Prioritization and Delegation

Principles for Implementation of Prioritization,

Assignment, and Delegation

RN SHOULD RN SHOULD STUDENTS, RN IS RN CANNOT EVERYTHING IN

ALWAYS START REFER TO THE NOVICES, ACCOUNTABLE DELEGATE THE A CLINICAL
WITH THE STATE NURSE FLOAT NURSES FOR NURSING NURSING SITUATION IS
PATIENT’S PRACTICE ACT AND OTHER JUDGMENT PROCESS TO A SHIFTING—RN
OUTCOMES IN INFREQUENT DECISIONS NON-RN IS
MIND WORKERS AND ONGOING ACCOUNTABLE
REQUIRE SUPERVISION TO CHOOSE
VARIABLE OF ANY CARE THE BEST
LEVELS OF THAT IS COURSE FOR
GUIDANCE PROVIDED ACHIEVING
AND SUPPORT PATIENT
OUTCOMES
Prioritization

• Deciding which needs or problems require immediate action and which ones
could be delayed until a later time
• Is it life-threatening or potentially life-threatening if the task is not done?
• Is this task essential to patient or staff safety?
• Is this task essential to the medical or nursing plan of care?
 Priority Setting
3 levels of priority setting:

2. CONCERNS SUCH AS 3. HEALTH PROBLEMS

1. AIRWAY, BREATHING, CARDIAC MENTAL STATUS OTHER THAN THOSE IN
STATUS AND CIRCULATION, AND CHANGES, UNTREATED THE FIRST TWO LEVELS
VITAL SIGNS (ABCS + V) MEDICAL ISSUES, ACUTE SUCH AS MORE LONG-
PAIN, ACUTE TERM ISSUES IN
ELIMINATION PROBLEMS, HEALTH EDUCATION,
ABNORMAL LABORATORY REST, COPING, ETC.
RESULTS, AND RISKS.
Assignment and Delegation
Assignment:
“Designating nursing activities to be
performed by another nurse or assistive
personnel that are consistent with his/her
scope of practice (licensed person) or role
description (unlicensed person)” (NCSBN,
2005)
Delegation:
“transferring to a competent individual the
authority to perform a selected nursing task
in a selected situation” (NCSBN, 2005),
however the ANA specifies that delegation is
a transfer of responsibility rather than
authority (ANA, 2006)
• Getting things done through other people
Arguments

Some contend that all nursing care is a part of the RN scope of practice

ANA and NCSBN (2006) white paper says “assign” describes the distribution of
work that each staff member is responsible for during a given shift or work period;
“delegation” is transferring authority to perform a task to a competent individual in
a selected situation but the RN retains the accountability for the delegation
Why Delegate?
• Develops people • Allows supervisor to do other
• Learning by doing things
• Builds trust • Planning, coordinating
• Troubleshooting
• Ownership of work

• Allows more work to be accomplished

• Doesn’t take power away, expands base of power
• More people become knowledgeable about priorities, gives a
broader perspective
 Delegation and Supervision

The person who delegates The nurse must also

must know the individual’s supervise
competence to perform the The provision of guidance and
task direction, oversight, evaluation
Must have the proper and follow up by the licensed
training to do the task nurse for accomplishment of a
nursing task delegated to
Can refuse if untrained nursing assistive personnel
What Should Not be Delegated
1. Assignments out of the scope of practice of the
delegatee
2. Any direct assignment that has been given
specifically to you
3. Confidential work
4. Pet projects
Knowing When to Delegate

• Do you do work that another employee could do just as

well?
• Do you think that you are the only one who actually knows
how the job should be done?
• Do you leave the job each day loaded down with details to
take care of tomorrow?
• Do you frequently stay after hours to catch up?
• Are you a perfectionist?
Why Supervisors Fail to
Delegate
Lack of trust

Think they can do it better

Control issues

Personality—domineering, insecure

Incompetent employees
 Delegation and the “5 Rights”

1. Right 4. Right
3. Right direction and 5. Right
circumstance 2. Right Task
person communicati Supervision
s
• Based on • One that • Know the on
• (4 Cs”) • RN
area of can be licensure, clear, remains
practice safely role, and concise, accountabl
and delegated preparatio correct, e makes
patient n of the and “checkpoin
condition delegatee complete ts” during
instruction the shift,
s and
provides
feedback
 Feedback process

SOLICIT INPUT GIVE CREDIT OBSERVATIONS THE DELEGATEE RN AND TEAM

FROM THE FOR WHAT HAS OR CONCERNS SHOULD BE AGREE ON A
TEAM BEEN SHOULD BE ASKED FOR COURSE OF
MEMBERS ACCOMPLISHED DISCUSSED IDEAS ON HOW ACTION AND
TO RESOLVE PLAN FOR THE
ISSUES FUTURE
Role of the Delegatee
Take the initiative
Relate to the supervisor
Be sure the delegation is realistic
Give feedback regarding results
Report periodically to the supervisor
Carry out the assignments effectively
Develop self to be able to handle more involved
assignments
• “The best executive is one who
has sense enough to pick good
people to do what s/he wants
done and self-restraint enough to
keep from meddling with them
while they do it.”

• Theodore Roosevelt
 T or F 1. Once I delegate a task to an unlicensed health care worker, I am
no longer accountable for what happens.
Know Your Practice
   

 T or F 2. My state’s Nurse Practice Act specifically allows me to delegate

nursing care activities.
 
 T or F 3. My state’s Nurse Practice Act specifies that I must know the
competencies and abilities of the person to whom I delegate.
  
T or F 4. Employer policies or directives relieve me of my responsibility for making judgments
about the delegation of nursing care activities.

T or F 5. If a nursing assistant makes a mistake during a task I have delegated, it could

mean I could lose my license.

T or F 6. If I fail to supervise those to whom nursing activities have been delegated, I may be
disciplined by the State Board.
Know What Needs to be Done
You have the following personnel to complete these assignments: one
CNA, one LPN, a unit secretary. How will you plan your assignments?
1. 65 y/o total hip, day 2, has hyperal, is confused, family problem,
very unhappy with care
2. 35 y/o bowel resection, day 3, very happy that cancerous bowel was
removed, ready to learn home care
3. 35 y/o hysterectomy, day 2, very stable, requires little care, ready to
go home in a day or two
4. 29 y/o motor vehicle crash, day 3, multiple lacerations, bruises,
dressings and wound care take about one hour
5. 41 y/o pneumonia, day 4, 2 IV antibiotics q4-6 h
6. 81 y/o TURP, day 2, from group home, ready to return tomorrow,
alert, friendly, understands basic instructions