Delegation according to North Carolina Administrative Code

Delegation according to North Carolina Administrative Code

            According to the North Carolina Administrative Code (NCAC, 2013), delegation is the process through which a nurse makes decisions using acquired knowledge, judgment, and comprehension of nursing laws and rules. It also involves retaining accountability for the outcome of delegated nursing care. While in nursing practice assignment and delegation are terms used interchangeably, according to NCAC, assignment is the designation of responsibility for implementation of a specific task to an individual who is competent and licensed to do the given task.

The delegation, on the other hand, is defined as the hand-off or transfer to a competent authority or individual to perform a task in a specific situation or setting. In this context, a competent person is a UAP. By delegating the performance of a nursing task to competent personnel, the nurse transfers accountability for the performance of the given task. However, the nurse who delegates a task retains accountability for the outcomes of patient care. Harris, (2017) postulates that maintenance of accountability by the nurse who delegates ensure that patient care is performed according to stipulated standards of practice, and facility policies. The competent personnel whom task has been delegated, however, is accountable for performing the nursing task correctly per facility procedures and policies. Besides, the nurse is responsible for supervising and monitoring the UAP to whom an activity has been delegated.

Ineffective Delegation

In the video in the link https://www.youtube.com/watch?v=pzBNBT49-Ow, the LPN did not effectively delegate the task of administering insulin to Mr. Peter by the UAP. Delegation is a process that begins with assessment and planning. That is, the nurse evaluates the suitability of the tasks to be delegated to a UAP. In the video, the LPN requests a UAP to administer insulin to Mr. Peter. The UAP, however, informs the LPN that it is not within her scope of practice to administer insulin. The LPN, however, tells the UAP that she had been administering insulin, and she should inject Mr. Peter his dose of insulin. In this case, the LPN did not adhere to the first step of the delegation process. The Assessment and Planning phase requires that the RN or LPN ensures that the task delegated is within the scope of practice of the person whom care is delegated. Second, the client’s care needs must be taken into consideration before the delegation of a task. Besides, the person whom a task is delegated should be assessed for competency in terms of knowledge and abilities to perform the given task. The LPN omitted all these aspects of the delegation in delegating the care of MR. Peter to the unlicensed assistive personnel.

Communication is also ineffective in the scenario in the video. The LPN did not give any instructions regarding the administration of insulin. Instead, she only wanted the UAP to administer insulin without considering patient safety. According to Fowler (2010), delegation is based on individual patient needs and is never an all-inclusive decision. Therefore, the RN/LPN is accountable for providing clear information and guidance about the delegated tasks. Clear communication about the task to be performed, special observations to be made before, and after the task, unique client needs, and required documentation of the given task. Also, the LPN did not supervise nor monitor the UAP while she injected insulin to Mr. Peter, which resulted in the wrong patient being injected insulin, and died. Surprisingly, the LPN knew about the mistake committed two hours later. In delegation, the nurse should monitor the performance of task by UAP and ensure compliance with facility policies and standards of practice. The frequency of monitoring and supervision should be based on the assessment findings during the evaluation of the UAP’s knowledge and abilities, and unique patient needs.

Evaluation and feedback is missing in the delegation process in the given scenario. The LPN did not assess the UAP’s performance in injecting insulin. Assessment of the delegated task would also include evaluation of the effectiveness of nursing care, achievement of desired goals, modification of nursing interventions according to outcomes, and achievements of the delegation process. (Zhang et al., 2017) argues that feedback provides an opportunity for both the RN/LPN and UAP to provide safe nursing care and improve the delegation process.

Delegation in nursing in Florida

Delegation encompasses the transfer of authority to a competent UAP to do a particular task or activity in a specific set up by a nurse who is licensed and has the experience to perform the activity or task. (Florida administrative register and Florida administrative code, 2010). Florida state regulations on delegation dictate that delegation should include the right task, person, circumstance, right direction, and supervision. In the context of delegation, supervision involves periodic inspection and guidance by the RN/LPN to the UAP. Supervision can either be direct where the delegator is within the premises where delegated task is performed.  Indirect supervision means the delegator is not physically with the UAP, but is available by two-way communication, through phone calls to give guidance, and answer questions. When delegating, the delegator must assess the complexity of the task to be delegated, potential harm to the patient, probable outcomes of the task, personnel, and resources available. Besides, the person whom task is delegated should be evaluated for their level of education. Scope of practice, supervision required, knowledge, and abilities of the person whom a task is delegated.

Delegation involves communication to the UAP, which includes identification of the task to be performed, the expected outcomes, and time when the task should be completed. (Murphy-Ruocco, 2018) argues that the RN/LPN may not delegate such activities as tasks involving the use of the nursing process, initial, and subsequent nursing patient evaluations, defining nursing diagnosis, and interpretation, and evaluation of outcomes of patient care activities. Also, the RN/LPN should not delegate a task which the UAP has not proven competence.

Compare and contrast the scenario with a scenario in nursing practice

Scenario

The RN on duty had received a call from the surgeon that Mrs. John needs to ambulate during her post-operative period. The RN had been working with An LPN for approximately six months in the surgical ward; thus, she is aware of her ability to assist in ambulation of patients. The RN assessed the patient and identified her individual needs as need to ambulate to prevent deep vein thrombosis. The RN informs the LPN that Mrs. John is a 46-year-old patient, in cube two, who was admitted 56 hours ago for hysterectomy. Her post-operative recovery had been uncomplicated. The surgeon wanted the patient to ambulate thrice daily. She then requested the LPN to assist Mrs. John in ambulating and observed how the LPN assisted Mrs. John in walking around the ward.

Comparison

Both scenarios involve the transfer of performing a task to unlicensed personnel from a licensed nurse.

Both cases involve the delegator stating the names of the patients who require care.

Contrast

While the first scenario does not involve the LPN stating diagnosis, age, and bed number or cube were Mr. Peter was, scenario two allows the LPN to know about the patient; thus, the probability of the LPN attending to the wrong patient is low.

In the first scenario, the LPN did not asses the knowledge and capabilities of Pricilla, the LPN. Instead, the nurse was only concerned with insulin being administered, while in scenario two, the RN assessed the abilities of the LPN.

In the first scenario, the patient’s special needs have not been put into consideration while in the second scenario, the RN was concerned about deep vein thrombosis postoperatively.

While in the first scenario, there was no supervision, in the second scenario, the nurse directly supervised the LPN while she assisted Mrs. John to ambulate.

Reference

Fowler, M. (2010). American Nurses Association Guide to the Code of Ethics for Nurses: Interpretation and Application. American Nurses Association: Silver Spring, MD

Florida administrative register and Florida administrative code. (2010). Division 64B9. Florida Department of State. Retrieved from https://www.flrules.org/gateway/Division.asp?DivID=332

Harris, M. (2017). Delegation by Registered Nurses. Home healthcare now, 35(9), 523-524.

Murphy-Ruocco, M. (2018). Delegating: Authority, Accountability, and Responsibility in Delegation Decisions. Leading and Managing in Nursing-E-Book, 298.

NCAC (North Carolina Administrative Code Title 21 Chapter 36 – Board of Nursing). Retrieved from www.ncbon.com January 23, 2013, 4-6, 19, 11, 39-40, 21-23, 24-26.

Zhang, X., Qian, J., Wang, B., Jin, Z., Wang, J., & Wang, Y. (2017). Leaders’ behaviors matter: the role of delegation in promoting employees’ feedback-seeking behavior. Frontiers in psychology, 8, 920.