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Slide 1: Objectives LEADERSHIP AND DELEGATION ADNU NURSING 2040 Define the term delegation. Define the term unlicensed assistive personnel. Describe the five rights of delegation. Understand the legal implications of making assignments to other healthcare personnel. Recognize barriers to successful delegation and leadership. Define leadership/compare and contrast: types and styles. Make appropriate assignments to team members. Discuss basic entitlements of individuals in the workplace Definitions Accountability is the taking of legal responsibility for an action. Definitions (continued): Responsibility includes concepts such as reliability, dependability, and obligations to perform professionally. Definitions (continued): Authority is the right, and the official power invested in a position, that an organization gives a designated employee to perform certain tasks. Definitions (continued): Leadership: guiding, directing, teaching, and motivating to goal setting and for achievement. Management: resource coordination and integration to accomplish specific goals. 1
Slide 2: Definitions (continued): Professionalism: an approach to an occupation that distinguishes it from merely a job, focuses on the ideal of service, follows a code of ethics, and is seen as a lifetime commitment. Definitions (continued): Leadership styles are defined as different combinations of task and relationship behaviors used to influence others to accomplish goals. Definitions (continued): Followership is an interpersonal process of participating by following. Empowerment instills a belief and confidence in one’s ability to achieve Levels of Leadership Individual level: Involves mentoring, coaching, Motivating others Group level of leadership involves: building teams and resolving conflict Organizational level of leadership Involves building culture Five interwoven aspects of LEADERSHIP GOALS Two critical skills needed to enhance professional practice include: COMMUNICATION PROCESS SITUATION #1 Skill at interpersonal relationships LEADER FOLLOWER 2
Slide 3: Two critical skills needed to enhance professional practice include: Are you a transactional leader? This type of leader functions best in a caretaker role focusing on day to day operations. #2 Skill of applying the problem-solving process: which involves the ability to think critically to identify problems to develop objectivity a degree of maturity or judgment Or,Are you a Transformational leader? This type of leader motivates followers to perform to their full potential and provides a sense of direction. Burns, 1978. Three styles of Leadership Authoritarian: direct and controlling behaviors, good in crisis situations) Three styles of Leadership (continued) Three styles of Leadership (continued) Democratic: team approach, the leader facilitates an shares responsibility for decision making Laissez-faire: non-controlling easy going (good with highly educated independent followers) 3
Slide 4: a new graduate RN has the same accountabilities and responsibilities as a more experienced RN… it is generally understood, however, that new graduates will gradually develop their delegation duties under the mentorship of a more experienced RN. By definition, delegation is the reassigning of responsibility for the performance of a job from one person to another… although the responsibility for the task is transferred, the accountability for the process or outcome of the task remains with the person delegating the activity. 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) Direct vs Indirect Delegation (continued): Indirect delegation is…“an approved listing of activities or tasks that have been established in P &P of the health care institution or facility” (ANA,1996,p.15) DO NOT CONFUSE DELEGATION WITH SUPERVISION The Five Rights of Delegation 1. Right Task 2. Right Circumstances 3. Right Person 4. Right Direction/Communication 5. Right Supervision/Evaluation 4
Slide 5: The Need for Delegation: Nursing Shortage/UAP’s Unlicensed Assistive Personnel are individuals who are trained to function in assistive role to the RN provide patient care activities as delegated by, and under the supervision of, the RN. Although some of these individuals may be certified (ie: CNA-Certified Nursing Assistant) it is important to remember that certification differs from licensure. When a task is delegated to a unlicensed person, the professional nurse remains personally responsible for the outcomes of these activities. (ANA,1994) Criteria for determining which patient care activities can be delegated to other personnel: Task-Related Concerns Potential for harm to the patient Complexity of the nursing activity Extent of problem solving and innovation required Predictability of outcome Extent of interaction Ability Priorities Efficiency Appropriateness Relationship-Oriented Concerns Fairness Learning Opportunities Health Compatibility Preferences Basic Entitlements of Individuals in the Workplace Professionals in the workplace are entitled to: Respect from others in the work setting A reasonable and equitable workload Wages commensurate with job Determine his or her own priorities Ask for what he or she wants 5
Slide 6: Basic Entitlements of Individuals in the Workplace (continued): Professionals in the workplace are entitled to: Barriers to Delegation Experience Issues Licensure Issues Quality-of-Care Issues Assigning Work to Others: “I’ll do it myself!” “She could never do that!” “If I don’t do it….I'll lose my skills” “You can do the paper work I’d rather be at the bedside…” Refuse without guilt Make mistakes and be accountable for them Give and receive information as a Professional nurse Act in the best interest of the patient BE HUMAN Behaviors of an effective Leader Thinking critically Solving problems Respecting the Individual Listening to others and communicating skillfully……. Skillful communication includes the following…. EFFECTIVE LEADERS ARE EFFECTIVE DELEGATORS Encouraging the exchange of information Providing Feedback Setting specific goals and communicating a vision for the future Developing oneself and others Elements to consider in Delegation State nurse practice act Other legal definitions of practice Nursing professional standards Agency policy and procedure Elements to consider in Delegation (continued): Knowledge and skill of personnel Individual strengths and weaknesses National Council of State Boards of Nursing http://w.w.w.ncsbn.org has a decision-making tree, and additional information 6
Slide 7: Patient care needs: RN skills Assessment Nursing diagnosis Planning care Implementing nursing and other medical orders Medications IVs/blood administration Sterile administration procedures Teaching Evaluation Patient care needs: LPN skills Vital Signs Passing medication/removing sutures/maintaining IV lines/some IV meds depending on state Nurse Practice Act and institutions policy and procedure Physical care Teaching from standard care plan Patient care needs: Ancillary Personnel Physical Therapy Occupational Therapy Nutrition/ Dietary Speech Direct Patient care needs: UAP’s Feeding/Drinking Hygiene/Grooming/Toileting Physical care/Ambulation Dressing Socializing Positioning/Bed making Specimen Collection I&O Urine check for glucose Vital Signs/Documentation Indirect Patient care needs: UAP’s Providing a clean environment Providing a safe environment Providing companion care Providing transport for non-critical patients Assisting with stocking nursing units Providing messenger and delivery services As a professional standard for all nurses in all states, the assessment, analysis, diagnosis, planning teaching, and evaluation stages of the nursing process may not be delegated. 7
Slide 8: Tools to develop Delegation Skills •Delegated activities usually fall within the implementing phase of the nursing process. Delegation Decision-Making Grid: this grid acts like a tool to help nurses delegate appropriatley it provides a scoring instrument for seven categories that the nurse should consider when making delegation decisions. AACN,1990(Tappen,1998. p.49 Criteria for determining which patient care activities can be delegated to other personnel Level of patient acuity Level of UAP capability Level of Licensed nurse capability Possibility for injury Criteria for determining which patient care activities can be delegated to other personnel (continued): Number of times the skill has been performed by the UAP Level of decision-making needed for the activity Patient’s ability for self-care On to clinical groups, and case studies for the completion of this lab session…..REMEMBER !! Delegator's Check List Develop a good attitude Decide what to delegate Select the right person Communicate responsibilities Grant authority Provide support Monitor the delegation Evaluate HAVE A FUN SUMMER! 8