3.5 Supervision

The licensed nurse has the responsibility to supervise, monitor, and evaluate the nursing team members who have received delegated tasks, activities, or procedures. As previously noted, the act of supervision requires the RN to assess the staff member’s ability, competency, and experience prior to delegating. After the RN has made the decision to delegate, supervision continues in terms of coaching, supporting, assisting, and educating as needed throughout the task to assure appropriate care is provided.

Because the registered nurse is accountable for client care delegated to other team members, communication and supervision should be ongoing processes throughout the shift within the nursing care team. The licensed nurse must ensure quality of care, appropriateness, timeliness, and completeness through direct and indirect supervision. For example, an RN may directly observe assistive personnel reposition a client or assist them to the bathroom to assure both client and staff safety are maintained. An RN may also indirectly evaluate an LPN’s administration of medication by reviewing documentation in the client’s medical record for timeliness and accuracy. Through direct and indirect supervision of delegation, quality client care and compliance with standards of practice and facility policies can be assured.

Supervision also includes providing constructive feedback to the nursing team member. Constructive feedbackis supportive and identifies solutions to areas of weakness. It is provided with positive intentions to address specific issues or concerns as the person learns and grows in their role. Constructive feedback includes several key points:

• Was the task, activity, care, or procedure performed correctly?
• Were the expected outcomes involving delegation for that client achieved?
• Did the team member utilize effective and timely communication?
• What were the challenges of the activity and what aspects went well?
• Were there any problems or specific concerns that occurred and how were they managed?

After these questions have been addressed, the RN creates a plan for future delegation with the nursing team member. This plan typically includes the following:

• Recognizing difficulty of the nursing team member in initiating or completing the delegated activities.
• Observing the client’s responses to actions performed by the nursing team member.
• Following up on any problems, incidents, or concerns that arose in a timely manner.
• Consulting with appropriate nursing administrators per agency policy if the client’s safety was compromised.
• Creating a plan for monitoring outcomes of future delegated tasks, activities, or procedures.