Healthcare Team Member Supervision and Education

Guidelines:

• Delegation and supervision are essential perioperative nursing skills
  • Delegation process is complex
  • Safe and consistent delegation practices requires shared responsibilities among the organization (administrative policies and procedures), the perioperative RN, and the delegatee
  • According to CMS, surgical technologists and LPNs in the scrub role are under the supervision of an RN who is immediately available
  • Supervision also includes non-OR personnel and healthcare industry representative (HCIR)

Considerations:

• Organization responsibility:
  • Implement a standardized method for delegation and supervision processes
  • Provide education and verify the competency of the delegatee for tasks that may be delegated
  • Create policies and procedures for nursing delegation that clarifies what may and may not be delegated in accordance with the state nurse practice act
    • Remember, policy cannot contradict state nurse practice act or any state/federal regulations!

Nurse’s role:

• Perioperative RN responsibility:
  • Complete competency verification activities related to delegation processes
  • A perioperative RN with authority to delegate (eg, an RN involved in the procedure, charge RN, RN manager) can
    delegate perioperative tasks (nursing activities)
    • The RN should NOT delegate tasks that require nursing judgment, clinical reasoning, and critical decision making (eg, assessing, evaluation) to a person who is not an RN
  • Supervise STs, LPNs, non-OR personnel, and HCIRs in the OR

Pitfalls:

• Delegatee responsibility:
  • Accepts only delegated responsibilities that they are competent to perform
    • Perioperative activities, skills, procedures
  • The delegatee may not then delegate responsibilities or tasks to another individual
  • Remember, the perioperative RN delegating a task maintains accountability for the patient while the delegatee is responsible for the performance of the delegated skill, activity, or procedure

Examples:

• N/A

Linchpins (Key Points):

• Delegation and supervision are essential perioperative nursing skills
• The perioperative RN supervises scrub techs and LPNs in the scrub role
• The perioperative RN supervises non-OR personnel and HCIRs
• The healthcare organization, perioperative RN, and delegatee are collaborative partners in delegation and supervision to promote patient safety