Delegation and How It Applies to the New Registered Nurse - Term Paper Example

Let whoever is in charge keep this simple question in her head (not, how can I always do the right thing myself, but) how can I provide for this right thing always to be done?” - Florence Nightingale Introduction: Delegation is a process of entrusting work to someone or the assignment of responsibility (Hansten and Washburn, 1999). It is a legal and management oriented concept, there are those that define it as being an art and a skill, a decision-making process; as a process delegation can never be absolute; the one delegating a task maintains ultimate answerability for the delegation and the decision-making process, and for the results of the task being delegated (Hansten et al., 1999). Efficient nursing delegation in a clinical setting is important for the proper management and implementation of the patient care process. In fact its importance cannot be stressed enough because it is the efficiency of the nursing delegation process that decides ultimately, the level of comfort that is provided to the patient and ensures faster recovery for all intents and purposes.   The registered nurse (RN) is accountable for to the public for providing culturally, competent, safe, and effective nursing care for patients in a variety of settings across the continuum of health care (Anthony et. al., 2001). These may include hospitals, long-term care facilities, nursing homes, and community and public health centers among many others. These are the clinical settings within which the RN needs to operate. It is the RN that is responsible for the supervising those to whom they have delegated certain tasks. The RN has significant responsibility as a supervisor of delegated or assigned activities. Each person involved in this process is accountable for his or her own actions or inaction and is potentially liable if competent and safe care is not provided. Certainly, the educational preparation and demonstrated ability of the person who will perform the designated act must be evaluated by the RN making the decision to delegate tasks to others. Inappropriate delegation may be specifically stated as grounds for disciplinary action by your Board of Nursing. Legal Facts: The regulating authority for the delegation function of a registered nurse in Queensland is balanced on the guidelines that are provided by Australian Nursing and Mid-Wifery Council (ANMC). To be more specific the guidelines laid out in the Queensland Council Guidelines to nursing, 1999 are the basis of the authority that the RN wields regarding delegation (QLD Nursing guidelines, 1999). The registered nurse must determine the level of skill and knowledge required to ensure the safety, comfort, and the security of the client prior to delegating care. This determination must be based on an accurate health assessment of the person including consideration of the complexity of the care required rather than the tasks to be performed (ANMC Code). The delegation of nursing care occurs between registered nurses, and registered nurses to enrolled nurses. The registered nurse may also delegate aspects of care, within a healthcare setting, to other healthcare workers. The employer must ensure that there are clear role descriptions for other healthcare workers, supervision/ delegation policies and communication systems to support the registered nurse in this role. It is the registered nurse’s responsibility to provide direct or indirect supervision according to the nature of the delegated tasks. Contingent upon the registered nurse's evaluation of each patient's condition, and also upon the registered nurse's evaluation of the competency of each unlicensed nursing personnel, registered nurses may delegate non-complex tasks to unlicensed nursing personnel. Underlying Principles: The principles underlying the process of delegation emanate from the fact that the nursing profession is supposed to determine the scope of the nursing practice; it is supposed to define and supervise education, training and utilization of resources available for assistant roles involved in the process of providing direct patient care (Carol, 2007). By this principle then the RN is supposed to take responsibility and accountability of the process of nursing care and its supposed to direct care and determine the appropriate utilization of any assistant involved in providing direct patient care. The process of delegation requires an application of what is known as the critical thinking. The process is the ability to solve problems by making sense of information using creative, intuitive, logical, and analytical mental processes…and the process is continual (Zerwekh and Claborn, 2006). A series of decisions made by the nurse, in interaction with the client regarding 1. The type of observations made in the clinical situation; 2. The evaluation of the data observed and the derivation of meaning (diagnosis) 3. Nursing actions that can be taken with or on behalf of the client.” The process of delegation requires and understanding of the process of critical thought and problem solving strategies that help get the preferred outcomes. This would mean logical, analytical, creative and intuitive thinking that helps bring out emotional intelligence. This would mean that the RN while delegating work functions, needs to be clear in his/her mind about the four Ps- purpose, picture, plan, and part, for each shift and each case, given the fact that each one is different would benefit most from different styles of nursing care. It is imperative that all members of the team share the same plan. Reports, checkpoints, timelines should be used to continually evaluate progress through the shift/case (Maine School Health Advisory Committee, 2002). All of this brings out into focus the leadership qualities of the RN. Delegation also requires effective and personalized communication and conflict resolution techniques. Finally, the RN and the process of delegation should be capable of providing appropriate feedback. Role of registered nurse: There are certain principles that should guide the process of delegation by the RN in a clinical setting (Stauton and Chiarella, 2003). First, all decisions that are to do with delegation of nursing tasks must be based on the fundamental principle of protection of the health, safety, and welfare of the public. Second, the Boards of Nursing are responsible for the regulation of nursing. Provision of any care, which constitutes nursing, or any activity represented as nursing is a regulatory responsibility of Boards of Nursing (Anthony, Standing, and Hertz, 2000). The process needs to follow the clear instructions that are laid out by the board with respect to the process of nursing in the clinical setting; a licensed nurse must be actively involved in and be accountable for all managerial decisions, policy making and practices related to the delegation of nursing care. However, it must be remembered that unlicensed assistive personnel are equipped to assist--not replace--the nurse. What this means is that delegation of authority needs to be focused on an ability-delegation variable. The idea is not to make the assistant nurse do the RN’s job, just help with the performance of duties. Nursing is a knowledge-based process discipline and cannot be reduced solely to a list of tasks (Badovinac, Wilson and Woodhouse, 1999). The licensed nurse's specialized education, professional judgment and discretion are essential for quality nursing care. These need to be brought in to focus during the delegation of nursing tasks. While nursing tasks may be delegated, the RN’s generalist knowledge of patient care indicates that the practice-pervasive functions of assessment, evaluation and nursing judgment must not be delegated. A task that has been delegated to an unlicensed assistive person, cannot be redelegated by the unlicensed assistive person to someone else. Consumers have a right to health care that meets legal standards of care. Thus, when a nursing task is delegated, the task must be performed in accord with established standards of practice, policies and procedures. Finally, the RN 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. The five variables to be considered while delegation of responsibility by RN: The Right Task: One that is delegable for a specific patient, it needs to be based on desired outcome, within the scope of practice and according to the job description of the one to whom the task is being delegated. The basic consideration under this principles being the task that is correct to perform for each specific patient needs to be based on outcomes planned in partnership with the patient. Right Circumstances: This needs to be in line with the appropriate patient setting, available resources, and other relevant factors under consideration. This is based on setting, patient situation, degree of supervision and predictability of results Right Person: Right person is delegating the right task to the right person to be performed on the right person. The factors under consideration are certification/licensure, job description, skill checklist, demonstrated skill Right Direction/Communication: Clear, concise description of the task, including its objective, limits and expectations; The Four Cs of Initial Direction i.e. ‘Clear- Concise- Correct- Complete’ need to be answered (Marx and Miceli, 2008). Right Supervision: This includes appropriate monitoring, evaluation, intervention, as needed, and feedback. This means that Giving and receiving feedback, while supporting each team member’s accountability, can improve performance by up to 60% if goals are also clear. It is the duty of the RN to negotiate and assess the situation, identify the needs of the patient, consider circumstances and settings and assure the availability of appropriate resources (McEwan, 2001)). For this purpose, the RN must plan for the specific tasks that need to be delegated. The nature of each task and the knowledge and skills required pertaining to it must be specified, documentation and demonstration of competence by the delegetee must be ensured. This also means that the RN needs to accept accountability for the performance of specific tasks. Finally, the evaluation and supervision functions should be flawless. For this purpose, the RN should provide direction, monitor performance on each task, intervene as and when necessary and again ensure documentation. The evaluation function requires that the RN evaluates patient condition, evaluates the performance of tasks and can obtain and provide feedback. Accountability and Delegation: Accountability is the state of being responsible or answerable (NCPP Paper, 1995). Nurses, as members of a knowledge-based health profession and as licensed health care professionals, must answer to patients, nursing employers, the board of nursing, and the civil and criminal court system when the quality of patient care provided is compromised or when allegations of unprofessional, unethical, illegal, unacceptable, or inappropriate nursing conduct, actions or responses arise. Strictly, in the context of delegation as a process, the RN needs to accept responsibility and be accountable for the performance of delegated tasks. S/he also needs to ensure that the delegate accepts the delegation and accountability for carrying out the task correctly. Patient Allocation and delegation: Delegation is usually task oriented. Nurses are given specific responsibilities like fluid and fluid balance charts for the whole ward, patient baths, dressing, recording etc (Lawton, Centrell and Harris, 2000). Patient allocation on the other hand is a method of organizing nursing care in which a nurse is allocated to care holistically for all the needs of a patient on a daily basis. Delegation is a more encompassing term that includes within itself all processes of ward management functions and task allocations including those of patient allocation. It can also be read as the old system of task allocation that was meant to fragment task between the available work force so each one was responsible for a specific responsibity. However, ideally, delegation would include all the work that is divided by the RN, while patient allocation is the specific function wherein a nurse is given charge of a single patient or a group, geographically or randomly. Professional Competence and delegation: Nursing Delegation in a clinical setting needs to be driven by high levels of professional competency by the one doing the delegation because there are major implications of his/her action (Cherry and Jacob, 2005). The RN that is delegating responsibility has the duty of knowing the background, skill levels, training received and job requirements of each person to whom a particular task is delegated. The job description involves using important information about what a staff member is allowed to do and delineates the specific tasks, duties and responsibilities required of the person as a condition of employment. Job descriptions generally comply with the state laws and health care organizational standards. The RN needs to be aware of the type of training and education the person received in order to effectively delegate a task. The RN also needs to be aware of the kind of orientation provided to new employees and be a part of the orientation process itself. What this means is that the professional competencies that the RN needs to display go beyond the realm of the purely medical. There are huge man management implications for the professional delegation proficiencies that need to be displayed while the delegation of tasks and allocations. A typical RN’s functions would include, 1. Assessment of patient condition 2. Assessment of capabilities of nursing staff 3. Understanding of task complexities of the task that is to be delegated 4. Evaluation of the task overload and an ability to get the best out of the available human resources 5. Finally, the job requires a certain amount of clinical oversight and supervision that the RN needs to provide Management of Interpersonal relationships: It is the purpose of delegation to manage different individuals from different backgrounds, in sensitive settings. The healthcare workforce is made up of individuals representing numerous cultures that vary in beliefs and in values (Lipe and Beasely, 2003). The most effective tool to manage interpersonal relationships within a team that works in a highly stressful environment would be to communicate better. Verbal exchanges should involve collaboration. Communication should be the basis of team building, this can bets be achieved in an environment of openness and honesty (Bambling, 2003). Task delegation should be strictly, on the principles of delegation, there should be no favoritism and focus on personal grudges needs to avoided completely. The RN should ensure that the team embraces the diversity and creativity of its members, recognizing that each one has strengths and weaknesses. A well functioning team uses this individuality to its advantage. The one delegating responsibility should be honest and humble; there should no talking down to the ones that are new or inexperienced. Finally, the concept of accountability needs to find application, each one needs to be able to take up responsibility not just for his actions but those of the team within which the function of delegation is being applied. In conclusion, therefore it may be reiterated that the delegation function plays an important role in the smooth functioning of the medical and clinical process. The concepts of accountability and open communication are at the center of the delegation concept of work management. There are set principles like using the right people for the right job that make the process work more effectively in some settings than it does in others. Finally, in order for the delegation principles to exhibit their full merit it is essential that the RN takes responsibility for the conduct of the team and carries the weight of the immense professional needs that related tasks have with a lot of dedication and sincerity. 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