Collaboration and Delegation in Nursing

Teaming Objectives

• Collaboration & Delegation in Nursing

  • Course: NUR301, Instructor: Dr. Rachel Seady

• Exemplars of Collaboration:

  • Nurse-Nurse Collaboration

  • Hospitals

  • Nursing Homes

  • Clinics

  • Hospice

• Organizational Collaboration

• Attributes of Collaboration

• 5 Rights of Delegation

• Nurse-Nurse Collaboration:

  • Definitions and examples

• Delegation: Definitions and tips

Learning Objectives

• Define and Describe Collaboration:

  • Understanding and describing key concepts of collaboration

• Attributes of Collaboration in Nursing:

  • Identify and define specific attributes

• Compare and Contrast Collaboration Types:

  • Distinguish between nurse-patient, intraprofessional, interprofessional, and interorganizational collaboration

• Applications of Delegation:

  • Identify appropriate delegation practices in nursing

• Types of Healthcare Organizations:

  • Explain different healthcare organizations where nurses work

Collaboration in Nursing

• Definition: "Development of partnerships to achieve best possible outcomes; reflect needs of the patient, family, or community, requiring understanding of what others offer" (Giddens, J).

  • Key stakeholders include:

    • Patients

    • Families

    • Communities

    • Health Care Professionals (HCPs), Pharmacists, UAPs, Therapists, Social Workers

• Origin of the Term: Latin "collaborare" means "to labor together"

Types of Collaboration

• Nurse-Patient:

  • Discuss behaviors, treatments, and end-of-life care

• Nurse-Nurse (Intraprofessional):

  • Support among nurses to care for patients

• Interprofessional:

  • Different professions collaborating for patient care

• Interorganizational:

  • Resource and data pooling between organizations at regional, state, national, or international levels

Nurse-Nurse Collaboration

• Examples:

  • Quality Improvement Projects

  • Mentoring Programs

  • Novice with Expert Nurse Partnerships

  • Shared Governance

  • Patient Care Handoff (using SBAR)

  • Bedside Report (nurse-to-nurse)

Interprofessional Collaboration (IPC)

• Examples:

  • Rapid Response Teams (MD, NP, Pharmacist, RN, Respiratory Therapist)

  • Ethics Committees (reviewing research proposals in hospitals)

  • Team Rounds and Disaster Preparedness Teams

Interorganizational Collaboration

• Example:

  • Alabama Perinatal Quality Collaborative (ALPQC) & March of Dimes

  • Objective: Share resources and training to hospitals for handling women in labor

  • Importance: Ensuring preparedness for hemorrhage risk

Attributes of Collaboration

• Values/Ethics:

  • Striving for safer, efficient, and effective care

  • Respecting diverse expertise within the team

• Roles/Responsibilities:

  • Understanding skill sets and legal constraints

  • Clarifying expected team responsibilities

• Communication:

  • Speaking in safe, respectful manners without jargon

  • Acknowledging individual experience and power dynamics in teams

• Teamwork:

  • Shared problem-solving, accountability, and decision-making

Benefits vs. Challenges of IPC

Benefits

• Improved patient safety and quality

• Increased mutual respect and learning

• Commitment to common goals

• Joint problem-solving

• Enhanced job satisfaction

Challenges

• Imbalance of power and authority

• Role/responsibility confusion

• Tension around boundaries

Delegation

• Definition:

  • Delegation is the transfer of responsibility for the performance of a task from one individual to another, ensuring task completion effectively within the scope of practice. An RN assigns responsibility and authority for a task to another person, but not accountability.

5 Rights of Delegation

1. Right Task

2. Right Person

3. Right Circumstance

4. Right Direction

5. Right Supervision

Helpful Tips for Delegation

• Assess knowledge and skill

• Match task appropriately

• Communicate clearly, specifying task, time frame, and outcome

• Allow for autonomy as applicable

• Listen and provide feedback

UAP Delegation

• Tasks:

  • Hygiene, toileting, feeding, I&O

  • Routine vitals on stable clients

  • Turning/Ambulation

  • Blood glucose checks

LPN Delegation

• Tasks:

  • Basic nursing tasks or processes

  • Medication administration: PO, SQ, IM

  • Observation of patient activities taught by RN

Delegation to RN

• Tasks:

  • Continuation of patient care after initial assessment

  • Medication administration

  • Nursing skills as appropriate

  • Monitoring requirements

  • Discharge and admission education

Avoid Delegating

• Client assessments

• Planning or Evaluating nursing care

• Developing a plan of care

• Teaching & Counseling (unless reinforcing prior content)

Types of Healthcare Organizations

• Hospitals:

  • Teaching/academic vs. community

  • Specialized rehab therapy

  • Comprehensive services: Radiology, OR, ER, etc.

• Clinics:

  • Outpatient services for primary care and chronic conditions

  • Treatment clinics (e.g., dialysis)

• Hospice:

  • End-of-life/palliative care

  • May take place at home or nursing homes

• Nursing Homes:

  • Long-term skilled nursing services for frail, ill elderly population

  • Provides skilled nursing care for extended periods

Professional Identity - NUR 301

• Objectives:

  • Discuss professional development in nursing

  • Recall nursing code of conduct and values

  • Understand QSEN competencies

  • Explain nursing license purpose

  • Discuss lawful guidelines from Nursing Practice Act

  • Define and describe professional identity

  • Recognize formation and fostering of a professional nursing identity

What is Nursing?

• Definition: Nursing involves protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through diagnosis and treatment of human responses, advocacy in care of individuals, families, groups, communities, and populations.

What is Professional Identity?

• Definition: Professional identity in nursing is defined as a sense of oneself and relation to others, influenced by the characteristics, norms, and values of the nursing discipline. This results in an individual thinking, acting, and feeling like a nurse.

Reflecting on Professional Identity

• Activity: Think of descriptive words for the kind of nurse you want to be. Compare lists with peers and share insights.

Nursing Values and Ethics

• Core Values:

  • Integrity, compassion, courage, humility, accountability, respect, advocacy, human flourishing.

• Importance: Essence and guide for conduct within the nursing profession.

Levels of Nursing Careers

• Progression:
  - Certified Nurse Aide (CNA)
  - Licensed Vocational/Practical Nurse (LVN or LPN)
  - Registered Nurse (RN)
  - Advanced Practice Registered Nurse (APRN - MSN or DNP)

Building Professional Identity

• Strategies:

  • Value debriefing & feedback, engage in reflection, adopt a professional identity, develop personal self-care habits, build relationships.

Governing Nursing Practice

• Standards of Practice: Define competent nursing care through the nursing process.

• Code of Ethics: Establish ideals of right and wrong in providing patient care.

• Nurse Practice Acts (NPAs): Regulate the scope of nursing practice and define authority for each state.

Becoming a Registered Nurse

• Education: Complete an Associate’s degree (2 years) or a Bachelor’s degree (4 years) in nursing

• Licensure: Successfully pass the NCLEX exam

• State Board of Nursing: Grants RN licenses and governs scope of practice

Continuing Education and Career Advancement

• Continuing Education: Required for maintaining licensure

• Specialty Certification: Validates knowledge and skills in specialized areas

• Advanced Degrees: Aim to improve patient outcomes and are often pursued by nurse managers and leaders

Clinical Judgment

• Definition: The cognitive process for nurses to reach decisions in clinical practice

• Tanner's Model of Clinical Judgment: Includes steps of noticing, interpreting, responding, and reflecting

• Critical Thinking: Distinguishes from clinical judgment by being knowledge-based and analytical across all situations

Ensuring Patient Safety

• Definition: "Avoiding injuries to patients from care that is intended to assist them" (IOM, 2001)

• Statistics: Medical errors contribute to significant patient death rates — 250,000 annually in the U.S.

Errors in Healthcare

• Types of Errors:

  • Adverse Events: Unintended harm from act of commission or omission

  • Sentinel Events: Expected death or serious injury

  • Near Miss: Errors that do not result in harm but could have

Just Culture in Healthcare

• Definition: A culture that fosters learning and accountability in the context of safety

• Nurse Accountability: Nurses are accountable for their actions in a just culture while being encouraged to report safety concerns without fear of retribution

The Role of Nurses in Documentation

• Quality Standards for Documentation:

  • Factual, accurate, complete, current, and organized

• Communication Guidelines: Ensure clarity and comprehensibility in documentation and patient interactions

Conclusion: Safeguarding Quality in Nursing

• Quality care is ongoing; emphasizing the importance of understanding and consistently applying processes in nursing practice. Feedback and reflection are key aspects of this process.