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Responsibility andaccountability in nursing
DESWANI
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CONTENTS : Responsibility, ward organization andrecord keeping
The nurse and the health care team Responsibility for professional
standards
Reporting and colleagues
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Define Delegation Differentiate betweenAccountabilityand Responsibility
Define the Delegation Process Determine Legal Risks
Examine Nurse Practice Acts and
their roles
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Current Healthcare
Environment Economic factorsMergers, network development, managedcare involvement
Reimbursement issuesFederal, state, and private payorreluctance to pay for healthcare services
Technological advancement Human factors/Patient needs
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Delegation Defined
The transfer of authority to performa specific nursingtask in a specificsituation to a competent individual
The competent individual isresponsiblefor the activity
The nursingprofessional remainsaccountable for the delegation
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Accountability and
Responsibility One and the Same?
Accountability: The nursing
professional is legally responsible(liable) for his/her actions as itrelates to the overall nursingcare of
his/her patients
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Responsibility The nursingprofessional or
Competent individual has anobligation to perform tasksreliably, dependably and at an
acceptable level
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Effective Delegation
Functions of the Professional NurseResponsible and accountable for theprovision of nursingcareResponsible for assessment, diagnosis,
care planning and evaluationAlways responsible for the patientoutcomeAware of limitations of other healthteam members
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Effective Delegation
- unlicensed assistive personnelvaluable member of the healthcare
team
extra pair of handstrained to perform in an assistive
role to the nursingprofessional
delegated duties and supervised bythe nursing professional
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Why Delegate
Professional nurses need assistanceNursingshortageStaffing issues - staff ratio debatesPatient acuity
acute care, home care, ambulatory and longtermcare settings
Need to deliver safe, competent, qualitycare to patients
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When May I Delegate
Nursingscope of practice
Specific activities are non-delegable UAPs do not have a scopeof practice
Can perform activities that do notrequire nursingskill, judgment andresults are predictable
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Verbal delegation v. approved tasklist
What is the patients condition?
Is there potential for harm?
Is the activity complex orcomplicated?
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When May I Delegate
Is problem-solving or innovationrequired to perform the task?
Can the outcome be predicted?
What level of patient interaction isrequired?
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When May I Delegate
The Five Rights of Delegation
Right task
Right circumstance
Right personRight direction/communication
Right supervision
t
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e egat onDecision-Making
Process Principle of protection of the public
Boards of Nursingresponsible for
regulation of nursing Boards of Nursingmust articulate
clear principles
Professional nurse has ultimate
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responsibilityand
accountability Professional nurse is actively involved time and place for UAPs in healthcare
Nursingis a knowledge-based process Tasks may be delegated, knowledge cannotCannot re-delegate tasks
Care must meet generally-accepted standards ofcare
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Decision-Making
Process The professional nurse determines and isaccountable for the appropriateness ofdelegated nursingtasks
Inappropriate delegation by the nurseand/or unauthorized performance ofnursingtasks by unlicensed assistive
personnel may lead to legal action againstthe nurse and/or UAP
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Delegation criteria
NursingPractice Act
Delegator qualificationsDelegatee qualifications
Assess the situationNeeds of the patientConsider the circumstances
Adequate Resources
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Plan for the specific taskSpecify nature, knowledge and skill
requiredDocumentation, demonstration of
competence
Determine implications Assure appropriate accountabilityDelegator accepts accountability
Delegatee accepts delegation
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Delegation
Supervise performance
Provide directions, expectations
Monitor performanceIntervene as necessary
Ensure documentation of task
Evaluate the delegation processReassess
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What May I Delegate Health-related activities that do not require nursingskill or judgment and produce predictable results
Standardized procedures1. Activities of daily living2. Collecting data3. Collecting simple specimens
4. Transporting, restocking, clerical duties, etc.
t t
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at annot eDelegated?
Activities within the scope of nursingpractice
Unstable patients
Activities requiring assessment, problem-solving, judgment, evaluation
Where outcome is unpredictable
Sterile technique, med administration, IVtherapy, invasive procedures
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Risks of Delegation
Patient Safety Ethical
Legal
s s
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ega s s oDelegation The
Professional Nurse1. Malpractice actions Negligent delegation Negligent supervision
2. Disciplinary action Licensing Board EmployerThe UAP3. Malpractice actions
Negligent performance of activity4. Disciplinary action Licensing Board Employer
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Risk/Benefit Analysis
of Delegation Assess the patient to determine if delegation is appropriate :
Verify that the UAP is competentReview the task w/the UAP
Follow institution policy
Monitor the patient
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Ensure accurate, timelydocumentation of the care rendered
Regularly evaluate or monitor theUAPs performance
Bring concerns to appropriateindividuals
- nurse manager, supervisor
Reporting obligations
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Generally, specific definitions forprofessional nurses, licensed
vocational nurses, and advancepractice nurses
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Professional nurses
(RNs) are Independent practitioners of nursingin all states
-supervision not requiredLicensed practical/vocational nurses
are dependent practitioners and
require supervision
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Regulatory Guidance States responsibility:
to protect the public from harm Permit the practitioner to practice
within a legally-defined and
protected scope of practiceBoards of Nursing regulate the practiceof nursing and interpret statutes, rulesand regulations regarding scope of
practice
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Boards of Nursing determine what
level of licensed practitioner orunlicensed person can perform aspecific task
Generally, each state providesguidelines for processes ofassignment, delegation and
supervision
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American Nurses Association and
National Council State Boards of
Nursing guidance statements
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Dont Forget Responsibility of professional nurseto be knowledgeable of the nurse
practice act in his/her state -Ignorance is not a defense
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State Nurse Practice Acts define
the practice of nursing and the legalrestrictions for delegation
Professional nurses are accountable
for the management and provision ofnursing care, including any tasksdelegated to UAPs
Priority is always the best interestof the patient
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Summarize Priority is always the best interestof the patient
When used appropriately, delegationis a vital tool for the professionalnurse and should ensure safe,
competent nursing care
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