of various The basic physiological needs come first because
health-care personnel. they are necessary for survival. For example, oxygen
People should not be assigned a task that they and medication administration, IV fluids, and enter-
are not skilled in or knowledgeable to perform, al feedings are included in this group.
regardless of their professional level. People are Identifying priorities and deciding the needs to
often reluctant to admit they cannot do something. be met first help in organizing care and in deciding
Instead of seeking help or saying they are not com- which other team members can meet client needs.
fortable with a task, they may avoid doing it, delay For example, nursing assistants can meet many
starting it, do only part of it, or even bluff their way hygiene needs, allowing licensed personnel to
through it, a risky choice in health care. administer medications and enteral feedings in a
Regardless of the length of time individuals timely manner.
have been in a position, employees need orientation
Efficiency
when assigned a new task. Those who seek assis-
tance and advice are showing concern for the team Efficiency means that all members of the team
and the welfare of their clients. Requests for assis- know their jobs and responsibilities and work
tance or additional explanations should not be together like gears in a well-built clock.They mesh
ignored, and the person should be praised, not together and keep perfect time.

Patient Care Needs

RN Skills LPN Skills Ancillary Personnel UAP

Assessment Vital signs
IV medications Some IV medication PT Feeding
Blood administration (depending on state OT Hygiene
Nurse Practice Act Nutrition Physical care
Planning care
and institution)
Physician orders Speech
Physical care
Teaching
Figure 9.3 Diagram of delegation decision-making grid.