Delegation: A Collaborative, Patient-Centered Approach

Submitter Information

Author: Susan Herman, RN, BSN, MSN
Title: Professor, Nursing
Institution: Chaffey College
Email: susan.herman@chaffey.edu
Coauthors: Juli McGinnis, RN, MSN Project Manager, Patient Care Services, Kaiser Permanente, Regional Offices SCAL

Competency Category(s)
Patient-Centered Care, Teamwork and Collaboration

Learner Level(s)
New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN

Learner Setting(s)
Classroom, Clinical Setting

Strategy Type
Case Studies

Learning Objectives

Teamwork and Collaboration:
K = Describe own strengths, limitations, and values in functioning as a member of a team
K = Describe scopes of practice and roles of health care team members
K= Describe strategies for identifying and managing overlaps in team member roles and accountabilities
K = Recognize contributions of other individuals and groups in helping patient/family achieve health goals
K = Discuss effective strategies for communicating and resolving conflict
K = Identify system barriers and facilitators of effective team functioning
S = Function competently within own scope of practice as a member of the health care team
S = Assume role of team member or leader based on the situation
S = Initiate requests for help when appropriate to situation
S = Integrate the contributions of others who play a role in helping patient/family achieve health goals
S = Communicate with team members, adapting own style of communicating to needs to the team and situation
S = Solicit input from other team members to improve individual, as well as team, performance
S = Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care
A = Acknowledge own potential to contribute to effective team functioning
A = Value the perspectives and expertise of all health team members
A = Respect the unique attributes that members bring to a team, including variations in professional orientations and accountabilities
Patient Centered Care:
K = Integrate understanding of multiple dimensions of patient centered care; coordination and integration of care
K = Examine nursing roles in assuring coordination, integration, and continuity of care
S = communicate patient values, preferences and expressed needs to other members of health care team
S = Communicate care provided and needed at each transition of care
A = Value seeing health care situations “through patients’ eyes”

Strategy Overview

Chaffey College and Kaiser Permanente have established a collaborative partnership with the overarching goal of narrowing the student-nurse preparation-practice gap and promoting quality and safety within healthcare.  Intermediary goals include elevating student nurse competencies and enhancing the clinical learning environment.  In response to the Institute of Medicine’s, 2010 “Future of Nursing” and Carnegie’s, “Educating Nurses: A Call for Radical Transformation” call for action, Chaffey College and Kaiser Permanente have partnered to improve patient care outcomes through nursing education.  This partnership includes the development of clinical learning activities such as the one outlined below.
Nursing students during their last quarter/semester synthesize the art and science of nursing leadership by combining information from  the classroom setting and application and evaluation in the clinical setting.  Leadership content includes delegation and the QSEN competencies regarding Teamwork and Collaboration and Patient-Centered Care are highlighted. Delegation is presented from a systems’ perspective with an emphasis on safety and quality of care. Additional leadership concepts that are accented include relationship-building, rewarding and recognizing others, and appreciative inquiry (Koloroutis, 2004, Kouzes & Posner, 2003, & Cooperrider et al, 2005).
The Clinical Delegation activity integrates leadership classroom teachings with clinical application.  The Clinical Delegation assignment is given to the seniors at the beginning of their Senior Preceptorship and is completed within a two week period.  The student instructions, Clinical Delegation activity template, Clinical Delegation grading rubric and associated KSA documents are available under “submitted materials”.

Submitted Materials

116.ASC-Delegation-instructions-and-tool.doc
116.ASC-Delegation-Rubric.doc
116.QSEN-Pre-Licensure-KSAs-Full-Doc.doc
116.QSEN-Prelicensure-KSAs-Teamwork-and-Collaboration.doc

Additional Materials

Evaluation Description

This Delegation Activity tool was created to enhance the students’ comfort and competency levels with “delegation” and highlights the critical importance of teamwork and collaboration and patient-centered care in delivering safe, quality care.  The various interventions embedded within the tool assist the students with team building, communication enhancement, and clinical prioritization and judgment.  The Delegation Activity evaluation rubric is attached. Clinical instructor, preceptor, UAP, and student satisfaction with this delegation tool is high and the tool has been adapted for use prior to the Senior Preceptorship. Additionally, commentary from the students’ reflections solidified the value of this clinical activity.
 
Comments:
 
“As a leader, it is important to recognize the contributions of others and to reward or praise their efforts.”
“When I interviewed a couple of UAPs, I learned that they don’t feel appreciated for what they do by most staff.  They say a simple ‘thank you’ or ‘great job’ is all they need to hear.”
“I was surprised on how this assignment went well.  UAPs were very receptive to my delegation and they also provided me with valuable tools and information to apply in the future.”