Assignment Delegation and Supervision (Nursing)

00:01 Hi, I'm Jessica Spellman. This is Delegation and Supervision, a review of the definitions and concepts of nursing delegation.

00:09 After taking this course, you will be able to explain the definition of delegation, review the rights of delegation, explain the delegation process, analyze effective delegation principles, review barriers to effective delegation, and provide strategies for overcoming those barriers. So let's start with the definition of delegation.

00:32 Delegation is the process of a nurse directing another person to perform nursing tasks and activities.

00:40 The supervision is the active process of directing, guiding and influencing the outcome of the individual's performance of a task. "The provision of guidance or direction, an oversight, evaluation and follow-up by the licensed nurse for the accomplishment of a delegated nursing task by assistive personnel" is how the State Boards of Nursing defines supervision. Let's look at an assignment versus a nursing delegation of a task. Let's compare them.

01:14 Under assignment of tasks: the division of work to each staff member during a period of time, the individuals are already authorized to perform that task. And delegation, we're transferring the responsibility from the nurse to a person that would not normally be allowed to perform that task.

01:31 And that gets a little tricky, so we're gonna need to look at a few examples here.

01:36 So under your assignment that you get. For example, an unlicensed assistive personnel, or UAP, performing routine vital signs on a patient they have been assigned to care for. This is already part of the UAP's assignment, so this is not considered delegation; this is considered their assignment.

02:02 In the delegation of tasks, the example of a nurse requesting a UAP to perform a set of vital signs outside of the routine timeframe due to complaints of dizziness by a patient. Since UAPs are allowed to perform vital signs, the nurse is able to request them to perform a set of vital signs outside of the normal parameters that they would normally do so. Why is delegation necessary? Well, it helps contain costs, multiple people can do multiple jobs; it helps utilize resources appropriately; it helps with time management; it improves patient outcomes and it's part of interdisciplinary care.

02:48 Nurses cannot do everything themselves. So the five rights of delegation.

02:53 Just like there's five rights of medication administration, there are five rights of delegation. Overall, we wanna provide the right supervision for the task. We want to define the appropriate task, we want to select the right situation, the right person, and we need to provide the right direction so that the person performing the task can be successful. Let's look at the process of delegation. The delegation process follows the nursing process model. We're all familiar with that, so let's review it.

03:29 The nursing process model starts with an assessment. So the nurse assesses the patient in a situation, uses their critical thinking skills to decide on a plan of care. After the assessment, they develop a plan, they use the five rights of delegation to have a task performed.

03:47 In the implementation stage, the nurse verifies that the delegate accepts and understands the task they're being asked to perform. And in the evaluation phase, the nurse evaluates the performance of the delegate, the patient outcome, and provides feedback.

04:04 So a few things to consider while we're delegating. A nurse may delegate components of care, but can never delegate the nursing process. The nurse still maintains accountability for the task being completed as assigned and nurses can only delegate tasks for which the delegate has the skills and knowledge to perform. That's why it's important to select the right person for the right task.

04:28 Nurses decision to delegate is based upon a few things to consider.

04:34 Nurses assessment of the patient, their nursing judgment, their knowledge of the competence of their team members, and the degree of supervision required. So what tasks can nurses delegate? They can delegate unlicensed assistive personnel to perform several tasks. They can set up patient rooms, orient patients to their room.

05:00 They can collect vital signs. They can measure and record intake and output.

05:04 They can remove peripheral IVs. The can perform oral suctioning and set up oxygen.

05:10 Again, this is just a short list of the things unlicensed assistive personnel can do.

05:17 They cannot delegate formulating a nursing diagnosis. They cannot provide patient education.

05:23 They cannot initiate a care plan or document the progress of a care plan. They cannot document patient response to a nursing intervention and they cannot discuss the plan of care with physicians.

05:36 Those are things that cannot be delegated to anyone but the nurse.

05:40 So why don't nurses delegate more often or why do they find it difficult to delegate? There are a few reasons for this. The first is nurses sometimes feel that they can do it better themselves.

05:55 And that's a misconception because interdisciplinary care that we're providing patients at this point.

06:01 Nurses cannot do everything themselves, they don't have the time to see four or five patients and perform all of the functions for those patients. Sometimes they have a lack of trust in their coworkers.

06:13 Maybe their skills, don't feel like they're knowledgeable to do the tasks they're being asked to do.

06:20 Sometimes I think nurses are afraid of subordinate resistance. Having the person say, no, they're not going to do that. Other times, I think nurses feel that it takes time to explain the task to somebody, so they go back to the 'I can do it quicker and better by myself' phrase, which isn't always the best response. And sometimes nurses have low self-confidence.

06:45 They have trouble working in a team and asking others to perform functions that they should also be able to perform. When they communicate clearly, that is very important. You want the person to understand what you're asking them to do.

07:02 And you wanna supervise progress. You are still responsible for the task being completed, you're just asking somebody else to do it for you. So supervision is absolutely required and the delegate needs that to make sure that they're doing the task the way that you wanted them to perform it.

07:25 So you have to provide them feedback and evaluation when the task is completed.

07:33 And you also wanna select a person with the necessary skill. So I have a quick question for you.

07:39 Let's test some of the concepts I've gone over with you. A nurse gets a new admission while caring for another patient that has an unstable blood pressure.

07:48 The patient she's already taking care of has the unstable blood pressure. So which task can the nurse delegate to the UAP? Can the nurse ask the UAP to perform and document the assessment? Get the patient up and ambulate to the bathroom? Orient the patient or family to the room and perform initial set of vital signs? Or notice that the patient is short of breath and place oxygen 2L via nasal cannula on the patient? The correct answer is C. They can orient the patient and family to the room and perform an initial set of vital signs.

08:28 Let's go through the incorrect answers for a moment. UAPs are never allowed to perform assessments and they definitely can't document them. Normally, a UAP would be able to get a patient up and ambulate them to the bathroom, but since the admitting orders haven't been reviewed by the nurse yet, their level of activity may not have been confirmed. So getting them up without asking the nurse may be inappropriate.

08:55 And then noticing that the patient is short of breath and place them on oxygen is also something that would need approval from the RN before they were allowed to do that.

09:05 So let's review some basic concepts of delegation. Nursing judgment and critical thinking are essential in delegation.

09:14 Nurses retain accountability for the completion and evaluation of tasks.

09:20 They must use the five rights of delegation.

09:26 They need to provide supervision and feedback.

09:32 Nurses can delegate tasks but not the nursing process.

09:38 Just a few things to keep in mind while you're delegating. This has been nursing delegation and supervision and I'm Jessica Spellman.