Transcript 13. Delegation Client Care

Delegation
Client Care
Class Objectives:
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:
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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
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 :
– 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:
 Specific
 Measurable
 Agreed
 Realistic
 Time bound
 Ethical
 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
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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
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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.