Nursing Delegation, Leadership, and Professional Practice Frameworks

Delegation

Defined as one person assigning tasks to another person.

Nursing Team

Includes nurse executive, nurse manager, clinical coordinator and nursing staff (direct care nurses).

Professionalism

The actions, behaviors, and attitudes of an individual that are reflective of the core values, ethical principles, and regulatory guidelines of the profession.

Unprofessionalism

Refers to conduct that does not adhere to the standards of practice or the code of ethics. Conduct unbecoming of a nurse by dishonoring, disgrace or harming the reputation of the profession.

Novice to Expert

Theory that states that it would take 5 years to become an expert. Every stage represents a year.

Stage 1: Novice

Beginner with little or no experience.

Stage 2: Advanced Beginner

Demonstrates basic skills but continues to need the support and guidance of a mentor.

Stage 3: Competent

Individual can plan, make decisions, and perform job responsibly and efficiently.

Stage 4: Proficient

Demonstrates advanced decision making, knowledge, resourcefulness, flexibility, and problem solving.

Stage 5: Expert

Role models deep knowledge and skills, teaches others, and multitasks.

Professional Identity

A nurse's sense of self as influenced by the values, beliefs, and attributes associated with the nursing discipline.

Advocacy

The nurses role in speaking up for their patients desires and rights.

Autonomy

The ability to make decisions independently regarding patient care.

Autonomous practice

Is under the jurisdiction of the Nurse Practice Act.

Accountability

A legal obligation with a moral and ethical commitment to do the right thing, every time, and in every situation while taking ownership of decisions and actions

Responsibility

An obligation to perform work, duties, or tasks using sound professional judgment.

Examples of responsibility

Thinking things through, completing tasks, being reliable, and dependable and persisting

Transactional Leaders

Establish standards, highlight obligations, concentrate on monitoring behaviors, and use rewards or punishments based on how tasks are completed.

Transformational Leaders

Establish a common mission and vision and, in turn, encourage employees to heighten their level of performance. Relay trustworthiness, voice an attractive and hopeful future.

Magnet status

Excellent nursing care attracts excellent nurses

Laissez-Faire Leaders/Lazy leaders

Hands-off leaders that oversee and encourage their team to work independently, providing little direct control over decision making.

What type of leaders relinquish power and responsibilities?

Laissez-Faire leaders

Bureaucratic Leaders

A 'by-the-book' leader who relies heavily on consistency and adherence to rules within a top-down decision-making organization.

What type of leader pays great attention to detail which helps bring control and clarity to situations?

Bureaucratic Leaders

Situational Leaders

Transition or move from one leadership style to another depending on the circumstances.

What type of leader changes its style depending on the situation?

Situational Leaders

Chain of Command

An organizational hierarchy identifying the lines of authority within an organization.

Chain of Command purpose

Confirms that appropriate leaders, beginning with those closest to the level of an event, are notified and involved in problem solving.

Shared Governance

A shared-decision structure that gives nurses control over their own practice.

No hierarchy

Means that you can make your own decisions.

Standardized delegation process

Should have clear guidelines to ensure activities are not delegated that are out of the health care personnel's scope of practice.

The Five Rights of Delegation

1. Right Task 2. Right Circumstance 3. Right Person 4. Right Directions and Communication 5. Right Supervision and Evaluation.

Errors in Delegation

Includes wrong task, wrong person, wrong directions, wrong amount of supervision, and wrong circumstance.

A nurse on a med-surg unit has received change of shift report on four patients. Which of the following tasks can be assigned to a UAP?

A. Updating a plan of care for a patient who is post-operative.

B. Reinforcing teaching with a patient learning to walk using a quad cane.

C. Reapplying a condom catheter for a patient with urinary incontinence.

D. Applying a sterile dressing to a pressure

C

2. A nurse manager is assigning care of a patient who is being admitted from the PACU following thoracic surgery. The nurse manager should assign the patient to which of the following staff members? A. Charge RN

B. RN

C. LPN

D. UAP

B

3. The nurse is delegating the ambulation of a patient who had knee arthroplasty 5 days ago to a UAP. Which of the following information should the nurse share with the UAP? (select all that apply)

A. The roommate ambulates independently

B. The patient ambulates wearing slippers over anti-embolic stockings

C. The patient uses a front-wheeled walker when ambulating

D. The patient had pain medication 30 minutes ago

E. The patient is allergic to codeine

F. The patient ate 50% of breakfast this morning.

BCD

The charge nurse is assigning the patient care for 4 patients. Which of the following tasks should the charge RN assign to the LPN?

A. Creating a plan of care for a patient recovering from a stroke.

B. Assessing a new pressure injury to a patient on bedrest

C. Providing nasopharyngeal suctioning for a patient with pneumonia

D. Teaching a patient who has asthma to use a metered dose inhaler. Comment

C

A nurse is preparing an in-service program about delegation. Which of the following are components of the 5 rights of delegation? Select all that apply.

A. Right place

B. Right supervision or evaluation

C. Right direction and communication

D. Right documentation

E. Right circumstances Comment

BCE

Right Task

A right task is repetitive, requires little supervision, and is relatively noninvasive for the client.

Example of Right task

Delegate an AP to assist a client who has pneumonia to use a bedpan.

Example of Wrong task

Delegate an AP to administer a nebulizer treatment to a client who has pneumonia.

Right supervision or evaluation

Evaluate the client and determine the client's outcome status. Evaluate task performance and identify needs for performance-improvement activities and additional resources.

Right supervision or evaluation example

Delegate an AP to assist with ambulating a client after the RN completes the admission assessment

Wrong supervision or evaluation example

Delegate an AP to assist with ambulating a client prior to the RN performing an admission assessment

Right direction and communication

Communicate specific tasks to perform and client-specific instructions. Detail expected results, timelines, and expectations for follow-up communications

Right direction and communication example

Delegate an AP to assist Mr. Martin in room 312 with a shower before 0900.

Wrong direction and communication example

Delegate an AP to assist Mr. Martin in room 312 with morning hygiene.

Right circumstances

Determining complexity of care the client requires and matching the demands to the skill level of the delegate

Example of right circumstances

Delegate an AP to measure the vital signs of a client who is postoperative and stable.

Example of Wrong Circumstance

Delegate an Ap to measure the vital signs of a client who is postoperative and required naloxone to reverse respiratory depression

Right Person

Determine and verify the competence of the delegate. The task must be withing the delegate's scope of practice or job description.

Example of Right person

Delegate a PN to administer enteral feedings toa cleint who has a head injury

Example of Wrong Person

Delegate an AP to administer enteral feedings to a client who has a head injury.