Delegation Client Care Class Objectives After the discussion

Delegation Client Care

Class Objectives: Ø After the discussion we will be able to: • Define delegation & the related terms. • Define the components of delegation. • Importance of Delegation , Why Delegate ? • Describe the five rights of delegation. • Who are you going to delegate to ? • When May I Delegate ? When not ? • Explain the process of delegation. • Recognize barriers to successful delegation and leadership, Delegating Errors • Describe Symptoms of Poor Delegation • Practice Delegation Assessment

Outlines: • • • • Introduction to delegation Delegation & related terms definitions The components of delegation. Importance of Delegation. The five rights of delegation. Persons going to delegate to. When May I Delegate ? When not ? The process of delegation Barriers to successful delegation and leadership, Delegating Errors Symptoms of Poor Delegation Assessment Conclusion Summary References

Woodrow Wilson " I not only use all the brains I have, but all I can borrow. "

Introduction … • The manager is granted the power to direct others and he / she is responsible for assuring that certain tasks within the organization are completed effectively and efficiently.

• Managers can be described as responsible if they perform the activities they are obligated to perform. Because managers have more impact on an organization than the non managers, responsible manager are prerequisite for management system success. Several studies have shown that responsible management behavior is highly valued by top executives because the responsible manager guides many other individuals within the organization in performing their duties appropriately.

When the responsibilities and duties of the manager become too much, delegation become an essential element in management process. For the manager delegation is not an option but a necessity.

Delegation Is considered as : Delegation Is considered as – Both an art and a science of Professional Practice. – It includes : cognitive, affective, and intuitive dimensions. ( Marjorie Barter ) - An essential element of the directing phase of the management process because much of the work accomplished by managers.

Delegation. . . • Can be simply defined as getting work done through others or as directing the performance of one or more people to accomplish organizational goals. . • Complex process , requiring insight and judgment regarding the environment in which the delegation is to take place and the individuals involved.

Delegation SMART or SMARTER • A simple delegation rule is the SMART acronym, or SMARTER. • It's a quick checklist for proper delegation. Delegated tasks must be: Ø Specific Ø Measurable Ø Agreed Ø Realistic Ø Time bound Ø Ethical Ø Recorded

Definitions of Delegation … • National Council of State Boards of Nursing ( 1995 ) – Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. • American Nurses Association ( 1996 ) – Transfer of responsibility for the performance of a task from one individual to another, while retaining accountability for the outcome.

Delegation … • It can be defined also as “ the process of assigning duties and responsibilities from a top organizational level to a lower one or from superior to subordinate and giving that person the authority to accomplish them. “ or "it is the process of downward flow of authority from top level in the organization to lower level. "

Delegation … • By Definition Is: The assignment of meaningful tasks, either operational or managerial, to others with supervision over time. • By Implication Is Not: The assignment of simple, unpopular or isolated tasks at the whim of the manager as an end in itself.

Direct vs Indirect Delegation Direct delegation: Is usually “ verbal direction by the RN regarding an activity or task in a specific nursing care situation. (ANA, 1996, p. 15)

Indirect delegation: Is …“ an approved listing of activities or tasks that have been established in Policy & Procedure of the health care institution or facility ” (ANA, 1996, p. 15) Policies Procedures

DO NOT CONFUSE BETWEEN DELEGATION & SUPERVISION

Supervision … • The provision of guidance, evaluation, and follow-up by a licensed nurse for the accomplishment of a nursing task which has been previously assigned. National Council of State (Boards of Nursing)

Assignment … • The downward or lateral transfer of both responsibility and accountability of an activity from one individual to another. American Nurses Association

Accountability … • It means that the nurse is legally liable for her actions and is answerable for the overall nursing care of her patients. • (the subordinates must be held answerable to properly carry out their duties. )

Responsibility … • It Includes concepts such as reliability, dependability, and also includes each person’s obligation to accomplish the work professionally. • ( It refers to the obligation involved when one accepts an assignment ).

Authority … • Is the right, and the official power invested in a position, that an organization gives a designated employee to perform certain tasks. • ( Is the right to take final decisions, to act or to command action of others. It moves in downward direction ). . .

Four Components of Delegation: • Delegation to others in the workplace involves four principal components : - Delegator - Delegatee - Task - Client / situation.

DELEGATOR • The delegator possesses the authority to delegate by virtue of both position in the agency and state government license to do certain tasks. • Delegation does not change the delegator’s accountability or responsibility for task completion.

DELEGATEE • A delegatee receives direction for what to do from the delegator. • The relationship between the two individuals exists within the workplace environment or through agency policy. • The delegatee has the obligation to refuse to accept tasks that are outside of his or her training, ability, or job description.

TASK • The task is the delegated activity. • The delegated activity generally should be a routine task.

CLIENT / SITUATION • Identification of a specific client or situation for delegated nursing care is necessary to ensure that goals for patient care can be met by the delegatee.

Importance of Delegation , Why to Delegate ?

Why to Delegate ? • Higher efficiency. • Increased motivation. • It enhances employee confidence, subordinate involvement and interest. • To use skills and resources already within the group. • Managers should delegate work if someone else is better prepared or has greater expertise or knowledge about how to solve a problem. • To keep from burning out a few leaders.

Why to Delegate ? • To develop new leaders and build new skills within the group. • To get things done. • To prevent the group from getting too dependent on one or two leaders. • To become more powerful as a group to provide professional development. • To allow everyone to feel a part of the effort and the success. • Group members feel more committed if they have a role and feel needed.

Benefits of Being an Effective Delegator • Sometimes manager must delegate routine tasks, to have time for handling more complex problems or require a higher level of experience. • Helps you focus on what is most important ! • Allows committee members to grow in capability and confidence ! • Allows you to develop, coach, and mentor committee members ! • Creates opportunities to provide recognition ! • Ensures successful results !

Risks of Delegation to be considered … Patient Safety Ethical Legal ( National Council of State Boards of Nursing) http: //w. w. w. ncsbn

Priority Setting – Maslow’s Hierarchy of Needs. – A B C’s – Stable verses Unstable.

The Five Rights of Delegation • Right Task • Right Circumstance • Right Person • Right Direction / Communication • Right Supervision / Evaluation

Who are you going to delegate to ? “ extra pair of hands ” – Unlicensed Assistive Personnel ( UAP ) – Licensed Practical Nurse ( LPN ) – Ancillary Personnel – Other Registered Nurses

When May I Delegate ? • Criteria for determining which patient care activities can be delegated to other personnel: • Nursing scope of practice • (UAPs) unlicensed assistive personnel do not have a scope of practice • What is the patient’s condition ? Extent of interaction • Is there potential for harm to the patient? • Is the nursing activity complex or complicated ? • Predictability of outcome

Works to be delegated …

Works to be delegated … • Unlicensed Assistive Personnel – Feeding – Hygiene – Physical Care • Licensed Practice Nurse – Vital Signs – Medications – Some IV’s if trained – Physical Care

Why some people do not like to delegate … • No time to instruct others. • Can do it quicker and better. • Might lose credit or recognition. • High personal interest in task. • Fear loss of control and power.

Which activities cannot be delegated in nursing care ? • Initial nursing assessment. • Nursing diagnosis, goals, and care plans. • Evaluation of patient progress. • Professional interventions which requires knowledge, judgment, or skills. • Discharge planning. • Educational planning. activities cannot be delegated

Administrative Tasks you should not delegate • Obviously some aspects of leadership are sensitive and should not be delegated. For example: • Hiring • Firing • Pay issues • Policy • Staff performance appraisal • Developing nursing assignment sheet • Supervisory duties • Personal matters • Emergencies • Sensitive issues

Delegation Process / Steps of successful delegation ( IDEALS ) • I – Introduce the task • D - Demonstrate clearly what needs to be done • E - Ensure understanding • A - Allocate responsibility, delegate authority, provide information and resources • L - Let go • S - Support and monitor

Other Steps for Delegation process • Delegation process consists of five steps, they are: - Preparing - Planning - Discussing - Auditing - Appreciating

1. Preparing Includes establishing the objectives of the delegation, specify the task that needs to be accomplished. Deciding who should accomplish it.

2. Planning Meeting with chosen subordinate to describe the task, and to ask the subordinate to devise a plan of action.

3. Discussion Includes reviewing the objectives of the task as well as the subordinate's plan of action, any potential obstacles, any ways to avoid or deal with these obstacles. The supervisor should clarify and solicit feedback as to the employee's understanding. Clarifications needed for delegation include the desired results, guidelines, resources available, and consequences (good and bad).

3. Discussion Delegation is similar to contracting between the supervisor and employee regarding how and when the work will be completed. The standards and time frames are discussed and agreed upon. The employee should know exactly what is expected and how the task will be evaluated.

4. Auditing Monitoring the progress of delegation and making adjustment in response to unforeseen problems.

5. Appreciating Accepting the completed task acknowledge the subordinate's efforts. and

Guidelines for Effective Delegation • • • Clarify the objectives and the performance standards. Shift authority commensurate with the responsibilities. Provide necessary support systems. Establish reasonable checkpoints and deadlines. Review results, not methods.

Barriers or obstacles to effective Delegation �� Barriers in the delegator… • Do - it-myself attitude, inability to ask others, inability to organize / manage, uncertainty and fear that the subordinates will not do a job well.

�� Barriers in the delegatee • Inexperience, incompetence, disorganization, irresponsibility , Decision Making is a hard mental work, and people seek ways of avoiding it, fear that the supervisor will be unavailable for guidance when needed. • Fear of Criticism for mistakes, Overload of work, Positive incentive may be inadequate (e. g. pay rate, opportunity for promotion, improved status)

�� Barriers in the situation • Inadequate support, hurried atmosphere, hostile management

Eliminating obstacles of delegation process • Manager must continually strive to uncover any obstacles to delegation that exist in the organization. • Manager should understanding that the obstacles may be deeply integrated and therefore, require much time and effort to overcome. • Building subordinate confidence in the use of delegation authority, minimizing the impact of delegation authority to established working relationship, and helping delegates cope with problems whenever necessary.

Eliminating obstacles of delegation process • The manager should accept, understand the need, importance and value of delegation • Understand his / her responsibilities and authority. • Determine the portion of the authority that she/he want to delegate • Plan carefully for completion of the delegated tasks to prevent problems. • Define clearly the standard of accountability • Ensure that the subordinates have understood the tasks delegated to them • Train subordinates, give the authority, details, opportunity for growth and written instructions if needed

Common Delegating Errors ( Frequent mistakes made by managers in delegating include the following )

Underdelegating – delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely. – The manager’s desire to complete the whole job personally due to a lack of trust in the subordinates. – The fear that subordinates will resent having work delegated to them. – They lack experience in the job or in delegation itself.

Over delegating – They are poor managers of time, spending most of it just trying to get organized. – They feel insecure in their ability to perform a task. • Note: Manager must be careful not to over delegate to exceptionally competent employee, because they may become over worked and tired, which can decrease their productivity

Improperly Delegating – Delegating at the wrong time, to the wrong person, or for the wrong reason. – Delegating tasks and responsibilities that are beyond the capability of the person to whom they are being delegated or that should be done by the manager. – Delegating decision making without providing adequate information

Symptoms of Poor Delegation • • • Staff is confused / conflicting / turnover Lack of Motivation / Morale Extended hours / burnout Crisis management / missed deadlines Continued interruptions / constant approvals • Redoing initial work/wasted time • External promotions / inadequate internal talent

Practice : • Mr. Jones, a bedridden but stable patient needs a bed bath. You – Assign the task to the nurse assistant. – Work together with the nursing assistant to give the bath. – Do the bath yourself because Mr. Jones is a VIP and you know you’ll do the best job. • You are the charge nurse, and one of your team members is a float nurse who has never worked on the unit before. You - Spend 15 minutes with her assessing her abilities and providing a brief orientation to the unit so that she can take the full assignment - Give her three of the “easiest patients” and pick up the rest of the assignment yourself - Call the supervisor and tell her that you have no time to orient some and the float will be more trouble than she’s worth

Conclusions … • A key aspect of leadership is delegation. Unless you delegate tasks to your subordinates, your team will become inefficient and demoralized. • When a task is delegated to a unlicensed person, the professional nurse remains personally responsible for the outcomes of these activities. (ANA, 1994) • “ The secret of success is not in doing your own work but in recognizing the right [person] to do it ” ( Andrew Carnegie ) • Delegation is a powerful tool when used correctly can create an effective and safe environment in which staff and patients work together to achieve positive outcomes.

Summary … • As a professional standard for all nurses in all states, the assessment, analysis, diagnosis, planning teaching, and evaluation stages of the nursing process should not be delegated. • Delegation is not an option for the manager - it is a necessity. • Delegation should be used for assigning routine tasks and tasks for which the manager does not have time. • Managers must delegate the authority and the responsibility necessary to complete the task. • Delegation does not change the delegator’s accountability or responsibility for task completion. • The manager should be a wear about when to delegate , & when not. • The manager has to identifies the Symptoms of Poor Delegation process within her / his organization & try to solve it or prevented in the future.