Delegation and Personnel Management

Guidelines:

• Perioperative patient care = team delivery
• The perioperative RN circulator:
  • supervises and evaluates the activities of the other team members
  • executes immediate directives and interventions in urgent or emergent situations
  • Delegates certain nursing tasks and functions

Considerations:

• So who is the perioperative RN supervising and delegating to?
• UAPs in the perioperative setting:
  • Nursing assistants
  • Orderlies
  • Environmental services personnel
  • Patient care technicians
• Other staff:
  • Scrub techs and licensed practical nurses (LPNs) in the scrub role are under the supervision of an RN who is immediately available

Nurse’s role:

• Delegation transfers the authority to perform a selected nursing task in a selected situation according to the “five rights” of delegation
• The Five Rights of Delegation:
  • The right task
    • Routine tasks performed according to a standardized procedure and which have predictable outcomes are safest to delegate
  • The right circumstances
    • Tasks delegated must not require independent nursing judgement
  • The right person
    • Institutional and state board of nursing policies
    • Job description of the UAP and competencies
  • The right communication and direction
    • 2-way communication
    • Clear, specific, and concise
    • Opportunity for questions and clarifying instructions
  • The right supervision and evaluation
    • Accountability for analyzing and evaluating the outcomes of delegated tasks
    • Monitor and evaluate
    • Intervene as necessary
    • Provide immediate feedback

Pitfalls:

• State Board of Nursing Practice Act determines scope of practice and rules for delegation
• Institutional policy cannot contradict the nurse practice act of their state
• Supervision cannot be delegated
• Activities that rely on the nursing process, such as performing assessments, making nursing diagnoses, establishing plans of care, providing extensive patient, family, and caregiver education, and planning for patient discharge, cannot be delegated
• The perioperative nurse who delegates a task retains accountability for that delegation

Examples:

• You are the RN circulator and the scrub tech assigned to your room informs you that they used to be a nurse’s aid and knows how to start IVs. Before delegating any tasks to the scrub tech, what are the most important things you need to know to make the right decision?
  • State board of nursing’s rules for delegation
  • Organization/Institutional policy on delegation
  • The job description and competencies of the scrub tech

Linchpins (Key Points):

• Know your state board of nursing rules for delegation
• Know your organization’s policies on delegation
• Know the job description and competencies of the UAP, scrub tech, or LPN
• Know that supervision cannot be delegated