Delegation & Prioritization

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Guidelines for Prioritization, Delegation, and Assignment Decisions

Definitions

Prioritization

Deciding which needs or problems require immediate action and which ones could tolerate a delay in response until a later time because they are not urgent.

Delegation

Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains the accountability for the delegation.

Assignment

The distribution of work that each staff member is responsible for during a given shift or work period.

Prioritization

Four P’s

Purpose

What is the patient’s outcome for care?

Picture

What does the patient look like now/what will his outcome or result be?

Plan

What are the patient’s priorities?

Part

Who will participated in the patient’s care/what will they be responsible for?

Criteria

Is it life threatening or potentially life threatening if the task is not done?

Would another patient be endangered if I do this now or leave this task for later?

Is this task or process essential to patient or staff safety?

Is this task or process essential to the medical or nursing plan of care?

Levels of Priority Setting

Ensure Patient/Caregiver Safety and Infection Prevention

First-Level Priority Problems

ABCs plus VS and Lab Valves concerns (high fever, hypertension, etc.)

EXCEPTION: CPR for cardiac arrest à begin compressions stat

Second-Level Priority Problems

Mental status change

Untreated medical problems requiring immediate attention

Acute pain

Acute elimination problems

Imminent risks

Third-Level Priority Problems

Health problems other than those at first two levels (health education, rest, coping

5 rights of Delegation & Assignment

Right circumstance

Rules and regulations based on area of practice

Practice Acts and BON

Nurse Practice Act

Factors to weigh in selecting task or activity

Potential for harm

Complexity of the task

Predictability/unpredictability of the outcome (rapid change in medical status)

Level of interaction/communication required with patient

Resources in equipment/personnel

Factors to weigh in selecting and delegating to specific delegate

Validation/verification of education and training

Normal assignments of the UAP

Patient conditions

Preferred patient results

Instability of patients immediately post-op or in the ICU requires more supervision

Right task

Nursing process or nursing judgment cannot not be delegated

Criteria for determining nursing activities

Knowledge and skills of the delegate

Verification of clinical competence by employer

Stability of patient’s condition

Service setting (resources), methods of communication, complexity and frequency of care, proximity and numbers of patients relative to staff

Cannot delegate: Ongoing assessment, interpretation or decision making

Right person

Licensure, certification, role description

Strengths and weaknesses

Support and lead the inexperienced

Right direction and communication

Relay instructions regarding the plan

Clear communication

Did the listener understand the communicated information?

Concise statements

Did you give the right amount of information? Not too much or too little?

Correct communication

Is information accurate & aligned with rules, regulations, & job descriptions?

Complete communication

Does the direction leave room for questions?

Right supervision and evaluation

RNs are responsible for the total care of client throughout entire shift regardless of delegation

Feedback Process

Ask for team member’s input

Give credit for accomplishments

Offer observations and concerns

Ask for ideas to resolve issues/concerns

Agree on a plan of action for the future

Prohibited Tasks for Delegation

Tasks not within the delegating/supervising nurses’ scope of practice

Nursing activities that include the use of the nursing process and require special knowledge, nursing judgment or skills

Initial assessment or any subsequent assessment

Determination of the nursing diagnosis or interpretations of nursing assessment

Establishment of the nurse care goals and development of the plan of care

Activities for which the UAP has not demonstrated competence

Evaluation of progression of plan of care

Delegation Summary

Guidelines

Can only delegate those tasks for which the nurse is responsible

Responsibility is determined

Nurse practice acts (defines scope of nursing practice)

Standards of care (established by organization)

Job description (defined by organization)

Policy statement (from organization)

REMEMBER – the RN delegates the task NOT the RESPONSIBILITY!

Staff mixes – think about the tasks that these individuals can and cannot do!

RNs

LPNs

UAPs

Support staff

Assignment – Describes the distribution of work that each staff member is to accomplish on a given shift or work period

Process

Determine nursing care required to meet patient’s needs

How complex is the patient’s required care?

What is the dynamic of patient’s status and their capability?

How complex is the assessment and ongoing evaluation?

What kind of infection control is necessary?

Are there any individual safety precautions?

Consider knowledge and abilities of staff members

Is there special technology involved in the care and who is skilled in its use?

How much supervision and oversight will be needed based on the staff's numbers and expertise?

How available are the supervising RNs?

Decide which staff person is best able to provide care

Can continuity of care be maintained?

Are there any personal reasons to allocate duties for a particular patient, or are there nurse or patient preferences that should be taken into account?

Determine assignments to increase efficiency

How will the physical location of patients affect the time and availability of care?

Is there an acuity rating system that will distribute care based upon a point or number system?