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Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team
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Sally Sutherland-Fraser - Health Education & Learning Partnerships - Delegation and Supervision in the Operating Suite: Implications for the Perioperative Team

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Sally Sutherland-Fraser delivered the presentation at the 2014 Operating Theatre Management Conference. …

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/optheatremgmt14

Published in: Health & Medicine
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  • 1. menna@healtheducationaustralia.com.au 0438408267 sally@healtheducationaustralia.com.au 0417480662 Delegation and supervision: Implications for managers Sally Sutherland-Fraser Operating Theatre Management Conference Sydney August 28-29th 2014
  • 2. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved.
  • 3. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Graduation Group PEPEN Pilot, 2003
  • 4. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Decision Making Tool for the delegation of the novice EEN to the instrument nurse role
  • 5. 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 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
  • 6. 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
  • 7. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 8. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Why do we need to delegate care?
  • 9. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Delegate because… Demanding clinical environment Separation of the team Match skills to patient needs Develop your staff
  • 10. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Why should we supervise delegated care?
  • 11. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 12. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. What level of supervision… I guess you’d call this Direct” Supervision…
  • 13. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 14. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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…
  • 15. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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.
  • 16. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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.
  • 17. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 18. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 19. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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?
  • 20. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 21. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 22. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. How do we identify these roles?
  • 23. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. “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?
  • 24. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. How do we identify these roles?
  • 25. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Before site incision - Confirm all team members have introduced themselves by name …and role
  • 26. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved.
  • 27. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved.
  • 28. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 29. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx NMBA Decision-making framework
  • 30. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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?
  • 31. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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?
  • 32. 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
  • 33. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Accountability p.16 ANMC, 2007 (NMBA, 2010), A national framework for the development of decision-making tools for nursing and midwifery practice
  • 34. Don’t just sit there - monitor the outcomes of your delegations!
  • 35. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Supervision p.19 ANMC, 2007 (NMBA, 2010), A national framework for the development of decision-making tools for nursing and midwifery practice
  • 36. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Clinically focussed supervision ANMC, 2007 (NMBA, 2010), A national framework for the development of decision-making tools for nursing and midwifery practice
  • 37. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 38. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Manager’s responsibilities 1. HCCC v Bousfield [2014] NSWCATOD 57 (2 June 2014)
  • 39. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 2. HCCC v Piper [2014] NSWCATOD 62 (12 June 2014) Individual’s responsibilities
  • 40. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. ‘Culture’ sometimes provides the means
  • 41. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Individual’s responsibilities
  • 42. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. Further resources: HPCA Legal News http://www.hpca.nsw.gov.au/Legal-Information/Legal- News/default.aspx
  • 43. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. http://www.heti.nsw.gov.au/nursing-and-midwifery/superguide/ Further resources: HETI NSW Superguide
  • 44. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 45. Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. 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
  • 46. menna@healtheducationaustralia.com.au 0438408267 sally@healtheducationaustralia.com.au 0417480662 Thank you – ANY QUESTIONS? Copyright © 2014 Health Education & Learning Partnerships. All Rights Reserved. PO Box 77 Leichhardt | NSW | 2040 contact@healtheducationaustralia.com.au

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