The delivery of high-quality, safe, and efficient care is central to nursing practice. The nurse promotes, advocates for, and optimizes the health of all types of people. In the twenty-first century, the number of individuals in need of healthcare is frighteningly increasing. Nursing services are in high demand due to current technology and fresh knowledge that is always being added. Surprisingly, the number of nurses is not keeping up with the expanding demand. In this chaotic situation within the hospital environment, the few remaining nurses are overburdened with work to the point where, as a result of work stress, the supply of quality nursing services has decreased. In addressing this need, nursing assistive personnel have been brought on board to relieve the registered nurse in charge of some of the overwhelming responsibilities that one nurse cannot care for alone.
Through delegation, the senior registered nurse is able to assign responsibility and authority to the assistant to complete a defined task while at the same time retaining the accountability for the outcome ("The art of harmonious delegation", 2014). National Council and State Boards of Nursing (NCSBN) and American Nursing Association (ANA) have thus come up the policies and principles that provide guidance in the delegation process. The purpose of this paper seeks to highlight on the delegation policies and principles as well as providing insight into the barriers to successful delegation.
Delegation Policies
The delegating nurse is responsible for all the care received by the patient. While delegating responsibility to assistive nursing personnel, the registered nurse determines the patient’s needs, draw an action plan, through implementation to the evaluation of the outcome. In this situation, the unlicensed nurse complements the licensed nurse in performing nurse function but cannot substitute the delegator. This ensures that the delegation falls within the nursing practice.
The registered nurse determines the degree of required supervision after evaluation of appropriate factors such as the assistive nursing personnel training and capability and stability of the patient’s condition, the nature of the task and the availability of the registered nurse when the unlicensed nurse is performing the assigned task.
According to American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) joint statement on delegation, the five delegation rights provides a resource in decision facilitation. The rights include the right task (patient-specific delegable); right circumstance (appropriate patients setting); right person (person performing the right task delegated by the right person); Right communication (clear and concise task description); and right evaluation (appropriate supervision and monitoring).
Delegation Principles
Registered nurses often find themselves in a variety of settings in their line of duty. The settings can be in schools, hospitals, public health centers, within the community and nursing homes. While in these settings, their main aim is to maintain the professional nursing practice. Due to the big number of individuals seeking nursing services, the registered nurse must look for some assistance, some of whom may be registered nurses, unlicensed, nursing assistive personnel while some informal caregivers. To effectively assign duties to others requires great critical thinking skills and sound knowledge. It is due to the reorganization of the demand for assistive nurse personnel in the provision of healthcare that the American Nurses Association has provided guiding principles in duty delegation (Barnett, 2013). The critical nursing approach that involves assessment, diagnosis, planning and the implementation is described as five rights.
Assessment
Analyzing the condition of the patient is significant in determining task delegation to nursing assistive personnel. This involves the nature, complexity and the urgency of the patient’s care. By diagnosing the patient’s root course problem, the registered nurse is able to come up with an action plan (long term and short term) depending on the severity of the situation while at the same time factoring in the capability of the nursing assistive personnel to handle the task. This is a principle that is key in leading into the next step in healthcare provision.
Communication
Communication is a key aspect for success in any form of relationship. Direction to the delegate regarding the care of the patient should be concise, clear and complete(Wagner, 2017). The assistive nursing personnel is able to affirm whether he/she has understood the assigned task or in need of more clarification for the success of the delegation outcome.
Surveillance and Evaluation
It is within the scope of the registered nurse to survey and supervise on the delegated task to the assistive nursing personnel. Evaluation through follow-up on the patient’s progress is paramount in timely intervening on the problems and concerns that may arise. The registered nurse is also able to monitor the patient’s condition that may be unexpected as well as coming in for assistant’s difficulties in accomplishing the assigned task.
Barriers to Successful Delegation
Poor patient outcomes in nursing care may be due to an ineffective delegation. To avoid this, the delegation barriers need to be done away with. Examples of these barriers include; poor registered nurse-assistant partnership, poor attitude, lack of trust (the registered nurse need to trust the assistive nursing personnel with the task even as the assistant proving the capability of handling the task) (Perdue, 2013). By eliminating these barriers, the positive patient outcome is guaranteed.
Conclusion
For success in nursing practice to be realized, a delegation of responsibilities is key. Practicing the ANA delegation guiding principle by the RN while eliminating any possible barriers highly reflect on the positive outcome of the patient. The reputation of the nurse in the provision of quality, safe and efficient service is thus maintained.
References
Barnett, B. (2013). Book Review: Essentials of Correctional NursingSchoenlyLorryKnoxCatherine M. (Eds.), Essentials of Correctional NursingNew York: Springer Publishing Company, LLC, 2012, 404 pp., Softcover ISBN-13: 9780826109514. Journal Of Correctional Health Care, 19(2),
Perdue, G. (2013). Book Review: Essentials of Correctional Nursing Schoenly Lorry Knox Catherine M. (Eds.), Essentials of Correctional NursingNew York: Springer Publishing Company, LLC, 2012. 404 pp. ISBN-13: 9780826109514. Journal Of Correctional Health Care, 19(2),
The art of harmonious delegation. (2014). Nursing, 44(5), 6. http://dx.doi.org/10.1097/01.nurse.0000445769.79619.cc
Wagner, E. (2017). Improving Patient Care Outcomes Through Better Delegation-Communication Between Nurses and Assistive Personnel. Journal Of Nursing Care Quality, 1. h
