Tips for Effective RN Delegation in Long-Term Care
Effective delegation is important to every profession, but it’s especially important in nursing. Some RNs – due to heavy workloads and limited staff – may be tempted to delegate responsibility to LPNs and nursing assistants before they’re ready for certain tasks. RNs, however, need to adhere to delegation guidelines found in many state’s laws.
For example, the Minnesota Nurse Practice Act states that RNs are the only nurses who have authority to delegate an appropriate plan of care. LPNs and others can only collect data, monitor and observe. If the LPN or nursing assistant performs an important task incorrectly, the RN is at fault; the nurse could receive a reprimand and possibly even lose her or his license and job. Additionally, the care center where she or he works could be cited and penalized. And, most importantly, residents could be harmed, perhaps seriously.
Guidelines can help RNs determine if and when to delegate. Here are six specific factors RNs should consider before delegating:
- Low potential for harm. The RN must bear in mind the physical and even psychological harm to patients from a botched nursing task. If it’s non-routine, it shouldn’t be delegated. One indication of a more involved task: If several steps are required to perform it or parameters require an evaluation or analysis.
- High predictability of outcome. How predictable is the outcome? Walking a person who needs minimal assistance is an acceptable delegation. But it may not be for a person who has experienced dizziness or who has had a few falls.
- Minimal required problem solving and innovation. Delegate routine, stable, predictable and controllable tasks, not those in which problem-solving is needed to achieve the expected outcomes.
- Ample opportunity for patient interaction. Time and other pressures may tempt RNs to cut short their first-hand interactions with residents. But residents’ contributions are key to their effective treatment. RNs shouldn’t minimize thatinteraction.
- Accessibility of the RN: This factor could be easily overlooked byoverburdened RNs. They may have carefully weighed the other factors above but then not sufficiently considered their availability to those to whom they’re delegating, especially when RNs are called to other units during emergencies. RNs have to make themselves available.
When the RN has made the decision to delegate, it’s incumbent to carefully communicate expectations to LPNs and other nursing assistants. That helps ensure a successful outcome for patients, LPNs and nursing assistants. Following are five factors the RN should be mindful of when delegating:
- Using a thoughtful decision making approach. Amid an oftenfrenetic work atmosphere, RNs need to be controlled and deliberate while delegating. It helps to ensure all the necessary caretaking steps are covered, inspires confidence and models professionalism.
- Get beyond embarrassment. If the person you’re delegating to is confused by the instructions, he or she may not tell you because of embarrassment. So consider asking the person to repeat, or at least summarize, your instructions. If there’s time, ask the person to whom you’re delegating to provide a demonstration of the task. Finally, make sure the person knows how to reach you should problems arise.
- Individualizing care plans to meet resident needs. Every resident has unique needs. Be wary of relying on computer programs or nursing textbooks that suggest cookie-cutter treatments. RNs should make time to talk with residents and collect information specific to their situation. Seek their suggestions and insights in formulating a specific care plan. With patient contributions and buy-in, not only is care delivery easier but successful outcomes are likelier.
- Evaluating the resident outcome. By assessing the resident’s outcome, RNs are closing the delegation loop. After the LPN or nursing assistant has performed the task and communicated with the RN, she or he needs to check the chart for relevant data and information. Only after assessing the resident’s status can the RN outline a future caretaking plan.
Effective delegation from the RN to the LPN and nursing assistant are essential to high quality care. If you have questions about RN delegation, feel free to contact Mary Leber at maryleber@ecumen.org.
Mary Leber is director of consulting services for Ecumen, the innovative leader of senior housing and services, empowering individuals to live richer and fuller lives.. Mary provides consulting services to long-term care providers across the country. Mary has been a nurse, working in long-term care for more than 30 years. She can be reached at maryleber@ecumen.org.
Download: RN-Delegation.pdf