AMS Leadership & Delegation

1. ABC and vital signs

2. DE (disability, exposure)

3. Long term/ chronic issues, inadequate rest, difficulty coping etc.

What are the levels of priority?

CAB

What is the priority when there is no pulse (cardiac arrest) in ABCs?

1. Physiological

2. Safety

3. Love/Belonging

4. Esteem

5. Self-Actualization

What are Maslow’s Hierarchy of Needs?

• Determine your goal(s) for each patient at the start of shift

• Decide which needs or problems require immediate actions, and which could be delayed until a later time

• Organize activities from the most important to the least important

How should you prioritize as a nurse?

Time management

Handling time with a measure of proficiency

• What is the relative importance of each task?

• How much time will each task require?

• When must the task be completed?

• How much energy must be devoted to these tasks?

What questions should you consider for time management as a nurse?

• Organize your work

• Set goals

• Document real time

• Make a schedule for meds

• Monitor your EHR Tasks and Order lists frequently

• Identify behaviors that waste time

How should you maximize your time as a nurse?

• Procrastination

• Poor planning

• Disorganization

• Improper delegation

• Inability to say no

• Manage by crisis

• Telephone calls

• Physician rounds

• Required meetngs and education

What impacts time management and prioritization?

Delegation

Reassigning responsibility for the performance of a job from one person to another

• Assistive personnel (AP)

  • Patient care techs (CNAs)

  • Licensed practical nurses (LPNs)

Who are the people the nurse will delegate?

• Helps prioritization and time management

• Offsets excess workload

Why should nurses delegate?

• ADLs (oral care and ambulation)

• Routine monitoring (VS and BG checks)

• Hygiene

What types of tasks are nurses delegating?

1. Amount of supervision

2. Patient condition

3. Competence of person

Cycle

What are the three factors of RN judgement when delegating?

• National council of the state boards of nursing (NCSBN)

• National council of licensure

• Florida (or state) board of nursing (FBON)

Who regulates delegation?

National council of the state boards of nursing (NCSBN)

• Make national rules

• Create NCLEX

Florida (or state) board of nursing (FBON)

• Decides who can be a nurse in their state

• Make rules nurses MUST follow in that specific state

• Enforces disciplinary actions when rules are broken

• Inital client assessment

• Decisions and judgement regarding client outcomes

• Formulation of client plan of care

• Interventions that require professional nursing judgement, decisions, and skills

• Evaluation of client care decisions and judgements

• Anything that the AP has not demonstrated competence in

What cannot be delegated?

Supervision

The provision of guidance and direction, oversight, and evaluation (follow up)

• Direct vs. Indirect

True (T)

T or F:
RN is ALWAYS accountable for what is delegated in nursing practice

• Right task

• Right circumstances

• Right person

• Right communication

  • 4 c’s of communication

• Right supervision

What are the 5 rights of delegation?

• Clear (RESTATE INSTRUCTIONS)

• Concise (relevant)

• Correct (accurate)

• Complete (no room for doubt)

What are the 4 c’s of communication?

SBAR; improves patient safety/forces communication

What is the standardized why of communicating with healthcare givers?

70%

What percentage of preventable hx mishaps occur because of communication problems during hand offs?

• S: situation

• B: background

• A: assessment

• R: reccomendation

What does SBAR stand for?

• Begin the shift with a short report to the AP outlining the day’s plan and plan for each patient

• Use interaction throughout the shift to update on tasks and any changes in plan of care

• Get feedback and give feedback about how the communication went/how shift went

How can you practice communication during delegation as a nurse?

Assignment creation

Distribution of work to each staff member, each shift or in a given work period

• Transfers responsibility and authority

• Does the person have the skill/experiences to perform this specific task?

• Is the task within the scope of practice guidelines?

What are the questions a nurse should consider during assignment creation?

Provider orders:

• Individual, patient specific

Protocols

• Must have an order to use protocol

• Utilizes core measures

• Standing orders

Hospital policy

• Routine care that does not require an order

• Unit protocols

• RRT protocols

• Patient screening tools (Falls, VTE, Braden)

Orders vs. Protocols vs. Policy