Delegation

Leadership is

the process of influencing people
to accomplish goals.

Management is

the process of coordination and
integration of resources through planning,
organizing, coordinating, directing and controlling
to accomplish specific institutional goals and
objectives.

Leadership Styles:

Transactional Leadership vs.
Transformational Leadership

Transactional Leadership:

the traditional “boss” image
where employees understand that a superior
makes the decisions with little or no input from
subordinates.

Transformational leadership:

based on inspiring a vision
that changes the organization. It involves
communication that causes employee emotional
engagement.

Five Key Practices, Kouzes & Posner (2007):

1. Challenge the process-question the old ways, be creative about solutions
2. Inspiring shared vision – bringing everyone together toward a common goal
 3. Enabling others to act – empowering people to believe that they will make a difference
 4. Modeling the way – leaders take an active role in the work of change
 5. Encouraging the heart – given attention to personal things, such as saying “thank you”

Hospital Compare –

allows customers to
1. Find information on how well hospitals care for
patients with certain medical conditions or surgical procedures
2. Access patient survey results about the quality of care hospitals provide
3. Healthgrades, Carechex, Healthstreams, and others also collect data and make this data public

Hosp

Delegation

The transfer of responsibility for the
performance of a task from one individual to
another while retaining the accountability for the
outcome.

Responsibility

the obligation involved when one accepts an assignment.

Accountability

is being responsible and answerable for the actions or inactions of self or others in the context of delegation.

Authority

is the right to act or command the
action of others, based on the Texas Nurse
Practice Act.

Supervision

the provision of guidance or direction, over-sight, evaluation and follow-up by the licensed nurse for the accomplishment of a delegated nursing task by a UAP.

Competence

The ability to perform a skill
according to a set procedural standard

RN’s

assess, plan care, monitor, and evaluate all
patients, especially complex, unstable patients
with unpredictable outcomes.

LVNs

care for stable patients with predictable
outcomes, they work under the direction of the
RN and are responsible for their actions within
their scope of practice.

Five Factor that must be assessed
before deciding to delegate:

1. Potential for harm: Determine if there is a risk for the patient in the activity delegated.
2. Complexity of the task: Delegate simple tasks, with psychomotor skills with little assessment of judgment needed.
3. Amount of problem solving: Do not delegate simple tasks that need a creative approach, adaptation or special attention.
4. Unpredictability of outcome: Avoid delegating tasks in which the outcome is unclear
5. Level of patient interaction: Value the time spent with a patient to develop rapport and build trust, others may not have developed the communication skills

NCSBN Five Rights of Delegation

 Right task
 Right circumstance
 Right person
 Right directions and communication
 Right supervision and evaluation

Underdelegation

Fear of being judged, being
disliked, being viewed as not capable, lack of
confidence, lack of knowledge, poor communication

Over delegation

depend too much on others uncomfortable with a task, unorganized, avoid responsibility, immerse themselves in paperwork, delegating inappropriately

Delegation Don’ts:

• Assessments requiring RN judgment, intervention, referral or follow-up

• Formulation of a nursing care plan

• Specific tasks in the nursing care plan and evaluation of the client’s response

• Responsibility and accountability of health teaching

• Medications via a non-permanent tube

• Receiving or requesting verbal or telephone orders related to medication administration

• Initial medication doses‡

Delegatee

One who is delegated a nursing responsibility by either an APRN, RN or LPN/VN (where
jurisdiction NPA allows), is competent to perform it and verbally accepts the responsibility. A delegatee may be an RN, LPN/VN or AP

Delegator

One who delegates a nursing responsibility. A delegator may be APRN, RN, or LPN/VN (where
jurisdiction NPA allows)

Assignment

The routine care, activities and procedures that are within the authorized scope of practice
of the RN or LPN/VN or part of the routine functions of the AP.

Licensed Nurse:

A licensed nurse includes APRNs, RNs and LPN/VNs. In some states/jurisdictions,
LPN/VNs may be allowed to delegate.

Assistive Personnel (AP):

Any assistive personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. This includes but is not limited to certified nursing assistants or aides (CNAs), patient care technicians, CMAs, certified medication aids, and home health aides (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]).