Delegation in Nursing Care - Article Example

Delegation in Nursing Care Name of Student: University: Subject Code: Course Instructor: Date Assignment is due: Delegation in Nursing Care Introduction This essay explores the role of delegation as part of health care leadership and management strategies that help an institution to achieve effective health care delivery. The aim of the study is to consider the reasons for delegating, delegation and supervision of unlicensed health care worker and the characteristics of effective delegation. Further, the essay will discuss the role and responsibilities of the UHCW in a clinical setup. The entire discussion is hedged around the analysis of the clinical nursing scenario involving a newly graduated registered nurse (RN), an unlicensed health care worker (UHCW) and the surgeon in charge of a busy surgical ward. Delegation a) Reasons for Delegating Ellis and Hartley discuss effective health care leadership and management and conclude that a health care leader’s ability to lead, guide and efficiently delegate the duties in a clinical setup are very essential skills if there will be a productive, effective and efficient health care services delivery in that setup (2009, pp. 42 - 48). One reason why it is important for healthcare leaders to delegate responsibility is to allow junior members adequate time to learn and gains experience in the performance of the relevant tasks in a progressive process of gaining expertise (Marquis, 2006, pp. 47-61). This will apply for the registered but newly graduated nurse in the case scenario. Secondly, delegation frees the leader’s time to execute other more important tasks. According to Huber (2006), a health care manager’s job ‘is to coordinate and integrate resources’ (pp.55), the resources constituting manpower, equipments and finances (pp. 50). The surgeon in the case scenario cannot afford to be checking and recording vital signs for all the patients in the ward at a time when he is supposed to be in the theatre. Delegation will free his or her time to perform other more important tasks that the juniors cannot. It is important that a leader manages his or her time effectively and which cannot be done by doing all the work themselves or being present in every situation. By delegating, a healthcare leader frees a lot of time and exploits the talent and abilities of the nurses in the establishment fully. Thirdly, delegation provides the leaders with a back up in times when they cannot execute certain tasks such as when patients require emergency help in the absence of the surgeon. Delegation helps build a work team that shares the responsibility of the workplace such that, in a healthcare setup such as the ward in the provided scenario, each of the nurses and the surgeon make up a team that compliments each other on the delivery of healthcare services. Finally, delegation provides a criterion of training and induction where the more experienced staff helps to coach the new staff members in particular routines in readiness for their taking over the responsibilities. b) Delegation and Supervision of Unlicensed Health Care Workers UHCW supervision in health care settings is an active process through which senior members of staff direct, guide and influence outcomes of patient care. In contemporary clinical setups, the registered nurse is given the authority to delegate and supervise unregistered health care workers (Shostek 2009, pp. 56–65). Ongoing restructuring, downsizing and optimizing personnel effectiveness in healthcare organizations has seen the introduction of cost-reduction efforts such as having a limited number of registered nurses complimented by unlicensed assistive personnel (UHCW’s) in the provision of patient care (Shostek 2009, pp. 56–65). In such scenarios, the RN is put over the UHCW’s and given the mandate to delegate patient care duties to the UHCW’s as he or she determines appropriate (Shostek 2009, pp. 56–65). The RN is then charged with the responsibility to supervise the UHCW’s in the performance of the delegated tasks since the outcomes of the UHCW care ultimately rests with the RN (Sullivan and Decker 1992, pp. 217 – 226). This is because the registered nurses are deemed to have been trained and certified in nursing care as opposed to the UHCW, in the administration and provision of patient care. In the clinical setup in this case, the registered nurse has been put under the supervision of the UHCW instead of the other way round, which is not ideal. Contemporary literature points out that most RN’s harbour fears in delegating their duties to UHCW’s believing that this exposes them to legal responsibility and liability in case the UHCW fail to perform the delegated duties accordingly. If the UHCW makes an error for instance that jeopardizes the safety of a patient, many RN’s fear that they will be held legally responsible for that error. These fears are however more prone in incidences where the RN is not conversant with the existing provisions for delegation and supervision of patient care within a clinical setup (Shostek 2009, pp. 56–65). RN’s should ideally understand their practice scope, role dimensions and appropriate job descriptions as well as those of the UHCW from the legal, ethical and even organizational perspective (Bleich 2007, pp. 107 – 119). Delegation for RN’s allows them more time in which to attend to nursing needs of the complex patients. RN’s are trained and certified as competent in certain health care procedures and tasks, some of which can be delegated to UHCW’s with close supervision. In many jurisdictions, when such tasks are delegated, the UHCW is held responsible for the procedures and tasks they perform, although the registered nurses delegating them must retain the full accountability for outcomes of the UHCW performance (Shostek 2009, pp. 56–65). This is where supervision becomes important and necessary (Bleich 2007, pp. 107 – 119). According to Douglass (2004, pp. 323), whenever an RN delegates responsibility to a UHCW, he or she can be held liable for any negligent act, error and omission of the UHCW for having nor supervised the performance of the task adequately. UHCW’s should not have any of the nursing intervention requiring independent, trained and specialized nursing knowledge, judgement or skill delegated to them by the RN, since that remains the absolute responsibility of the certified nurse. Such tasks and procedures must solely be left for the RN and not delegated to the UHCW. c) Characteristics of Effective Delegation Effective delegation has several key characteristics. Proper delegation requires that the manager/leader and his staff acts independently where each has separate authority and jurisdictions as regards the performance of tasks. The senior most person in the delegation chain has a set of responsibilities and authority just as well as the junior most person in the chain. This means that each member of the team has a field of play in which he or she can exercise authority and responsibility. Effective delegation of responsibility must also be accompanied by appropriate authority for the performance of certain tasks. Authority in this case refers to the resources necessary in doing the actual tasks and command over the people who are responsible in a certain jurisdiction. When a responsibility is assigned, it must also be accompanied by requisite authority (Douglass 2004, pp. 323). The unregistered health care worker for instance, has been given the authority over the registered nurse in maintaining the patient’s records in that ward in the case scenario. However, he or she has not given the registered nurse the authority to record such information as the vital signs, despite having passed on the responsibility to the registered nurse. It is important that the leader/manager gives the junior workers to whom he or she has delegated; the space to perform the tasks delegated to them. After delegation, it will be improper for the leader to stand at the back of the juniors and give instructions on how the delegated task should be performed, constantly. Ideally, the staff should be given time and space to execute their responsibility if at all the delegation is to be effective. Effective delegation is also attained where there is adequate supervision of the duties assigned each delegatee (Douglass 2004, pp. 323). Supervision ensures that each member of is kept accountable for the responsibility and accompanying authority assigned them. Supervision enforces the guidelines and standards ascribed to each delegation role as the process through which performance is achieved. Supervision helps to reward good performance and to punish/reprimand poor execution of the delegated tasks (Douglass 2004, pp. 323). This introduces another characteristic of effective delegation. Delegation is effective when the responsibilities and authority are given and then rewards for proper execution and or consequences of improper or inadequate performance are clearly identified. The staff should always be sure of what will happen when they perform the tasks delegated to them well or poorly. Delegation is usually pegged on the willingness, ability and motivation of employees to achieve the objectives stated during the delegation process as the goal of their performance (Sullivan and Decker 1992, pp. 217 – 226). When that goal is attained, such as good patient outcomes, the employees should be rewarded accordingly (Huber 2006, pp. 33-56). Unlicensed Health Care Workers In recent times, healthcare personnel shortages and costs has seen a proliferation of unregistered nursing practitioners such as the UHCW’s (Bleich 2007, pp. 107 – 119). UHCW’s today assume the responsibilities historically in the licensed nurses’ scope of practice. Growth of managed care establishments and other new care models have also helped unlicensed personnel assistants gain a footing in the healthcare establishments in recent times. An unregistered health care worker (UHCW), such as the one in charge of the newly graduated nurse in this case scenario, has a set of duties and responsibilities assigned him or her by the job position they occupy. In any clinical setup, the UHCW has a central role that is vital in the productive, effective and efficient health care services delivery. UHCW are health care workers not licensed and or certified to perform nursing duties in a clinical setup (Shostek 2009, pp. 56–65). Some UHCW may actually be trained and certified in patient care activities and procedures, but still not licensed for such roles (Shostek 2009, pp. 56–65). Examples of UHCW include certified nursing assistants, patient care technicians, home health aides etc. The only procedures and tasks that the RN assigns UHCW’s are those judged as not to require any professional judgment and scientific application of skills. In many instances, UHCW should be assigned only the tasks that fulfill the following set of conditions. These includes tasks and procedures that are considered routine in patient care, those that pose no or little potential hazard, those that involve no or little modification between different patients and different care situations, those that are performed with a very predictable outcome (Shostek 2009, pp. 56–65). Finally, UHCW can be assigned those procedures and tasks that are not inherently involving assessment, interpretation or decision-making processes in a logically separated way from the particular procedure (Shostek 2009, pp. 56–65). Examples of such tasks include the clean catheterization techniques, simple dressing changes after an assessment by an RN etc. It is important to note that UHCW are never supposed to reassign any of their assigned tasks as the UHCW in the case scenario did. Every UHCW must receive delegation and consequently supervision from the RN directly (Shostek 2009, pp. 56–65). The RN must always have the direct responsibility to decides how to assign particular tasks appropriately to particular UHCW’s. In most cases, the delegation of tasks to the UHCW by the registered nurse is guided by the knowledgeable of the education, training and experience of the UHCW. Again, overtime the RN verifies the individual UHCW’s ability and reliability in performing specific tasks during supervision (Shostek 2009, pp. 56–65). As such, the UHCW his/herself should never reassign the tasks accorded them (Shostek 2009, pp. 56–65). Conclusion The essay has effectively explored the reasons for delegating, delegation and supervision of unlicensed health care worker and the characteristics of effective delegation. Further, the essay has also discussed the role and responsibilities of the UHCW in a clinical setup. These factors of the delegation process have been discussed with regards to the given clinical nursing scenario involving a newly graduated registered nurse (RN), an unlicensed health care worker (UHCW) and the surgeon in charge of a busy surgical ward. Delegation helps leaders/managers to achieve results and attain the objective of their organisation, by granting their juniors the authority to perform certain tasks that they are ultimately responsible for. Delegation helps save their time for more important tasks, ensures perpetual training of new graduates and provides for backup manpower in times of emergency. The paper has established that in a clinical setup, the RN is supposed to delegate to the UHCW and not the other way round as in the case in the given scenario. Conclusively therefore, registered nurses are supposed to delegate and supervise the UHCW in the performance of those clinical and care procedures and tasks that do not require the training and certification of registered nurses. (Word Count – 2,148 Words) References Bleich, M 2007, Overview and summary: The value of RNs: How can we communicate our economic worth? Online Journal of Issues in Nursing, Vol. 12 (3), pp. 107 – 119. Bleich, M and Kosiak, C 2006, Managing, Leading, and Following In Yoder-Wise, P (Ed), Leading and managing in nursing, Fourth Edition, Chapter One, St. Louis, Mosby Elsevier, pp. 3-25. Douglass, L 2004, The effective nurse leader and manager. Third edition, St. Louis: Mosby, pp. 323. Ellis, J and Hartley, C 2009, Managing and Coordinating Nursing Care, Melbourne: Lippincott Williams & Wilkins, pp. 42 - 65. Huber, D 2006, Leadership and Nursing Care Management, Third Edition, Chapter Two, Philadelphia, W.B. Saunders Company, pp. 33-56. Marquis, 2006, Leadership Roles and Management Functions in Nursing: Theory and Application, Sixth Edition, Chapter Three, Philadelphia, Lippincott Williams & Wilkins, pp. 47-61. Sullivan, E and Decker, P 1992, Effective Management in Nursing, Chapter 16, New York: Addison-Wesley Publishing Company, pp. 217 – 226. Volp, K 2006, Let’s Talk Nursing (Part 4): Professionalism, The Queensland Nurse, Vol. 25(6). pp. 4-5. Available Read More