Essentials of Nursing Leadership and Management, 5th Edition

chapter 9 | Delegation of Client Care 123

caregivers within each discipline because ability
differs with each level of education. Additionally,
individuals within each level of skill possess their
own strengths and weaknesses. Prior assessment
of the strengths of each member of the team will
assist in providing safe and efficient care to
clients. Figure 9.3 outlines the skills of various
health-care personnel.
People should not be assigned a task that they
are not skilled in or knowledgeable to perform,
regardless of their professional level. People are
often reluctant to admit they cannot do something.
Instead of seeking help or saying they are not com-
fortable with a task, they may avoid doing it, delay
starting it, do only part of it, or even bluff their way
through it, a risky choice in health care.
Regardless of the length of time individuals
have been in a position, employees need orientation
when assigned a new task. Those who seek assis-
tance and advice are showing concern for the team
and the welfare of their clients. Requests for assis-
tance or additional explanations should not be
ignored, and the person should be praised, not

criticized, for seeking guidance (Tappen, Weiss, &

Whitehead, 2004).

Priorities

The work of a busy unit rarely ends up going as

expected. Dealing with sick people, their families,

physicians, and other team members all at the same

time is a difficult task. Setting priorities for the day

should be based on client needs, team needs, and

organizational and community demands. The val-

ues of each may be very different, even opposed.

These differences should be discussed with team

members so that decisions can be made based on

team priorities.

One way to determine patient priorities is to base

decisions on Maslow’s hierarchy of needs. Maslow’s

hierarchy is frequently used in nursing to provide a

framework for prioritizing care to meet client needs.

The basic physiological needs come first because

they are necessary for survival. For example, oxygen

and medication administration, IV fluids, and enter-

al feedings are included in this group.

Identifying priorities and deciding the needs to

be met first help in organizing care and in deciding

which other team members can meet client needs.

For example, nursing assistants can meet many

hygiene needs, allowing licensed personnel to

administer medications and enteral feedings in a

timely manner.

Efficiency

Efficiency means that all members of the team

know their jobs and responsibilities and work

together like gears in a well-built clock. They mesh

together and keep perfect time.

Five Factors for Determining if Client

Care Activity Should Be Delegated

• Potential for harm to the patient


• Complexity of the nursing activity


• Extent of problem solving and innovation required


• Predictability of outcome


• Extent of interaction
  Adapted from American Association of Critical Care Nurses (AACN). (1990).
  Delegation of Nursing and Non-Nursing Activities in Critical Care: A
  Framework for Decision-Making.Irvine, CA: AACN.

LPN Skills

Vital signs

Some IV medication

(depending on state

Nurse Practice Act

and institution)

Physical care

Ancillary Personnel

Patient Care Needs

PT

OT

Nutrition

Speech

UAP

Feeding

Hygiene

Physical care

RN Skills

Assessment

IV medications

Blood administration

Planning care

Physician orders

Teaching

Figure 9.3Diagram of delegation decision-making grid.

box 9-3