Time Management & Time Management & DelegationDelegation

Natalie Bermudez, RN, BSN, MSNatalie Bermudez, RN, BSN, MS Clinical Educator for Cardiac TelemetryClinical Educator for Cardiac Telemetry

Telemetry Telemetry CourseCourse

OrganizationOrganization

Being organized is the key to Being organized is the key to effective Time Management!effective Time Management!

Steps to Steps to OrganizationOrganization

Prioritization

Delegation(Assignment &

Supervision)

PrioritizationPrioritization

“Prioritization is defined as deciding which needs or problems require immediate

action and which ones could be delayed until a later time because they are not

urgent.”

(LaCharity, Kumagai, & Bartz, 2006, p. 4)

PrioritizationPrioritizationPrioritize the tasks in order of importance

– Is it life threatening or potentially life threatening if the task is not done?

– Would another patient be endangered if I do this now or leave this task for later?

– Is this task or process essential to patient or staff safety– Is this task or process essential to the medical or nursing plan

of care?

How much time will each task require?– Try to leave tasks that are not urgent, but take more time for

last

Tickler List– Check Boxes of tasks– To-Do List

Levels of Levels of PrioritizationPrioritization

First Level– “ABC’s plus V”:

airway, breathing, cardiac/circulation, vital signs

(LaCharity, Kumagai, & Bartz, 2006, p. 5)

Levels of Levels of PrioritizationPrioritization

Second Level – Immediately

subsequent to the 1st level

– Mental status changes, untreated medical issues, acute pain, acute elimination problems, abnormal lab results, and risks

(LaCharity, Kumagai, & Bartz, 2006, p. 5)

Levels of Levels of PrioritizationPrioritization

Third Level – Health problems

other than the first two levels

– Long-term issues in health education, rest, coping, and so on

(LaCharity, Kumagai, & Bartz, 2006, p. 5)

DelegationDelegation“According to the ANA Code of Ethics for Nurses with Interpretive Statement, (ANA

2001) the nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation

of tasks consistent with the nurses’s obligation to provide optimum patient

care.”

(Kelly-Heidenthal & Marthaler, 2005, p. 2)

DelegationDelegation“Delegation is defined as the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the

outcome.”(Kelly-Heidenthal & Marthaler, 2005, p. 6)

a.k.a. “Assignment”

DelegationDelegation“Delegation is needed because of the

advent of cost containment, the shortage of nurses, increases in patient acuity

levels, an elderly chronic population, and advances in healthcare technology.”

(Kelly-Heidenthal & Marthaler, 2005, p. 3)

DelegationDelegation• After creating your prioritized “To Do” list,

decide which tasks can be delegated– This can be a written or mental list

• Charge Nurse, PCA’s, physical therapists, respiratory therapist, etc…

• What are some tasks that can be delegated???

Florence Florence NightingaleNightingale

“But then again to look to all these things yourself does not mean to do them

yourself…But can you insure that it is done when not done by yourself?”

(Nightingale, 1859, p. 17)

The 4 Rights of The 4 Rights of DelegationDelegation

Right Circumstances– Rules & regulations of your area of practice

– Patient condition & preferred patient outcomes

Right Task Assigned to the Right Person– Licensure, certification, & role description– Strengths & weaknesses

Right Direction/Communication– Clear & concise communication

Right Supervision

The 4 Rights of The 4 Rights of DelegationDelegation

Right Supervision– Ask for the team member’s input first– Give credit for all that has been

accomplished– Offer observations and concerns– Ask for the delegate’s ideas on how to

resolve the problem– Agree on a course of action and plan for the

future

Obstacles to DelegationObstacles to Delegation

What should you do when a delegate refuses to complete a task?

UnderdelegationUnderdelegation

New nurses often underdelegate– Fear of older staff resentment– Seek to demonstrate capabilities– Perfectionism or “Control Freaks”

Avoid underdelegation– Overwhelmed & frustration– “Burnout” of assistive staff

OverdelegationOverdelegation

Overdelegation may place patient at risk– Uncomfortable performing unfamiliar duties; dependence– Disorganization– Inclined to avoid responsibility or immerse themselves in trivia

Avoid overdelegation– Leads to asking staff, such as PCAs & LPNs, to perform duties

that are not within their scope of practice– “Burnout” of assistive staff

Obstacles to DelegationObstacles to Delegation

• Fear of being disliked

• Inability to give up control

• Inability to determine what to delegate and to whom

• Past experience with delegation that did not turn out well

• Lack of confidence to move beyond being a novice nurse

Obstacles to DelegationObstacles to Delegation

• Tendency to isolate oneself and choosing to complete tasks all alone

• Lack of confidence in delegating to staff that were previously one’s peers

• Inability to prioritize using Maslow’s Hierarchy of Needs and the Nursing Process

Obstacles to DelegationObstacles to Delegation

• Thinking of oneself as the only one who can complete the task the way it is supposed to be done

• Inability to communicate effectively• Inability to develop working relationships

with other team members• Lack of knowledge of the capabilities of

staff including competency, skill, experience, level of education, job description, and so on.

Obstacles to DelegationObstacles to Delegation

What should you do when a delegate refuses to complete a task?

Organization: More Organization: More Tips Tips

Make a Schedule:

Create deadlines for tasks to be accomplished

Create reasonable deadlines as a guideline to accomplish tasks in a timely manner

Don’t procrastinate

Prevent Fires instead of Fighting Fires all day!!!

Saying “No”Saying “No”“Heavy Patient Assignment”

• Can I refuse a patient assignment?

• What should I do?

Eliminate Unnecessary Eliminate Unnecessary WorkWork

• Duplicate documentation – charting by exception

• Social Talk in Hallways, nurses’ lounge, cafeterias, etc…

• Avoid re-writing report or lab values, etc.

Time AllocationTime Allocation

Time Management Time Management Issues???Issues???

• Keep a Time Log or Time Allocation Diary

• Assists with tracking daily routines and identification of tasks that can be

delegated or eliminated

• Follow each task to completion

Documentation: Documentation: Dealing With Dealing With InterruptionsInterruptions

• Delegate tasks…

• Close door…

• Visitors will need to wait…

• Ask HUC to hold non-urgent calls…

• Document while in patient’s room…

ReferencesReferencesKelly-Heidenthal, P., & Marthaler, M. T. (2005). Delegation of nursing

care. Clifton Park, NY: Thomson Delmar Learning.

LaCharity, L. A., Kumagai, C. K., & Bartz, B. (2006). Prioritization, delegation, and assignment: Practice exercises for medical-surgical nursing. St. Louis, MO: Mosby Elsevier.

Nightingale, F. (1859). Notes on nursing: What it is and what it is not. London, England: Harrison & Sons.