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Course: Fundamentals of Nursing�Topic: Nurses Role in Supervision

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Learning Outcomes

Learners will be able to:

Explain the difference between supervision and delegation.
Discuss the guidelines used in supervision and delegation.

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Definitions

ANA , n.d.

Supervision:

Derived from Latin. Super means ‘from the above’ and vision means ‘to see’
Overseeing the activities of others

OR

The active process of directing, guiding and influencing the outcome of the individual’s performance of a task

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Definitions: Nursing Supervision

Supervisor:

A person who supervises a person or an activity
For example: A qualified and experienced RN or Midwife who supervises an individual, such as a Student Nurse.
The supervisor assesses, monitors and provides feedback to the relevant state board

Supervisee:

A person being supervised
For example: A Nurse or Midwife who holds provisional registration and is not yet fully licensed.

NMBA, 2021

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Clinical Supervision

TRaNSforM, n,d

A formal, systematic and continuous process of professional support and learning, for practicing nurses, in which nurses are assisted in developing their practice through regular discussion with experienced colleagues and aims to promote autonomous decision-making, valuing the individual’s protection and safe care provision through reflective processes and clinical practice analysis.

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Importance of Supervision

NMBA, 2021

Assurance to the community that a nurse or midwife’s practice is safe and does not place public at risk.

The public has a right to expect safe, competent and evidence- based care.

Enables Learner to receive feedback, and identify areas to improve.

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Functions of Supervision

Three key components of effective clinical supervision:

Accountability (Normative component)

Learning (Educative component)

Support (Restorative component)

Helen and Douglas House,2014

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Accountability

Helen and Douglas House,2014

Referred as normative component
It focuses on:

Supporting individual to develop ability in their clinical role
Enhancing their performance for and within the organization
Supporting reflection on practice with an awareness of local policy and codes of conduct

Benefits:

High standards ethical and safe care

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Learning

Helen and Douglas House,2014

Referred as educative component
Focuses on the development of:

Skills knowledge
Attitude
Understanding

Benefits:

Supports personal and professional development
Encourages and supports lifelong learning
Helps to identify further training and developmental needs

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Supports

Referred as restorative component
Concerned with how participants respond emotionally to the work of caring others
Fosters resilience through nurturing supportive relationship which offers motivation and encouragement
Benefits:

Feel supported (supports self-care and well -being)
Experience less stress (provides insight into emotional responses)
Enhances morale and working relationship

Helen and Douglas House,2014

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Scope of Supervision

NMBA, 2021

Students
New graduates or Junior nurses
Performance review for professional development
Nurses or midwives may require to work under supervision if they hold:

Provisional registration
General registration with conditions
Are returning to practice after an absence

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Levels of Supervision

Level 1. Direct supervision

The supervisor takes direct or principal responsibility for the nursing care provided. (assessment or treatment of individual).
The supervisor must be present physically all the time observing the supervisee providing clinical care according to supervised practice plan.
The supervisee must consult the supervisor about the nursing or midwifery care before delivering the care.

NMBA, 2021

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Levels of Supervision

NMBA, 2021

Level 2. Indirect supervision

The supervisor and supervisee share the responsibility for individual care.
The supervisor is easily contactable and is available to observe and discuss nursing care the supervisee is providing
The supervisor must be present physically at the workplace throughout the entire supervision process

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Levels of Supervision

The level of supervision required will be depend on:

Purpose of supervision
Previous practice experience, qualifications, skills and attributes of supervisees
Duration of any period of absence from practising the profession
Level of risk associated with the purpose of supervision
Policies of the organisation in which the period of supervised practice is being undertaken
Requirement of relevant legislation.(eg. drugs, poisons and controlled legislation)

NMBA, 2021

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Supervisor Responsibilities

NMBA, 2021

Reasonable steps as required by the level of supervision
Clear direction and constructive feedback
Be available when the supervisee is practising
Ensure the supervisee:

Understands the legal responsibilities
Follows ethical principles that apply to the profession
Acts in under the direction of supervisors

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Supervisees Responsibilities

Work with supervisor to develop Supervision plan for submission and approval by the relevant state.
Take joint responsibility for putting in place a schedule of regular meetings with the supervisor.
Be sufficiently prepared for meetings with supervisors.
Participate in assessment done by your supervisor to help determine your progress and future supervision needs.
Recognise the limits of your professional competence.
Familiarize themselves with professional responsibilities.
Responds to feedback.

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Critical Thinking Question

Miss Sharma is a student nurse on the first day of rotation on a gerontology unit. She will be providing basic care to one client including hygiene and medication administration.

What directions should she expect from the nurse who is supervising her?

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Meaning of Delegation

The word delegation is derived from the latin word Delegare consisting of two words:

De: From
Legure: to send

The meaning of delegate is “To give a job or responsibility to someone in a lower position instead of doing it yourself”

Cambridge Dictionary, n.d

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Definitions

Delegation: The transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. (ANA, 2005)

Example: A RN delegates a task to an assistive personnel, transfers the responsibility for the performance of the task but retains professional accountability of the overall care

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Definitions

Delegator: a person who delegates a nursing responsibility (eg. APRN, RN or LPN/VN) where jurisdiction NPA allows.

Delegatee: one who is delegated a nursing responsibility either by APN, RN or LPN/VN (where jurisdiction NPA allows) who is competent to perform it and accept the responsibility.

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Components of Delegation

Authority:

the power or right to give orders, make decisions.

Responsibility:

the obligation of an individual to carry out the assigned activities to the best of their ability.

Accountability:

to be answerable to oneself and others for one’s own choices, decisions and actions as measured against a standard

Barrow, 2020

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Features of Delegation

Assignment of duties by the superior (delegator) to the subordinate (delegatee).
Granting of authority by the delegator to the delegatee to facilitate the work assigned to him.
Creation of an obligation, that is, the delegatee becomes duty bound to complete the work.
No further delegation of the obligation by the delegatee to his subordinates.

Marume, 2016

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Rights of Delegation

NCSB-ANA,2019

Five rights of delegations are:

Right task
Right circumstance
Right person
Right directions and communication
Right supervision and evaluation

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Right task: Activities should fall in the job description of delegatee. job description should describe the expectation and limits of the activity and provide any necessary training.

Right circumstance: The health condition of clients must be stable. if the health condition of the client changes the delegatee must inform to the delegator (ie.licensed nurse). the delegator must reassess the condition and appropriateness of delegation.

Right Person: The delegator (i.e. licensed nurse), the employer and the delegatee are responsible for ensuring that the delegatee has the knowledge and skills to perform a particular task.

Right direction and communication: Each delegation situation should be specific to the client. The delegator should give specific instructions for the delegated activity. There should be always two way communication between the delegator and delegatee. The delegatee should ask if they have any clarifying questions.

The communication includes the data need to be collected, method for collecting it, the time for reporting the results and any information pertaining to the situation to the delegator.

The delegatee must understand the term of delegation and accepts the delegated activity.

the delegator should ensure that the delegatee understands that the delegate can not make any modification in carrying out the delegated activity without first consulting the delegator.

Right supervision and evaluation:

The delegator (ie licensed nurse) is responsible for monitoring delegated activity. they should follow up with the delegatee at the completion of activity and evaluate the clients outcomes. The delegator should be ready and available to intervene as necessary. The licensed nurse should make sure there is proper documentation of the activity is completed.

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Principles of Delegation

According to ANA the accepted principles of delegation are:

Overarching principles

Nurse related principles

Organization-related principle

ANA, 2005

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Overarching Principles

The Nursing profession:

Determines the scope of nursing practice.
Defines and supervises the education, training and utilization of any assistant role.

The RN:

Takes responsibility and accountability of nursing practice.
Directs care and determines utilization of an assistant role.

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Nurse-related Principles

The RN:

Delegates elements of care but does not delegate the nursing process itself.
Has duty to answer for personal actions related to nursing process
Takes into account the knowledge and skills of the person to whom they delegate the task.
Understands that the decision to delegate is based on the RN’s judgement.
Delegates the task to other health worker who has the knowledge and skills to perform.

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Organization-Related Principles

The Organization:

Is accountable for delegation through the allocation of resources to ensure the sufficient staffing.
Is accountable for documenting competence for all staff so that the RN has access to competency information.
Policies of delegation are developed in with the participation of all nurses and staff.

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Employer/ Nurse Leader Responsibilities

NCSB-ANA, 2019

Identify a nursing leader.
Determine nursing responsibilities that can be delegated to whom and in what circumstances.
Develop delegation policies and procedures.
Evaluate delegation process periodically
Promote positive culture and work environment.

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Licensed Nurse Responsibilities

Determine client’s needs and when to delegate.

Ensure availability to delegatee.

Evaluate outcomes and maintain accountability of delegated work.

Provide feedback information about delegation process and any issue regarding competence level of delegatee to the nurse leader.

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Delegatee Responsibilities

NCSB-ANA, 2019

Accepts activities based on own competence level.
Maintains competence for the delegated responsibility.
Maintains accountability for delegated work correctly and completing timely.
Completes Documentation according to policy.

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Critical Thinking Question

A nurse is a charge nurse in a surgical ward of a pediatric unit. During her busy night shift, she has several tasks that need to be completed quickly. These tasks include a linen change for a client who just vomited, an assessment of a possibly infiltrated intravenous line, and the administration of intravenous pain medication for a client who rates her pain at 10 out of 10. There are two nursing assistants (NA) on the unit.

The nurse will need to delegate some tasks to the NA. What does the nurse need to consider before delegating tasks in this situation?

Identify which tasks may be delegated and to whom.

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The licensed nurse Miss Merry has to follow the five Rights of Delegation. ie.

Right task
Right circumstance
Right person
Right directions and communication
Right supervision and evaluation

(NCSB-ANA,2019)

Among the tasks (Linen Change for client who has vomited, assessment of infiltrated intravenous line and the intravenous of pain medication for the clients who rates 10 out of 10 in pain scale) She might delegate the linen change because it does not have any risk for the clients.

She can not delegate the administration of pain medication because this is outside the scope of the nursing assistants. She also can not delegate the assessment of infiltrated IV line because it also need to be assessed by an RN

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Red Flags

These guidelines do not apply to the transfer of responsibility for care of a client between licensed health care providers (e.g., RN to another RN or LPN/VN to another LPN/VN), which is considered a handoff (Agency for Healthcare Research and Quality, 2015).

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References

American Nurses Association (2005). Principles for Delegation. https://www.healthsystem.virginia.edu/alive/elearning/documents/principlesdelegation.pdf

Barrow JM, Sharma S. (2020). Five Rights of Nursing Delegation. https://www.ncbi.nlm.nih.gov/books/NBK519519/

Helen and Douglas House. (2014) Clinical Supervision Toolkit. https://www.helenanddouglas.org.uk/wp-content/uploads/2018/01/hdh-clinical-supervision-toolkit.pdf

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References

Marume,SBM, Ndadzo, Chikasha. (2016). The essence of the principle of delegation of authority. Quest Journals: Journal of Research in Humanities and Social Science. https://www.questjournals.org/jrhss/papers/vol4-issue6/C461014.pdf

NCSBN-ANA. (2019). National Guidelines for Nursing Delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf

Nursing and Midwifery Board of Ahpra (MNBA)(2021). Supervision Guidelines for Nursing and Midwifery. https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD15%2F17457&dbid=AP&chksum=1f77r9nOSi75OufMD%2BVkHw%3D%3D

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