Delegation and Continuity of Care Practice Flashcards

Definitions and Foundations of Delegation

American Nurses Association (ANA) Definition of Delegation: The transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.
National Council of State Boards of Nursing (NCSBN) Definition of Delegation: The transfer of authority to another to perform a specific nursing task in a specific situation.
Core Definition: Delegation occurs when a nurse gives a competent individual the authority to perform a selected nursing task in a selected situation. During this process, the nurse retains accountability for the delegation.

Principles of Delegation

First Principle of Delegation: Nurses must possess comprehensive knowledge of the Nurse Practice Act (NPA) specific to the state in which they are currently licensed. This act defines the legal scope of practice and the boundaries of what can and cannot be delegated.
Second Principle of Delegation: The Registered Nurse (RN) is prohibited from delegating clinical judgment or essential parts of the nursing process. Specifically, the RN cannot delegate: * Assessment * Planning * Evaluation * Accountability for the assigned task
Third Principle of Delegation: The individual to whom a task or assignment has been delegated does not have the authority to delegate that assignment to another person (this is known as a prohibition of sub-delegation).

The Five Rights of Safe Delegation

To ensure client safety and professional standards, the RN must follow the five rights:

Right Task: The task is appropriate to delegate for a specific client; it should be repetitive, require little supervision, and not require the nursing process.
Right Person: The delegator must ensure the right person is delegating the right task to the right person to be performed on the right person.
Right Circumstance: The health status and stability of the client must be considered. The setting must be appropriate and resources must be available.
Right Communication: This involves clear, concise descriptions of the task, including its objective, limits, and expectations.
Right Supervision: This involves appropriate monitoring, intervention, evaluation, and follow-up.

Communication of Delegation

Effective delegation requires specific communication between the RN and the delegatee. The following details must be clearly transmitted:

The specific tasks to be completed for each individual client.
The precise timeframe or schedule of when each task is to be completed.
The expected outcome or specific result desired for each task.
Information regarding who is available to assist if the delegatee encounters difficulty.
Clear instructions on when and what information should be reported back to the nurse.

Scope of Practice: Task Allocation by Role

Unlicensed Assistive Personnel (UAP)

Vital signs measurement.
Intake and Output ( $I \& O$ ), which includes the specific duties of emptying foley catheters, surgical drains, and colostomy bags.
Client transfers and ambulation, restricted to stable clients only.
Postmortem care (care for a client after death).
Bathing and hygiene tasks.
Feeding clients (typically those without swallow precautions).
Simple dressing changes (non-sterile).
Attending to client safety, such as the setting up of bed or chair alarms.
Obtaining client weights.
Performing Cardiopulmonary Resuscitation (CPR).

Licensed Practical/Vocational Nurse (LPN/VN)

Medication administration (exception: LPNs cannot administer IV medications unless they have specific IV certification).
Complex dressing changes (sterile or complicated wound care).
Basic nursing skills, including the placement of Nasogastric ( $NG$ ) tubes and the insertion of indwelling Foley catheters.
Enteral feedings (administration of nutrition via $G$ -tube or $NG$ tube).
Updating existing client care plans (the initial care plan must be created by an RN).
The LPN/VN is also qualified to perform every task listed under the UAP scope of practice.

Continuity of Care and Decision Making

The Delegation Decision Tree: This is a structured tool used by nurses to evaluate whether a task is appropriate for delegation based on the client's stability, the delegatee's competence, and the required level of supervision.
Continuity of Care: * Definition: The process by which healthcare providers ensure that the client's healthcare needs are met consistently across various settings through effective coordination and communication. * Nurse Responsibilities: Nurses must ensure thorough documentation, clear hand-off reports, and coordination with the multidisciplinary team to provide seamless care. * Home Care Referrals: Nurses must identify clients requiring home care, typically those with chronic conditions, mobility issues, or those needing complex wound care or medication management at home.

Questions & Discussion

Knowledge Check 1

Scenario: An RN and an LPN are providing care for an unstable client in Room $2$ , but the client in Room $4$ used the call light and needs assistance with ambulation to the bathroom. The RN plans to delegate this task to another healthcare team member. Which of the following actions by the nurse is best? a. The RN should perform the task and not delegate. b. The RN delegates the task to the LPN. c. The RN delegates the task to the UAP. d. The RN delegates the task to the Unit Secretary.

NGN NCLEX-RN Practice Matching

Task Selection Board: Match the task to the correct professional ( $LPN/VN$ or $UAP$ ):

Indwelling catheter insertion: LPN/VN
Simple dressing changes: UAP
Postmortem care: UAP
Enteral feedings: LPN/VN
Complex dressing changes: LPN/VN
Vital signs: UAP
CPR: UAP

NGN NCLEX-RN Practice: Principles Sentence Completion

Sentence: A nurse must have knowledge of the ( $1$ ) in the state where they are licensed. The RN cannot delegate ( $2$ ), planning, evaluation, or accountability for the assigned task. The person to whom an assignment was delegated ( $3$ ) delegate that assignment to someone else. These three principles of delegation are foundational to the RN's ability to safely delegate.

Options for completion:

Option 1: ( $1$ ) Nurse Practice Act.
Option 2: ( $2$ ) Assessment.
Option 3: ( $3$ ) Cannot.