Delegation in Nursing Practice - Term Paper Example

Delegation in nursing Delegation is business or professions refer to the transfer of responsibilities from an ized individual to the subordinate or the personnel who is not otherwise licensed to do that work. In nursing, delegation refers to “the transfer of responsibility for the performance of a selected nursing task from a licensed nurse authorized to perform the task to an individual who does not otherwise have the authority to perform the task”. “The nurse who delegates a nursing task or adopts the responsibility for individuals who are receiving delegated nursing care” is known as delegate nurse. (“4723-13-01 Definitions”, 2007). With time, Health Care assistants are beginning to gain a prominent role in satisfying the demands faced by the General Practice Team and the demand of the changing ways of delivering health care services. Such assistants are gradually taking on the work that was previously done by the Registered nurses only. Most of this delegation comes from these registered nurses. Careful delegation is very important and needs to take care of several issues and questions. It is important to take this delegation job seriously and handle with discretion because improper delegation or delegation to the wrong or inappropriate personnel might pose a threat to life itself. As far as the history of nursing is concerned, delegation in nursing has been observed and practiced during the 1800s when Florence Nightingale has been quoted to have said, “But again, to look at all these things does not mean to do them yourself…But can you ensure it is done when not done by itself (Ulrich, 1992, p.38)” Proper delegation will ensure the reduction in health care costs through the efficient use of nursing time and the resources of the health care canter. Delegation is a common practice even for a nurse who is experiences as well as for those who are fresher. While allocation of the task is done the delegate nurse might face delegatees who may have come from various levels of the nursing program and therefore it depends on the intelligence of the delegate nurse is very much counted upon. The skill of the nurse is required in order to judge and assess the abilities of the delegatee such that the safety of the patient is ensured. A student might be faced with the test questions, which might help in assessing the capacity of the nurse to delegate the task of care. Safeguard of the patients is a priority. In order to ensure that this responsibility is fulfilled, the nurses are accountable to the law for themselves as well as the task deliver the care of that delivered by the Unlicensed Assistive Personnel (UAP). These assistants might encompass personnel from all levels. These include nurse aides, nurse technicians, patient care technicians, personal care attendants, unit assistants, nursing assistants and others. (Kelly-Heidenthal, 2003) Certain efforts towards reducing the costs have been made recently and this had led to the nurses being posted to new roles and assigned with new tasks. In the process the traditional nursing tasks are left and this might be delegated to the UAPs in an effective and efficient manner. Therefore the UAPs might be asked to consider the duties that might otherwise not fall under their responsibilities or within the scope of their education. The opportunities of delegation will not only make life easier for the nurses but also make them able to cover a lot of activities that would otherwise not be possible. Without the delegation skills they would not be in a position to meet the challenge and patients might suffer in wrong hands. Otherwise nurses might feel stressed and exhausted by all the burden of their roles. However, only delegation shills can help them achieve the required objective otherwise. Improper delegation might lead to loss of reputation and legal cases as well because the nurses are responsible for their actions as well as those of their subordinates whom they have assigned with their task. Thus, there can be another standpoint; the use of unlicensed people might increase the responsibility of the nurses instead of reducing or relieving them from the work pressures. Further newer nurses might not be right in their judgments since they lack in experience that the older ones have. Besides the skill of delegation they might even fall short of the correct assessment of the health condition of the patient and evaluate their responses and status. Proper nursing requires a focus on the patients’ responses and not simply on the technical parts of the job of nursing. Hence the nurse also needs to learn the art of studying the patient closely in the context of the time, setting and emotional and physical state. This would be the core of nursing. Unless this is understood the nurse would not be able to properly judge the patient and hence might delegate the wrong person at the wrong hour. The legal issue arises mainly from accountability of the nurses. Accountability necessitates that a nurse is liable legally for all her actions and is answerable for the overall care in the process of nursing her patients. A registered nurse is accountable for all the steps she takes as well as the possible consequences or outcome that might follow from her actions. This includes both the initiative and carrying on the nursing process. The nurse is responsible and hence accountable for proper supervision and monitoring of the changes in the conditions of the patients as well as observing the response towards different treatments. They are also accountable to follow the ethics-legal model of behavior, standards of professional practice and the policies of the health care organizations. According to American Association of Critical-Care Nurses (AACN) in 1995, those tasks in nursing which do not pertain to a direct care of the patients can be delegated in a more liberal manner without much of legal implications or responsibilities for the registered nurses than the direct nursing tasks. UAPs might be assigned with the task of patient hygiene, nutrition and the activities of daily living. Delegation of the role of important functions like assessment, analysis, diagnosis, planning or teaching and evaluating the different stages in the nursing process to the UAPs may not be a wise decision to follow and may be avoided. Ideally the delegation takes place during the implementation of the nursing process. (Barter and Furmidge, 1994) According to the AACN (1990), there are five facts that may be considered for the delegation of patient care: Potential harm or vulnerability of the patient to further deterioration Complexity of the nursing activity The extent of solution to a problem and innovation required. How predictable an outcome is. Extent of interaction (Kelly-Heidenthal, 2003) According to the American Nurses Association (ANA) public registered Professional nurses and unlicensed Assistive Personnel (1996) health care centers are increasingly being misusing UAP, especially when they are asked to perform duties outside their scope of practiced. The logic behind the accountability of nurses is simple. Nurses are expected to respond favorably to the needs of the patients because of their education. Therefore they must also take the responsibility of delegating the task on themselves. A particular case where the necessity to delegate rose and imposed confusion for delegation can be described as follows: The study is about a Registered Nurse (RN) Jane who came into her job in an extended care skilled nursing facility at Heavenly Health Care Nursing Home (HHCNH). The idea was to look after 50 patient sin an apartment and there were four nurses only. The situation demanded heavy duty and it was observed by the director that Jane was taking too much time and also working overtime, thus imposing cost for the organization. Margaret advised Jane to delegate her responsibilities to the UAP who was adept at removing bedpans and providing the patient with shower. This creates the confusion about what tasks could be delegated to the personnel with very basic knowledge of what the tasks is all about. According to the book “Delegation to unlicensed assisted personnel’, the controversy of improper delegation can arise.” According to the paper, “The licensed nurse determines and is accountable for the appropriateness of delegated nursing tasks. Inappropriate delegation by the nurse and/or unauthorized performance of nursing tasks by unlicensed assistive personnel may lead to legal action against the licensed nurse and/or unlicensed assistive personnel” (“Delegation to unlicensed assisted personnel”, 2006). When the UAPs are made to perform functions that are outside the scope or field of their practice, it is a violation of the state nursing practice Act. 1996 and also pose a threat to the safety of the patient. Thus, misuse of UAP is becoming common and the increase in the number of UAP in each health center is becoming a concern to thee acute care setting. The House of Representatives helps in implementing the level of staffing by applying the suitable mix of skills. This Act would ensure that a registered nurse is assigned to each patient. The Act also recommends that these UAPs should be trained in the feasible jobs of bathing the patient, nutrition, and toileting the patient. Also they need to maintain documentation and reports of these activities. The registered nurse might delegate the task to these assistive personnel but they are also responsible for the outcome. According to ANA, only when the registered nurse understands that the UAP is reliable land the ability of the personnel is desirable, then the nurse may delegate this task to the UAP deeming it to be effective and efficient. (Kelly-Heidenthal, 2003) According to the Alabama Board of Nursing, professional nursing tasks include care and counseling, provision of restorative and supportive care to ensure well being. Delegation in nursing can take place in selected areas. This takes place according to education and the competence or efficiency observed in the person. Independent nursing judgment or intervention is not required when the nursing tasks are delegated to assistive personnel who are independent. Certain nursing functions might not be delegated and this includes performance of invasive or sterile procedures and administration of medical procedures. According to the policy undertaken by the state law of Alabama incorporates that school nurses need not delegate the task of administering medication to those personnel who are unlicensed. The state also published the guidelines for delegation of nursing functions to assistive personnel. As far as the local agencies are concerned, the guidelines are not supposed to be regulatory. They would rather offer best practice recommendations. If the local school board permits, the guidelines lead to the students having the right to self-administer the prescribed medicines. (Alabama Board of Nursing, 2007) Delegation in nursing practices is helpful in more than one way both to the nurses as well as to the patient and the system. On one hand it relieves the nurses of daily jobs of feeding and toileting and on the other hand there is now greater scope for these registered nurses to look into serious and more standard issues. This is not a bad concept after all, but is conditioned by the efficiency of the people involved. This would hence bring an added responsibility to the nursing manager who is assigned with the task of looking into the delegation activities. This is important mainly to the fresh graduates and delegation would become perfect on practicing. Even the appropriate mix of personnel in a particular nursing care unit is also defined. The nurse manager sometimes also looks into the choice of personnel mix within a nursing unit. The manager would need a wide range of skills and variety to read. Ethical behavior comes from humanitarianism and realization of the fact that the lives of the patient is totally in the hand of the nurse concerned. Besides the law, some turnaround needs to be brought at individual level and an overall concern and supervision of the patient should always be in the background of all delegation activities. References 1. “4723-13-01 Definitions”, Ohio Laws and Rules (2007), available at: http://codes.ohio.gov/oac/4723-13-01 2. Alabama Board of Nursing (2007), ‘Standards of Nursing Practice’, available at: http://www.alabamaadministrativecode.state.al.us/docs/nurs/MWd6NURS.pdf (accessed on July 3, 2008) 3. Barter, M., & Furmidge, M.L. (1994). Unlicensed assistive personnel. Issues relating to supervision. Journal of Nursing Administration, 24(4), 36-40 4. “Delegation to unlicensed assisted personnel” (2006), Nursing Legal Issues, Medi-Smart Nursing Education Resources, available at: http://medi-smart.com/delegation.htm 5. Kelly-Heidenthal, P. (2003) Nursing Leadership and management, Thomson Delmar Learning 6. Ulrich, B. (1992). Leadership and management according to Florence Nightingale. Norwalk, CT: Appleton & Lange Read More