...Continuing Education Effective Delegation: Understanding Responsibility, Authority, and Accountability Christine Mueller, PhD, RN, FAAN, and Amy Vogelsmeier, PhD, RN The obligation to provide safe, quality care creates challenges and concerns when registered nurses (RNs) delegate duties to unlicensed assistive personnel. These challenges and concerns are magnified in today’s health care environment of shrinking resources; patients with complex, chronic conditions; health care settings with high patient acuity rates; and the use of sophisticated technology. To make safe, effective delegation decisions, RNs must understand the responsibility, authority, and accountability related to delegation. Delegation decisions must be based on the fundamental principle of public protection. This article describes effective delegation by presenting the factors affecting delegation, explaining when and what an RN can delegate, and describing the delegation process. Learning Objectives ⦁ ⦁ ⦁ Identify three factors that affect delegation. Discuss what registered nurses can and cannot delegate. Explain the steps of the delegation process. N ursing’s Social Policy Statement (American Nurses Association [ANA], 2010), the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001), and individual state nurse practice acts (NPAs) underscore the responsibility, authority, and accountability of registered nurses (RNs) for their nursing practice. The RN’s obligation...
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...2003, p. 268). Accountability is defined as, "being responsible and liable for actions or failure of actions of oneself or others in the context of delegation" (NCSBN, 2009). This is in reference to the nurse's legal liability for the actions taken and patient outcomes. Accountability and responsibility are different, as responsibility belongs to the person doing the task and accountability belongs to the person who assigned the task. The nurse is both accountable for the task being completed and is also responsible for the patients in their care. (RCN, 2010) Accountability and responsibility are two essential parts of delegation. DeWits and O’Neill (2014) define delegation as "transferring the authority to perform a selected nursing task in a selected situation to a competent individual ". When delegating, the registered nurse (RN) allocates nursing tasks to health care assistants (HCAs) while still remaining accountable for the patient and the task that was assigned. Delegating is a management technique that is used to provide more efficient care to patients. (NCSBN, 2009) Permitting HCAs to take on nursing responsibilities allows the nurse to complete other tasks that need to be completed; however, delegation is done at the nurses' discretion and is a personal choice. Nurses need to make careful decisions regarding delegation, taking into account the skill and training of the HCA, the difficulty and risk of the task, and the patient's condition. The expected outcomes, a time...
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...Delegation in nursing is the most evident but yet most overlooked of management skills. Integrating this ability is an essential constituent within the scope of the nursing practice. The American Nursing Association (2006) defines delegation as, “The transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome”. With the anticipation of the baby-boomer generation and the utilization of unlicensed nursing assistive personnel (NAP) on the rise; how will healthcare prepare for such conditions? By distinguishing the nature of communication as well as personal interaction during delegation, may better clarify how both roles work together to carry out patient care and...
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...The patient always needs to be number one when nurses are providing care. Collaboration between providers and staff members goes a long way in patient care because taking care of a patient can become a team effort. I run ideas past other nurses or providers to make sure I am giving the best care possible for that patient. To trust and respect other providers to be included in the care of your patient is beneficial to that patient. When I have a laboring patient that does not have great heart tones on their baby I make sure that I have a NICU nurse and a respiratory therapist there for delivery incase the baby needs assistance after delivery. I cannot stress enough how important using your resources is because in turn it will increase patient...
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...their work. Delegation of tasks is important so that the nurse can have more time to critically reason, plan and coordinate healthcare given to patients. The act of delegating is attributed to the fact that, as a registered nurse, one has greater knowledge and critical reasoning ability than the assistive personnel. As a result, the RN has the responsibility of delegating, assigning and supervising the assistive personnel. According to the NCBSN and the ANA, appropriate delegation of tasks can result in effective and safe nursing care (NCSBN & ANA, 2006). In the case study given, the recently graduated registered nurse (RN) is new in the field, thus does not have enough experience with regard to attending to six patients during the morning shift. Six patients are too many for the new RN thus, need for the UHCW. Delegation of duties as stated earlier on should be done so that the registered nurse gets enough time to complete tasks that require his or her specialized attention and knowledge. The reason why the RN has delegated the UHCW to assess the patients’ vital signs is so that he or she can do the final touches with regard to personal hygiene care. This reason is not professional enough in that the RN can use the help of the UHCW in completing the personal hygiene care process. The UHCW can gather up the dressing the used up dressing materials and subsequently deliver them to the cleaners for washing while the RN prepares to make sound judgement in coordinating care that is...
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...before they could achieve an optimal level of functioning. I believe that a noisy, uncomfortable environment, along with an unappealing diet will make the patient miserable and uncomfortable. When one is miserable and uncomfortable, it makes it very difficult to achieve a successful outcome. Nightingale believed that her nursing career was a calling from God. She utilized her attributes of love, compassion and veracity to promote quality care of the patient. Nightingale proved to be a provider of care, as she integrated holistic human needs in the provision of safe and effective nursing care. The holistic approach to medicine attempts to treat both the mind and the body. I thoroughly believe that a person’s social, mental, and physical conditions all contribute to the healing process. Nightingale believed that you had to treat the patient as a whole, not just by analyzing data. When treating the patient, you have to look at the big picture. In order to meet the patient’s needs, you must observe and fully understand what kind of care will particularly meet that patient’s personalized needs. Florence Nightingale possessed moral authority, so firm because it was grounded...
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...Consumer Name: Date: 12/5/12 RN Plan of Care: 1. Perform S-SAM’s Assessment annually per LVN to re-evaluate ability/knowledge to self-administer routine and ‘prn’ medication, OR with competent staff supervision OR appropriateness of RN exemption/delegation for medication administration (1hr/yr- LVN; 1hr/yr-RN) 2. Complete LVN focused nursing assessment on admission and semiannually to obtain current medical data to monitor decline/improvement of current medical and/or psychiatric diagnosis. (2 hrs/yr- LVN) 3. RN will perform QA review of chart annually to monitor compliance/recommendations of medical/dental/vision/consultant appointments, and intended effects of routine and ‘prn’ medications and to develop the RN Plan of Care for annual IP. (4hrs/yr- RN) 4. RN will perform a follow-up QA of chart within 90 days of annual QA to confirm compliance to DADS regulations and to RN Plan of Care. (1hr/yr-RN) 5. Perform verification of current MD orders on pharmacy printed MAR (3hrs/yr-LVN) 6. Perform verification of compliance to medication/treatment orders documented by unlicensed staff on MAR (3hrs/yr-LVN) 7. Nurse to monitor monthly weight and inform PCP of weight gain/loss > 8lbs (1hrs/yr-LVN)(1hrs/yr-RN). 8. Nurse to provide annual residential/day habilitation staff education/training on SAM’s process in order to deem staff competent to administer medications per BON-RN Delegation.(2hr/yr-LVN) (2hrs/yr-RN) 9. Provide RN on-call after office hours to triage/assess...
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...today. The information provided will speak to lessons learned in the Everest College Nursing program. Topics covered shall consist of a reflection of the personal nursing philosophy, impact and concepts of the Nursing Code of Ethics and how it applies to Nursing as a profession, the concept of patient centered care, use of technology in documentation, and the leadership aspects that are considered as a new graduate. Leadership aspects entail team leading, delegation, and role transition from graduate to RN. This is the point of view of the author and information given here will be both objective and subjective. Nursing Philosophy In a previous paper written, the reflection of this student’s own nursing philosophy seemed to coincide with that of Florence Nightingale as well as Dorothy Orem. Orem’s school of thought leans toward the nurse having a large hand in aiding a patient to achieve total self-sustainability. Dorothy Orem’s theory is actually three separate theories that work synergistically. These theories are the theory of self-care, theory of self-care deficit, and the theory of Nursing systems. This works well for a patient, when achieved, due to the self-care aspect. Someone whom is actively involved in their own progress displays an inherent will to do well by oneself. This promotes compliance which can be a large barrier in healthcare. Education is an extremely important aspect in all of nursing but even more so in this philosophy. Florence Nightingale paid close...
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...together between different agencies with increased flexibility of available services and a locality based and needs- led approach was introduced. For this to work, joint working requires a multi-disciplinary team approach not just at the professional level but also at the management level. Clear delegation of responsibility for the delivery of different aspects of community care would prevent professional boundaries been broken and in return would improve co-ordination and relationships between the agencies that provide community care. Community Care Assessments/ Placements in appropriate setting would be able to be completed in time. This would prevent blocking of beds and allow the patient to be in their own home or a residential home setting. If a planned approach to the resourcing of community care was made. This would allow key decisions to be made and how future needs should be resourced. If there was more flexibility in budgets to facilitate greater innovation and creativity in response to need. There should be a degree of ring-faced especially for new finance with clear guidance to how it is spent.. There should be no permanent decisions made about a person's future care in an acute hospital setting. Assessments done in these settings can lead to the clients proper needs not been met and they could be placed in a unsuitable setting. If hospital staff had access to budgets for services for people with less complex needs, e.g., home helps ,this would not delay them...
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...Nightingale Executive Summary Western Governor’s University Nightingale Executive Summary Nightingale Community Hospital is a 180 bed hospital that provides acute care and a range of services to their community. Nightingale has four core values that consist of safety, community, teamwork, and accountability. Communication is a key concept in achieving and defining those values. According to the National Patient Safety Goal Data in regards to communication for Nightingale Community Hospital there is not consistency and goals are not being met for the following: reporting critical results within 60 minutes as evidenced by documentation, verbal orders/read-backs, unacceptable abbreviations, and time out hospital wide. Critical Results Within 60 Minutes Nightingale Hospital has showed variations in compliance with reporting critical results within 60 minutes for the months of January through December. Compliance went from 63% in January to 80% in December. In between this time there have been significant variances. As noted there from the data there was only 56% and 57% compliance for the months of June and July. Reporting of Critical Results with 60 minutes should be at 100% compliance. Verbal Orders/Read-Backs The ED met 100% compliance with verbal order/read-back audits for the fiscal year to date. Ortho is at 62% compliance. The other departments at Nightingale Hospital are ranging from 91% to 99%. For JCAHO standards the departments should be at 100%. ...
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...Professional Health Care Communication Professional Health Care Communication There are many different modules of communication in healthcare. Communications relays feelings, and thoughts through a series of verbal and non-verbal cues. In the healthcare setting effective communication among the healthcare team is crucial. It allows for minimal miscommunication, and safe quality care of the patient. The lack of communication results in healthcare providers missing important information which can lead to misunderstanding or wrong interpretations of the patient’s needs and/or expectations. Poor communication affects both healthcare professionals and patients. Patients may not understand their rights and the choices available to them if communication is not clear, concise and correct. (Arnold & Boggs. 2011). Additional exploration will show of how relevant effective professional healthcare communication is to health outcomes, and how the lack of effective personal and professional communication contributes to poor health outcomes. “Healthcare communication is concerned with the application of communication concepts and theories to transactions that occur among individuals on health-related issues” (Northhouse, 1998). The healthcare spectrum is a broad entity that encompasses roles of healthcare providers ranging from community outreach programs, to physician’s offices, hospitals, and individuals working in the community, to the insurance companies, and includes individuals...
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...Organizational Change Plan -Part 1 Kristine Vyers HCS/587 August 20, 2013 Organizational Change Plan -Part 1 Abstract Rapidly changing patient care environments result in significant ramifications for nursing team members caring for patients. These recent changes have refocused the current workflow views back onto inter-disciplinary teams, and collaborative working environments, and lead to a reexamination of nursing roles in the Long-Term Acute Care (LTAC) arena. Using action research methodology allows for the identification of areas of change, clarification of core and specialty skills, which in turn assist in the redefinition of nursing roles and eventually the adaption of a new nursing model. The new nursing model requires ongoing, detailed, and process driven education to establish and clarify the change objectives and new nursing roles. Quantitative and qualitative data collected from numerous sources, in conjunction with unit-based round tables, individual patients, nurse managers, and administrative interviews allows for consideration of multiple stakeholders. When patients vocalize a positive experience with services provided, this information helps to shape the new roles and responsibilities for the nursing teams. Proposed Change After the second California Medicare Services survey in 2013 major nursing deficiencies were highlighted between K Hospital’s patient acuities and the current staffing mix. In response to these specific deficiencies...
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...My Leadership Style By Berthe Chenekan To Dr. Boseman June 7, 2010 My Preferred Leadership Style I consider myself a democratic leader because I am relationship- and people-oriented. I believe that policies and decisions made in a group setting are best for all involved. Democratic leaders emphasize theme work and are willing to share responsibilities. I like to lead through cooperation, not by bossing around others. This means that I would seek to promote policies through group discussion, and place strong emphasis on teamwork. I believe that an effective manager not only encourages, but listens to input of the workers; an effective manager not only instructs the worker, but shows how the instruction should be carried out; the effective manager eliminates inspectors, and instead teaches the worker the value of doing their own inspection, fostering their own self-worth on the job and their part in making the company works. Effective leadership thus enhances job satisfaction, efficiency and work production (Huber, 2006). Leadership Theory I believe that I would be a good leader because I believe that all effective leaders recognize that their power to achieve organizational objectives comes from having a motived workforce who shares in the organization’s vision. In addition to my ability to establish clear visions and identifies ways to achieve goals, I am a people-oriented individual who believe that people perform at their best when the work that they do enables them to achieve...
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...As the saying goes, Change is the only constant and nothing can be closer to truth when it comes to the world of business. Businesses around the world are changing rapidly and it is imperative for companies to keep up the pace or they vanish. If there has to be a Darwin’s principle of business it has to be ‘survival of the most adaptable’. In this rapidly changing world hence, the importance of managers who can keep the companies running and adapting is paramount. Not only does the manager have to be a talented individual he has to have qualities of working as a great team player and certain qualities. A talented manager must have the skills of motivation to keep the team going, He must be willing to learn from mistakes made in the past and he must understand that respect has to be earned and is not a right. Penguin’s vice president Chris Kolbe have demonstrated that he possesses most of the skills discussed above and more and have taken the business to new altitudes altogether. Even though the Kolbe seems to be doing a reasonable job, this essay intends to point out two key skills which Kolbe must master in his job and also this essay intends to explain the importance of communication in the two skills discussed in detail. The first main skill that Kolbe must have as a senior manager (Vice President) is that of being a motivator for the team. When the going gets tough just as it did for the Penguin, it takes tough employees and tough managers to come out of the situations...
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...WEEK ONE: LEADING, MANAGING & FOLLOWING (Chapter 1, p. 3-21) 1. Relate leadership and other motivational theories to behaviors that serve as important functions of professional nursing. a. Leadership theories i. Trait theories: 1. 2. Innate leadership skills: being born with a certain set of physical and emotional characteristics for inspiring others to reach a common goal ii. Style theories: 3. 4. How leaders behave in certain environments and situations. a. Democratic: you care about what others think b. Lasae faire: no structure; people can do what they want c. Authoritarian: you are in charge iii. Situational-contingency theories 5. 6. These theories consider the challenge of a situation and encourage an adaptive leadership style to complement the issue being faced. Assess, assess, assess 7. You are typically democratic; you assess the situation and change your style based on what the situation is. iv. Transformational theories 8. 9. Inspires, motivates, empowers, mentors, provides intellectual stimulation and promotes creativity b. Motivational Theories v. Hierarchy of needs 10. 11. Low level needs will always drive behavior before higher levels needs can be addressed. For example, pain level, nutrition...
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