sally sutherland-fraser - health education & learning partnerships - delegation and supervision...
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Sally Sutherland-Fraser delivered the presentation at the 2014 Operating Theatre Management Conference. Focusing on strategies for implementing the National Safety and Quality Health Service Standards and the importance of communication to improve patient safety and clinical practice, the 2014 Operating Theatre Management Conference brought together operating room management and perioperative professionals to review current initiatives across the country. For more information about the event, please visit: http://bit.ly/optheatremgmt14TRANSCRIPT
[email protected] 0438408267 [email protected] 0417480662
Delegation and supervision:
Implications for managers Sally Sutherland-Fraser
Operating Theatre Management Conference Sydney August 28-29th 2014
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Graduation Group PEPEN Pilot, 2003
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Decision Making Tool
for the delegation of
the novice EEN to the
instrument nurse role
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The full spectrum of roles, functions, responsibilities, activities
and decision-making capacity which individuals within a
profession are educated, competent and authorised to perform
Scope of Practice
Cannot be defined as a simple list of tasks or procedures
Some functions within the scope of practice of any profession
may be shared with other professions / individuals / groups
Activities delegated to another person by a registered nurse or midwife
cannot be delegated by that person to any other individual, unless they
have since obtained the autonomous authority to perform the activity
Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved.
The full spectrum of roles, functions, responsibilities, activities
and decision-making capacity which individuals within a
profession are educated, competent and authorised to perform
Cannot be defined as a simple list of tasks or procedures
Some functions within the scope of practice of any profession
may be shared with other professions / individuals / groups
Activities delegated to another person by a registered nurse or midwife
cannot be delegated by that person to any other individual, unless they
have since obtained the autonomous authority to perform the activity
Scope of Practice p.19 ANMC, 2007 (NMBA, 2010),
A national framework for the development of decision-making tools for nursing and midwifery practice
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Session Content
1. Show you why you need to be good at this
2. Examine our regulatory framework
3. Review definitions
4. Explore legal case reports
5. Identify resources to support front-line managers
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Why do we need to delegate care?
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Delegate because…
Demanding clinical environment
Separation of the team
Match skills to patient needs
Develop your staff
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Why should we supervise delegated care?
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Supervise delegated care because…
Diverse teams – roles and designations
Different scopes of practice and mixed skill levels
Ensure delegations remain lawful
Monitor performance and patient outcomes
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What level of supervision…
I guess you’d
call this Direct”
Supervision…
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Additional burden of management role
Not only managing
diverse teams…
Also managing
individuals who may have
a poor grasp of
Scopes of practice
Delegation & supervision
Decision-making tools
Accountability
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Garling Report 2008
13.19 A complaint was referred to …the HCCC
[which] found that the intern had failed to assess
the severity of the patient’s renal and cardiac failure
and therefore did not undertake appropriate
investigations.
13.20 …The HCCC’s expert reviewer said that as an intern, the doctor
would not be expected to make a sufficient assessment of the
patient or a management plan without direct senior involvement…
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Garling Report 2008
13.102 Another common complaint …which
impacts on the supervision of junior nurses,
was that the ‘skill mix’ in nursing has become
too junior…
with inadequate support for junior nurses,
either in terms of education or supervision by more
experienced nurses.
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Garling Report 2008
19.35 Why clinical staff do not respond to
deteriorating patients:
• unclear as to the criteria;
• overdependence on automatic monitoring;
• lack of clarity in respect of their role and responsibilities;
• lack of adequate/clear documentation;
• inadequacies in handover practices; and
• issues arising from the organisation of the staff of a ward;
• inadequate staffing levels;
• doctors who would not accept the subjective judgments advanced by
more junior medical officers or nursing staff.
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Health plans for 2015 = More workers to supervise?
• Increase in midwifery staffing, aligned to Birthrate Plus
• 2475 more nursing staff
• Increased capacity for EN and AIN training
• Commonwealth funding, RTOs and NSW Health to support
delivery of training places
• 60 Re-entry to Nursing Scholarships targeting
individuals who don’t meet the NMBA recency of
practice standard
• Expand the access to the Hospital Skills Program to a
broader range of health workforce professionals
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1. Regulatory framework
Statutory body established in July 2010 under the Health
Practitioner Regulation National Law (NSW)
Manages notifications (complaints) about the conduct,
performance or health of nursing and midwifery
practitioners and students
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What roles exist within this framework?
From A to Z:
Assistant in Nursing
Enrolled Nurse
Midwife
Midwife Practitioner
Nurse Practitioner
Registered Nurse
Student Midwife
Student Nurse
Midwife Practitioner
Midwife
Student Midwife
Nurse Practitioner
Registered Nurse
Enrolled Nurse
Student Nurse
Assistant in Nursing
Who is regulated under this system?
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What roles exist within this framework?
From A to Z:
Assistant in Nursing
Enrolled Nurse
Midwife
Midwife Practitioner
Nurse Practitioner
Registered Nurse
Student Midwife
Student Nurse
Midwife Practitioner
Midwife
Student Midwife
Nurse Practitioner
Registered Nurse
Enrolled Nurse
Student Nurse
Who is regulated under this system?
Un licensed health care worker
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Non nurse, non midwife, support worker
• May have care-worker qualification or no formal education
• Not professionally regulated, so not bound by standards set by
licensing authority
• Support workers are individually accountable for their own actions and
accountable to the registered nurse or midwife and their employer for
delegated actions.
• Routine client-specific activities requiring a narrow range of skill and
knowledge may be delegated to support workers.
• An activity is routine if the need for the activity, the consumer’s
response and the outcome of the activity have been established over
time, and are therefore predictable.
ANMC, 2007 (NMBA, 2010), A national framework for the development of decision-making tools for nursing and midwifery practice
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How do we identify these roles?
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“Finally, in this chapter I wish to make
recommendations about the wearing of
uniforms and name badges by health professionals.”
Commissioner Peter Garling SC, 2008
How do we identify these roles?
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How do we identify these roles?
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Before site incision - Confirm all team members have
introduced themselves by name …and role
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NMBA Decision-making framework
• Supports nurses and midwives in
dynamic environments to make informed
decisions about the provision of safe and
high quality care
• Enables and facilitates the evolution of
new practice roles
• Provides a consistent approach to
informed decision-making
• Improves critical thinking of staff,
enhances understanding of accountability
and empowers staff
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http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx
NMBA Decision-making framework
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NMBA Decision-making framework
Need • Is there a need for the care activity?
Practice
• Is it within scope of practice and accepted professional standards?
Approval
• Is it supported / approved by the organisation?
Skill
• Is there a competent person available to perform the care activity?
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How does this play out in your unit?
1. Allocation of roles at the start of the shift
Who delegates care activities and what guides those
decisions?
2. Relieving roles during the shift
Does this change the balance / authority?
3. Requests by medical officers
What would your nurses do if the surgeon asked them to
close the wound?
Delegation
• Transferring authority to a
competent person
• Can only be made by a person
who themselves is competent
to perform the activity they are
delegating
Conditions:
• Right person available at right
time to provide right service
• Delegator retains
accountability for the
decision to delegate and for
monitoring outcomes.
Allocation / Task
Assignment
• Asking another person to care
for one or more clients
• Activities are normally within
that person’s responsibility
and scope of practice.
Comparison
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Accountability p.16 ANMC, 2007 (NMBA, 2010), A national framework
for the development of decision-making tools for nursing and midwifery practice
Don’t just sit there - monitor the outcomes
of your delegations!
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Supervision p.19 ANMC, 2007 (NMBA, 2010), A national framework for the
development of decision-making tools for nursing and midwifery practice
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Clinically focussed supervision ANMC, 2007 (NMBA, 2010),
A national framework for the development of decision-making tools for nursing and midwifery practice
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Coroner’s Case
• Re-deployment of EN to surgical ward with postop
patients
• Regulatory requirements not observed
• Geographic isolation from RNs – “Reasonable”?
• Management lines not clear = inadequate supervision
• Poor communication and handover with failure to
detect and escalate care of deteriorating patient
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Manager’s responsibilities
1. HCCC v Bousfield [2014] NSWCATOD 57 (2 June 2014)
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2. HCCC v Piper [2014] NSWCATOD 62 (12 June 2014)
Individual’s responsibilities
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‘Culture’ sometimes provides the means
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Individual’s responsibilities
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Further resources: HPCA Legal News
http://www.hpca.nsw.gov.au
/Legal-Information/Legal-
News/default.aspx
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http://www.heti.nsw.gov.au/nursing-and-midwifery/superguide/
Further resources: HETI NSW Superguide
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Further resources: References & websites
ANMC, 2007 (NMBA, 2010) A national framework for the development of decision-making tools for nursing and midwifery practice
file:///C:/Users/Sally%20SF/Downloads/Nursing-and-Midwifery-Board---Codes-and-Guidelines---National-framework-for-decision-
making---September-2007%20(2).PDF
HETI, 2013, The superguide: A supervision continuum for nurses and midwives http://www.heti.nsw.gov.au/nursing-and-
midwifery/superguide/
State of NSW, 2008, Final Report of the Special Commission of Inquiry: Acute Care in NSW Public Hospitals, Commissioner Peter
Garling, SC http://www.lawlink.nsw.gov.au/Lawlink/Corporate/ll_corporate.nsf/pages/attorney_generals_department_acsinquiry
Health Professional Councils Authority HPCA http://www.hpca.nsw.gov.au/Legal-Information/Legal-News/default.aspx
NSW Nursing & Midwifery Council NMC http://www.hpca.nsw.gov.au/Nursing-and-Midwifery-Council/Home/Home/default.aspx
Nursing & Midwifery Board of Australia NMBA http://www.nursingmidwiferyboard.gov.au/ http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx
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Pieces in a chess set – a helpful analogy?
Know the moves
Work within the rules
Be strategic
Maximise potential
Scopes of practice
Regulatory framework
Workforce redesign
Grow your team
[email protected] 0438408267 [email protected] 0417480662
Thank you –
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PO Box 77 Leichhardt | NSW | 2040