9781401814052

The long standing nursing shortage has prompted many institutions to rely on nurses to delegate critical tasks. Delegation of Nursing Care establishes safe delegation as an indispensable skill in delivering quality patient care. The book discusses the demanding roles of a professional nurse and explores the elements of decision making nurses use most. It also highlights the importance of communication, time management, and accountability, and is designed to build the diverse skills needed in the world of nursing.

Patricia Kelly-Heidenthal earned a Diploma in Nursing from St. Margaret Hospital School of Nursing, Hammond, Indiana; a baccalaureate in nursing from DePaul University in Chicago, Illinois; and a master's degree in nursing from Loyola University in Chicago, Illinois. She has worked as a staff nurse and as a school nurse. Pat has traveled extensively, teaching conferences for the Joint Commission on Accreditation of Healthcare Organizations. She was director of quality assurance for nursing at the University of Chicago Hospitals and Clinics in Chicago, Illinois. Pat has taught at Wesley-Passavant School of Nursing, Chicago State University, and Purdue University Calumet in Hammond, Indiana. She is Professor Emerita, Purdue University Calumet, Hammond, Indiana. Pat has taught fundamentals of nursing, adult nursing, nursing leadership and management, nursing issues, nursing trends, and legal aspects of nursing. She has taught nursing conferences in almost every state in the United States, as well as in Puerto Rico and Canada on quality improvement. Pat also teaches NCLEX reviews nationally with Health Education Systems, Inc., and is a member of Sigma Theta Tau and the American Nurses Association. She is listed in Who's Who in American Nursing, 2000 Notable American Women, and the International Who's Who of Professional and Business Women. Pat has served on the Board of Directors of Tri City Mental Health Center, St. Anthony's Home, and Mosby's Quality Connection. She is the editor and author of Nursing Leadership and Management, Delmar, 2003; Essentials of Nursing Leadership and Management, Delmar, 2004; and she contributed a chapter entitled "Preparing the Undergraduate Student and Faculty to Use Quality Improvement in Practice" to Improving Quality, Second Edition, by Claire Gavin Meisenheimer, Aspen, 1997. Pat has written several articles, including "Chest X-Ray Interpretation" and many articles on quality improvement. Pat is a disaster volunteer for the American Red Cross and volunteers at a church food pantry in Austin, Texas. Throughout much of her career, she has taught nursing at the university level and has continued to work part time as a staff nurse in the Emergency Department. This has allowed her to wear several hats and see nursing from many points of view. Pat currently lives in Austin, Texas, and can be reached at patkh1@aol.com. Maureen T. Marthaler earned a baccalaureate degree in nursing from Lewis University in Romeoville, Illinois, and a master's degree in nursing education from DePaul University in Chicago. She taught at Prairie State College in Chicago Heights, Illinois. Currently, Maureen is an assistant professor at Purdue University Calumet in Hammond, Indiana. Maureen has taught fundamentals of nursing, adult nursing, nursing leadership and management, nursing ethos, and critical care nursing courses. She has taught nursing conferences on various neurological conditions, such as assessment, seizures, Guillian-Barre, Parkinson's Disease, and blood gas assessment. Maureen has also taught NCLEX reviews nationally. She is the treasurer for Mu Omega Chapter of Sigma Theta Tau and is a member of the National League for Nursing. Maureen contributed a chapter on delegation of nursing care to the Kelly-Heidenthal textbook published by Delmar, Nursing Leadership and Management, 2003. Maureen also wrote a continuing education program for Sigma Theta Tau International on delegation. Her most recent publication "SARS: What Have We Learned" in the nursing journal Registered Nurse, was co-authored with her colleagues at Purdue University Calumet. She has traveled to Romania and assisted a nursing school there with curriculum development. Throughout her career, she has continued to work part time as a staff nurse in the Intensive Care Unit at St. Margaret's Hospital in Hammond, Indiana. Maureen has been licensed as an RN for over 23 years. She is married to David, a very supportive husband. She is the mother of two wonderful teenage boys, Luke, 15, and Jake, 13. They live in Crete, Illinois, where Maureen can be reached at maureen@calumet.purdue.edu.

Contributors

vii

Reviewers

xi

Preface

xiii

Organization

xiv

Chapter Features

xv

Acknowledgments

xvii

About the Authors

xix

List of Patient Descriptions

xxi

Concept of Delegation

1

(28)

Perspectives on Delegation

2

(7)

Delegation

6

(1)

Assignment

6

(1)

Assignment versus Delegation

7

(1)

Supervision

8

(1)

Accountability

8

(1)

Authority

9

(1)

Responsibility

9

(4)

Types of Delegation

13

(3)

Direct Patient Care Activities

14

(1)

Indirect Patient Care Activities

14

(1)

Underdelegation

15

(1)

Overdelegation

15

(1)

Organizational Responsibility for Delegation

16

(4)

Chain of Command

18

(2)

Critical Thinking, Decision-Making, and an Ethics Test

20

(1)

Decision Making Process and Delegation

21

(1)

Case Study

21

(2)

An Ethics Test

23

(1)

Review Questions

23

(1)

Review Activities

24

(1)

Exploring the Web

25

(1)

References

26

(1)

Suggested Readings

27

(2)

Delegation Decision-Making Grid and the Five Rights

29

(24)

The National Council of State Boards of Nursing (NCSBN) Delegation Decision-Making Grid

30

(2)

The Five Rights of Delegation

32

(3)

State Boards of Nursing

35

(1)

Knowledge and Skill of Delegation

35

(1)

Power

35

(5)

Delegation Responsibilities of Health Team Members

40

(7)

Nurse Manager Responsibility

40

(1)

New Graduate Responsibility

41

(1)

Registered Nurse Responsibility

41

(1)

LPN/LVN Responsibility

42

(2)

UAP Responsibility

44

(3)

Delegation Suggestions for RNs

47

(2)

Review Questions

49

(1)

Review Activities

50

(1)

Exploring the Web

51

(1)

References

51

(1)

Suggested Readings

52

(1)

Effective Communication

53

(44)

Elements of the Communication Process

54

(1)

Sender and Message

54

(1)

Communication Channel and Receiver

55

(1)

Feedback and Educational, Cultural, Emotional, and Perceptual Influences

55

(1)

Communication and Delegation

55

(6)

Communication Skills

56

(2)

Attending

58

(1)

Responding

58

(1)

Clarifying

58

(1)

Confronting

58

(3)

Culture and Delegation

61

(2)

Communication

61

(1)

Space

61

(1)

Social Organization

61

(1)

Time

62

(1)

Environmental Control

62

(1)

Biological Variations

62

(1)

The Professional Role of the Nurse

63

(4)

Potential Barriers to Communication

67

(6)

Gender

67

(1)

Anger

68

(1)

Incongruent Responses

69

(1)

Conflict

70

(1)

Thought Distortions

70

(3)

Additional Barriers to Communication

73

(1)

Overcoming Communication Barriers

73

(1)

Helpful and Non-Helpful Roles in Communication

73

(5)

Destructive or Difficult Behaviors

75

(3)

Myers-Briggs Personality Types

78

(1)

Workplace Communication

79

(11)

Communicating with Superiors

81

(1)

Communicating with Co-Workers

82

(3)

Communicating with other Nursing and Medical Practitioners

85

(5)

Review Questions

90

(2)

Review Activities

92

(1)

Exploring the Web

92

(1)

References

93

(1)

Suggested Readings

94

(3)

Time Management and Setting Priorities

97

(34)

General Time Management Techniques

99

(1)

Outcome or Goal Orientation

100

(1)

Analysis of Nursing Time

100

(6)

Value of Nursing Time

100

(1)

Use of Time

101

(1)

Activity Log

101

(3)

Create More Time

104

(2)

Effective Use of Available Time

106

(6)

Setting Priority Patient Outcomes

106

(1)

Priority Traps

107

(1)

Considerations in Setting Priorities

108

(3)

More Priority Setting

111

(1)

Shift Report and Making Assignments

112

(8)

Making Assignments

115

(2)

Making Patient Care Rounds

117

(2)

Evaluation of Outcome Achievement

119

(1)

Review Questions

120

(3)

Review Activities

123

(5)

Exploring the Web

128

(1)

References

129

(1)

Suggested Readings

130

(1)

Legal Aspects of Patient Care and Delegation

131

(32)

Tort Law

132

(9)

Negligence and Malpractice

133

(7)

Do Not Attempt to Resuscitate (DNAR) Orders and Following Orders

140

(1)

Resources for Safe, Legal, and Ethical Nursing Practice

141

(9)

State Nurse Practice Act

141

(1)

Policies and Procedures of the Institution

141

(1)

Good Samaritan Laws

142

(1)

Good Communication

142

(2)

Documentation

144

(1)

Patient Advocacy and Ethical Behavior

144

(1)

Risk Management Programs

145

(3)

Malpractice/Professional Liability Insurance

148

(2)

Nursing Risk in Litigation

150

(4)

Common Monetary Awards

151

(1)

Selected Monetary Liability Limits

152

(1)

Other Legal Risks for the Nurse/Practitioner/Hospital

152

(2)

Nurse-Attorney Relationships in a Lawsuit

154

(1)

Review Questions

155

(1)

Review Activities

156

(1)

Exploring the Web

156

(1)

References

157

(1)

Suggested Readings

158

(1)

Case References

158

(5)

Glossary

163

(2)

Index

165

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Delegation of Nursing Care

Delegation of Nursing Care

1401814050

Summary

Author Biography

Table of Contents

Supplemental Materials