Responsibility and Accountability in Nursing

8/14/2019 Responsibility and Accountability in Nursing

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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

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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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Responsibility and Accountability in Nursing

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