Delegation in Nursing - Assignment Example

Delegation in Nursing Name: Course: Tutor: Date: Delegation in Nursing Introduction Effective health care requires proper delegation of duties, the ability to guide and good leadership skills (Ellis & Hartley 2009, p. 1). Nursing and other health care departments require team work and this cannot be achieved if delegation is poor. Gardner (1990, p.25) states that leading involves envisioning goals in partnership with colleagues. This further clarifies that a leader must be trustworthy, a decision maker, competent, self-assured and able to prioritise. This way, patients will be in the best hands and they will have their needs addressed appropriately. This case study seeks to delve deeper into the role of delegation in nursing assignment in regard to a clinical scenario. Delegation Reasons for delegation Delegation is the allocation of duties by a registered practitioner to a support worker who is competent enough to perform that particular duty (Pigram et al. 2006, p. 57). Delegation requires the support worker to be responsible of the duties allocated to him or her while the registered practitioner remains accountable. Delegation is done with the patient in mind and is supposed to in all cases cater for the patient’s best interests. Support staff must be capable of accomplishing the task assigned to them and registered practitioners must refrain from delegating duties to those lacking in experience and skill. Supervision follows the delegation act to ensure that the duties assigned are performed satisfactorily (Cherry & Jacob 2005, p. 34). According to Buthe (2006, p. 4), the basic reason as to why delegation is vital in nursing is to enhance efficiency. Leaders are bombarded with work and the best way to ease the workload is to delegate duties to their subordinates. Specialisation is an after effect of delegation as certain duties are delegated to the most able members of staff. Another reason for delegation is to exploit the expertise in the members of staff. Other parties will in the process become experts since they will become used to performing certain duties repeatedly. Health care institutions are busy centres and delegation of duties gives the registered nurse more energy to attend to other calls of duty. As a nurse, one is required to be constantly on his or her feet and this may cause fatigue, which calls for delegation to ease the workload. Being overburdened at work kills productivity and morale and delegation of duties ensures that everybody is working towards a common goal. This brings about a positive attitude towards work since the workload is manageable. Delegating duties to others gives the one in power a sense of control and this allows for more work to be done. At the same time, people have time to do what is in their jurisdiction since the rest is taken care of by the others. In the long run, time is saved as people perform the duties they are supposed to, and as this becomes routine work is made easier (Cherry & Jacob 2005). Baker (2010) notes delegation of duties provides training for the staff and this makes them confident and experienced enough to handle their duties. They are also prepared for emergencies. Delegation of duties also shows how well one is capable of handling a certain task and this may also count when it comes to appraisals. Being given an opportunity to shine is a sure way of propagating a healthy working relationship with subordinate staff. The role of delegating responsibilities in clinical nursing leadership has led to major restructuring in health institutions and the repercussions have been a decrease in the number of registered nurses. On the contrary, the number of unlicensed health care workers has increased with escalating demand to cut down on running costs. Delegation and supervision of unlicensed health care workers The Australian Nursing & Midwifery Council (2004, p.1) states clearly the relationship between delegation and supervision. According to Queensland Nursing Council (2005, p. 5), once the RN delegates duties to the unlicensed health care worker (UHCW), they must be available to supervise the task. Supervision embodies the coordination of the activities in question, the elements of direction, oversight and guidance. Supervision can either be direct or indirect and it must comply with the laid down policies as laid down by the National Competency Standards. Direct supervision refers to the act of the nurse and the UHCW working together as the nurse issues directives and observes the performance off the UHCW. In indirect supervision, the nurse is absent but is easily contactable in case need arises. The delegation and supervision of unlicensed health care workers is a task that the nurses undertake and it is safe for them to have the guidelines necessary for the process (Queensland Nursing Council, 2005, p. 5). For a harmonious working relationship with the UHCW, the nurses must ensure that they delegate duties to those that have the desired skills and knowledge. Dealing with the lives of people is a delicate task and utmost care must be taken to ensure the safety of the patient. Effective delegation and supervision must be based on the stipulated policies and the communication lines must be open. The role of each professional must be clearly described to ensure that each staff performs according to expectations. For instance, the Nursing Act of 1992 states clearly what roles may not be delegated to UHCW. These include carrying out comprehensive assessment on clients and interpreting assessment data. Other restrictions are the establishment of a care plan for a client, evaluating clients’ responses as well as assigning nursing duties to the UHCWs (p.5). The registered nurse must at all times supervise the UHCW and ensure that they are only assigned tasks that match their competence, lawful authority, experience and education. An RN must accept responsibility for duties they allocate to UHCWs and this gives this work the title ‘delegated nursing’. The delegation must meet the stipulated rules and regulations as listed by the Nursing Act of 1992 (Queensland Nursing Council, 2005, p.7). Accountability is essential in the health care sector and the UHCW are accountable for the duties delegated to them. They are answerable to the nurse that delegates these tasks to them and that is why they have to perform them responsibly. In regard to the scenario aforementioned, the UHCW did not deliver as instructed by the registered nurse (RN) to assess the patient’s vital signs and note them down (Australian Nursing & Midwifery Council 2004, p.1). The Queensland Nursing Council (2005, p.10) clearly outlines the roles of a UHCW and the RN. It further details that UHCW are not supposed to perform nursing tasks due to the primary fact that they are not registered. However, UHCW may perform non-complex nursing care as instructed by the RNs who must ensure that the duties they assign match the UHCW’s experience. However, the nursing council has not passed any regulations on the UHCWs scope of practice (p.10, 25). The Queensland Nursing Council (2005, p.26) has a set of principles that must be applied when RNs are delegating duties to the UHCWs. These principles state that the RNs have a right to delegate roles to the UHCWs after assessing the client’s needs. Delegation should also be done if it is geared at benefiting the client and if it is lawful. Delegation will only be done if according to the context in question it is appropriate. The principles of delegation further state that delegations will only be done if it is not contrary to the service provider’s policies. Delegation will also be done if planning and consultation has been done in advance. On the flipside, the UHCW who is being assigned the job must agree to take up the responsibility. The UHCWs must also have the appropriate education and they must have been passed as competent to face the task. They must also be accountable and must understand the role that has been designated to them. Once these principles are met, the RNs can feel free to delegate the duties in question to the UHCWs. In this scenario however, the UHCW failed to deliver and this reflects negatively on the RN since there is a clear breakdown of communication coupled with negligence of duty. The surgeon on duty has the right to reprimand the RN since he is directly answerable to him according to the chain of command. He was not aware that the UHCW had been assigned the task of noting down the patient’s vital signs (Queensland Nursing Council, 2005, p.26). In this case, delegation and supervision have failed miserably and this puts the RN on the spot. Effective clinical supervision is addressed by the Board of Registered Nursing (2004, p. 2) and it states clearly that the RN has the responsibility of assessing the nursing situation and determining if the UHCW is competent enough to undertake it. Characteristics of effective delegation In their book, ‘Professional Nursing Concepts: Competencies for Quality Leadership’, Finkelman and Kenner (2004, p. 354) address the characteristics of effective delegation. They applaud the delegation of tasks to UHCW that will help them grow and at the same time learn and therefore develop their career. They discourage menial tasks that may in turn kill UHCW’s morale and lead to low productivity. They further argue that for effective delegation, the RN must at all times seek to understand the UHCW abilities. This will dictate their competence on the assigned task. It is also important to weigh UHCW’s total workload to ensure that they are not overworked. Understanding the UHCW job status is also a vital step towards achieving effective delegation. Cost is a defining factor when it comes to effective delegation and Finkelman and Kenner (2004, p.354) elaborate that delegating tasks makes financial sense to institutions since they may get “less expensive” subordinates willing to do the job. Effective delegation is also successful when tasks are assigned to skilled personnel. This way, the leader will rest assured that the piece of work is in the hands of an expert. Another characteristic of effective delegation is supervision, whereby a professional monitors the progress being made by the professional who has been assigned the task. Effective delegation is governed by a set of laws and rules that support it. Absence of these laws and rules clearly shows that no delegation procedures should be initiated to curb overstepping or delegating unrealistic tasks to incompetent staff. The task in question must always be within the RN’s scope and if its not, it should not be delegated. Effective delegation demands that the clients’ needs be assessed first before any delegation is done. The RN must take it upon himself to assess the patient’s needs before delegating the task to an UHCW. The RN must be competent enough to be able to make a decision involving delegation. If not, it will be unprofessional to ask someone else to perform the task in question. (Finkelman & Kenner 2004, p. 355). In the given scenario, effective delegation is clearly absent since the UHCW is unable to accomplish the task assigned to him by the RN. There are many questions that such as whether the UHCW understood the assignment and if he was competent enough to undertake the task. On the other hand, one cannot fail to question if the RN took time to understand the role of the UHCW and if he had assessed the patients first before delegating such a delicate task to the UHCW. Another question regards the UHCW’s qualifications and his suitability to perform the assigned task. Possible conclusions are that maybe the UHCW was overburdened by work bearing in mind that they both had six patients to take care of in a busy surgical ward. The failure of this delegation is summarised in the five rights of delegation which advocate for right task, right supervision, right circumstances, right communication and delegation of duty to the right person (Finkelman & Kenner 2004, p. 353). Unlicensed health care workers (UHCW) Role delineation An unlicensed health care worker (UHCW) as defined by the Society of Gastroenterology Nurses and Associates, Inc. (2010, p.1) is an individual who is not licensed to carry out the nursing duties but is rather trained to give assistance to the nurses. The UHCW performs duties as assigned by the RN whom they have been assigned to. These people are mostly specialists in various ways to handle patients and therefore give the desired care to patients under the supervision of a RN. According to the Board of Registered Nursing (2004, p.2), UHCWs include patient care technicians, home health aides and certified nursing assistants. The Nursing Practice Act in Section 2727 (a) states that the UHCW may perform nursing care to patients with or without the consent of licensed nurses. The role of the UHCW includes taking down a patient’s vital signs, bathing the patients, feeding the patient, ensuring that the patients are in a safe environment, checking the weight of patients, ambulating and offering assistance in elimination. It is important to note that their role is not limited to the aforementioned. Basically, the role of the UHCW lies within providing hygiene and basic health activities on the patients and their surrounding environment. The RNs are on the hand restricted to technical and scientific tasks such as parenteral medications, complex procedures, sterile techniques, evaluation of a patient’s condition, patient education, handling invasive lines, patient assessment and patient triaging among other nursing processes. The RNs have the authority to delegate tasks to the UHCW if they revolve around routine care given to patients. Other tasks that RNs may assign to the UHCW include those that do not put the patient’s safety at risk. Tasks with a predictable outcome may also be assigned as well as those that do not require modification. Tasks that do not require decision making, ongoing assessments or interpretations may also be assigned to the UHCW accordingly. Some of these tasks include changing simple dressings and gastronomy feedings and drawing blood among others. It is important to note that an UHCW is not supposed to reassign his duties to another under whatever circumstances. The task of reassigning is left to the RN who understands the UHCW under him in terms of their ability to perform some tasks. (Board of Registered Nursing 2004, p. 2-3). In relation to the given clinical scenario, it is clear that assessing the vital signs of a patient is among the role of the Unlicensed Health Care Workers. For the UHCW not to perform the task that was allocated to him by the RN amounts to absconding duty. The breakdown in communication is also evident in that the RN was not aware that the UHCW had decided not to perform the task of assessing the patient’s vital signs for reasons best known to him. Going back on the role of the UHCW as stated above, the person must perform the task assigned to them and they may not reassign the duties assigned to them by the RN. This puts the patient’s life in danger since there could be life threatening signs that have not been documented. Conclusion It is quite evident that support workers in the form of unlicensed health care workers have taken over the health sector courtesy of delegation. It is therefore of essence to ensure that they are properly trained to be able to undertake the task of working with the nurses to provide nursing care to patients. Quality has to be maintained in the face of cutting down on running costs and this is more reason why the UHCW must be competent enough to take care of patients. The registered nurses in return have to delegate duties to the UHCW confidently bearing in mind their abilities to avoid such a scenario as the one addressed by this case study. References Baker, C. 2009, Five reasons to delegate and one reason not to, Emergency Consulting, Seattle, WA. Board of Registered Nursing. 2004, Unlicensed Assistive Personnel Defined, Department of Consumer Affairs, NPR-B-16 11/94. Buthe, T. 2006, Institutional persistence and change in international delegation, Department of Political Science, Duke University. Cherry, B. & Jacob, S. R. 2005, Contemporary nursing: issues, trends, & management (3rd edition), New York: Elsevier Health Sciences. Finkelman, A., & Kenner, C. 2010, Professional Nursing Concepts: Competencies for Quality Leadership, Jones and Bartletts Publishers, New York. Gardner, J. 1990, Tasks of leading, managing, and following, Gardner’s tasks of Leadership, On Leadership. Chapter 1, p. 15. Pigram, J., Simpson, R., Hopkins, S., Brown, J., Caulfield, H., Smith, C., Giles, S., Nancarrow, S. 2006, Supervision, accountability, and delegation of activities to support workers. A guide for registered practitioners and support workers, CSP, RCSLT, BDA and RCN Institutions. Queensland Nursing Council 2005. Framework for nurses and midwives. Scope of practice. Setting the standards, Australia. Read More