Delegation/Collaboration PPT

What can and cannot be delegated?

• No definitive list of what can/cannot be delegated

  • Varies among states, organizations, & specific
    situations
    ○ Assessment, evaluation, and nursing judgment cannot
    be delegated

Where must a RN integrate delegation information from?

• RNs must integrate information from:
  ○ state nurse practice acts
  ○ patient needs
  ○ job descriptions
  ○ employee competency
  ○ policies and procedures
  ○ clinical situation
  ○ professional standards of nursing practice

When is a delegated task considered high-risk based on legal or professional standards?

When the task is legally, professionally, or organizationally restricted to only be performed by a registered nurse (RN).

What type of task should not be delegated due to safety concerns?

A task that involves substantial risk or harm to a patient

Why is it high-risk for an RN to delegate a task to someone without proper training?

Because the individual may not be competent, increasing the risk of harm to the patient.

What makes delegation high-risk even if the person is trained?

If the RN fails to provide adequate supervision during the task.

What follow-up action is essential after delegation to avoid high-risk situations?

The RN must evaluate the delegated action by reassessing the patient.

What is delegation?

the transferring of responsibility to another staff member the authority and responsibility to perform a selected nursing task. The delegatee given the task has the education,
training, and validated competence to perform the task

ACCOUNTABILITY IS RETAINED, EVEN IF RESPONSIBILITY IS TRANSFERRED!

How does delegation impact the cost of healthcare delivery?

It increases the cost-effectiveness of providing patient care

How does delegation help RNs prioritize care?

It allows RNs to delegate tasks for stable patients to UAPs, so they can focus on more critical patients.

What is one operational benefit of effective delegation?

It ensures timely completion of tasks through efficient task management.

How does delegation promote patient safety?

It requires effective communication, which helps prevent medical errors.

How can delegation improve workplace culture?

It fosters trust, cooperation, and boosts staff morale.

What are the RN’s responsibilities when delegating tasks?

RNs delegate nursing care but retain accountability, supervise LPNs and UAPs, and follow standards set by the Georgia Board of Nursing (assessment, diagnosis, planning, intervention, teaching, evaluation, supervision).

Can RNs transfer accountability when delegating?

No, RNs remain accountable and do not transfer accountability when delegating tasks.

What can LPNs do in terms of delegation and care?

LPNs can receive delegation from RNs, delegate to CNAs, and provide care under supervision. They can give IV push meds and hang blood only if checked by an RN.

Can UAPs delegate tasks to others?

No, UAPs are not allowed to delegate tasks.

What kinds of tasks can UAPs perform?

Tasks that don’t require complex observation, have predictable outcomes, and follow exact, unchanging directions.

What must be considered before delegating a task to someone?

Their ability to perform the task, specific instructions given, and whether they have the necessary knowledge and skills.

What documentation supports safe delegation?

Written documentation of staff competencies must be known by the person supervising the task.

How do organizational policies affect delegation?

Policies may vary by setting and can require RNs to take on more tasks or restrict what LPNs/UAPs can do.

What must be ensured before assigning a task to a delegatee?

They must be trained in and understand the organization's standards of care (e.g., infection control).

Who helps determine agreed-on levels of nursing practice?

The American Nurses Association (ANA) and specialty nursing organizations.

What does the ANA standard say RNs must consider before delegating?

RNs must assess the patient’s condition before delegating a task

Why should RNs assess the capabilities of nursing and assistive staff?

To ensure the delegatee is competent and safe to perform the task.

Why does the complexity of a task matter in delegation?

More complex tasks may require the RN to retain responsibility or provide closer supervision.

How does clinical oversight factor into delegation decisions?

The RN must consider how much supervision they can realistically provide.

How does staff workload affect delegation?

An overloaded team member may not be safe or efficient to delegate to.

What are the five rights of delegation?

• Right Task

• Right Circumstance

• Right Person

• Right Direction & Communication

• Right Supervision and Evaluation

What is the Right Task in delegation?

The task must conform to established policies, procedures, and guidelines.

What is the Right Circumstances in delegation?

The situation must not require independent nursing judgment or critical decision-making.

What is the Right Person in delegation?

The delegatee must be qualified, trained, and competent to perform the task.

What is the Right Direction and Communication in delegation?

The RN must give clear instructions about the task, expected outcomes, and when to report back.

What is the Right Supervision and Evaluation in delegation?

The RN must provide feedback, monitor the task, and evaluate the patient’s outcomes.

Why is the competency and orientation of a CNA/LPN important in delegation?

The nurse must know how competent and trained the CNA or LPN is before assigning a task.

How does the clinical situation influence delegation?

Delegation depends on the patient’s diagnosis or procedure—some situations may require direct RN involvement.

Why is understanding patient needs essential in delegation?

The nurse must know which patients are priority to safely delegate lower-priority tasks.

What does scope of practice mean in relation to delegation?

Knowing the legal and professional duties and limits of each role (RN, LPN, CNA) to delegate safely.

Name some tasks that cannot be delegated by the RN.

Administering pain meds, changing bandages, and delegation by CNAs or LPNs beyond their scope.

Name some tasks that can be delegated to CNAs or LPNs.

Transferring patients, taking vital signs, and assisting with ADLs.

When should vital signs and ADLs not be delegated?

When the patient is unstable, showing a change in condition, or requires clinical judgment.

What does TAPE stand for in nursing delegation?

• T: Teaching

• A: Assessment

• P: Planning

• E: Evaluation

Tasks that RNs cannot delegate.

What types of assessment cannot be delegated?

Initial and ongoing assessments requiring nursing judgment, like head-to-toe and pain assessments.

• ASKING PAIN LEVELS IS AN ASSESSMENT ONLY NURSE SHOULD DO

Why can't nursing diagnoses be delegated?

Because determining nursing diagnoses requires critical thinking and professional judgment.

What planning tasks are exclusive to the RN?

Creating or updating the care plan, setting nursing goals, and deciding interventions.

Can patient education be delegated to a UAP or LPN?

No. Teaching about care, medications, or discharge instructions must be done by the RN.

What are examples of evaluation tasks only an RN can do?

Interpreting patient responses, reassessing care plans, and determining if outcomes are met.

Could u delegate an unstable pt to a lpn to do vitals?

No, you should not delegate vital signs of an unstable patient to an LPN.

Here’s why:

• Unstable patients require frequent assessments and clinical judgment, which are responsibilities that fall under the RN's scope.

• Taking vital signs in an unstable patient isn't just about collecting numbers — it involves interpreting trends, identifying subtle changes, and making quick decisions.

• Only the RN has the authority to assess, interpret, and intervene based on those findings in unstable situations.

✅ You can delegate vitals to an LPN or CNA only when the patient is stable, the task is routine, and there’s no need for immediate nursing judgment.

Can an RN delegate the evaluation of a patient’s progress?

No. Evaluation includes reassessment during and after the care plan, which requires nursing judgment.

Why can’t health counseling or teaching be delegated?

Because it requires nursing expertise to educate patients, especially those with new diagnoses or medications (e.g., diabetes, new prescriptions).

What are examples of specialized nursing tasks that cannot be delegated?

Starting IVs, maintaining central lines, and administering injectable medications (IV PUSH)

Who is responsible for tasks requiring critical thinking and judgment?

The RN, because these tasks cannot be safely or legally delegated to LPNs or UAPs.

What are some common emotional fears that prevent novice nurses from delegating?

Fear of being disliked, losing control, taking risks, or making mistakes.

How does a lack of knowledge affect delegation?

It leads to lack of confidence, especially when delegating to others like new hires.

Why might a nurse avoid delegating due to personal beliefs?

They may feel they can do everything better themselves.

How does concern about the delegatee’s competence act as a barrier?

Nurses may hesitate to delegate if they believe the person isn’t capable of completing the task safely or correctly.

What is essential for successful delegation and supervision?

Clear and effective communication.

What should the RN know before delegating a task?

What needs to be done and the expected outcomes.

What personal qualities should the RN maintain during delegation?

Self-control and confidence.

Why is it important to listen to the delegatee's response?

To ensure understanding, clarify concerns, and build trust in the delegation process.

How should an RN respond if the delegatee reacts negatively to a task?

Use open-ended, nonthreatening questions to ask for feedback and understand their concerns.

Why is it important to maintain a nonthreatening and nonjudgmental attitude?

It encourages team members to report problems quickly and openly

How should an RN respond when mistakes occur?

Avoid blaming or criticizing; instead, look for root causes like lack of training or workload issues.

What helps create a safe environment for staff communication?

Encouraging team members to report and discuss problems without fear of judgment.

When is the delegation process complete?

Only after the RN reassesses the patient to evaluate the outcome.

Why is honest feedback important in delegation?

It helps the delegate grow, reinforces expectations, and improves future performance.

How should the RN respond to good performance?

Offer praise to encourage continued excellence and boost morale.

What should the RN do if the task was poorly performed?

Address the issue clearly, provide guidance, and identify what went wrong.

What action should be taken when there is inappropriate behavior?

Address it immediately to ensure patient safety and maintain team accountability.

What should be done if a delegatee lacks proper training?

Identify the gap and arrange for further training or education.

What is the definition of incivility or bullying in the workplace?

Any rude or disrespectful behavior toward another person, with or without intent to harm.

What are examples of bullying in nursing?

• Invalid criticism

• Profane or disrespectful language

• Public put-downs

• Threatening or hostile emails

How does bullying impact patient safety and quality of care?

It creates a toxic environment that can lead to communication breakdowns and medical errors.

How does bullying affect staff morale?

It leads to decreased job satisfaction, teamwork breakdown, and emotional distress.

What are organizational consequences of bullying and incivility?

• Increased absenteeism

• Health issues for victims

• Higher costs due to workplace violence and turnover

Who must take the lead in stopping workplace bullying in healthcare?

Nurses must provide the leadership to stop bullying in the workplace.

What are individual steps a nurse can take to address bullying?

• Recognize and address it calmly

• Understand the victim is not the problem

• Know bullying is about control

• Keep written records

• Follow workplace policies on incivility

What should victims of bullying do to protect themselves?

Keep detailed records of incidents and report them following workplace policy.

What leadership steps help prevent bullying in nursing?

• Enforce zero-tolerance policies

• Provide education on incivility

• Encourage staff to report incidents

• Create a safe, respectful environment

What effect does a zero-tolerance policy have on bullying?

It leads to fewer reported bullying incidents