Decision-Making Process in Nursing Delegation
The level of competence and efficiency within the healthcare industry is founded on the execution of the respective roles and responsibilities of the registered care providers. This means that the nurses must ensure that the patients are attended to while promoting quality services and patient satisfaction. Among the most common practices in ensuring such a common goal is met is the delegation of responsibilities. On this note, nurses transfer responsibility to another team member intending to complete a particular task while ensuring adherence to quality services and accountability standards. The delegation process is complex and sophisticated as it requires crucial clinical judgment and the understanding of authority, responsibility and accountability from the involved practitioners. The primary objective is to ensure that the unlicensed assistive personnel execute the duties of the Registered Nurses (RN) in absentia while maintaining high standards of professionalism, credibility, and accountability. The decision to delegate duties has to be founded on the fundamental principle of safe and quality care and public protection. In this regard, delegation is vital across the nursing environment as it allows nurses to operate efficiently under high pressure while making quick decisions and prioritizing tasks, thereby increasing competence within the industry.
The delegation process is based solely on providing clear standardization and direction from the employer while maintaining the patient care perspective to execute the nursing responsibilities safely. The intended users for this approach are healthcare facilities, nurse educators, professional associations, and licensed nurses, among others. Understanding and adhering to the respective state laws is important when practising this technique. The licensed nurse must familiarise themselves with the states’ laws on what is allowed and what is not to ensure compliance with the relevant policies, rules, and regulations.
Primarily, three individuals are involved in the delegation process: the employer or nurse leader, the licensed nurse, and the delegate. Each individual is tasked with their respective responsibilities that allow the process to achieve its desired efficiency, effectiveness, and competence. As for the employer, they are obliged to select a nurse leader who would oversee the delegated responsibilities across the facility. It is also upon the employer to ensure that the policies and procedures involved in the process are adhered to while promoting a positive work culture and environment that supports a smooth delegation process (National Council of State Boards of Nursing, 2016). On the other hand, the licensed nurse must follow up with the delegate, provide feedback about the delegation process, and offer guidance to the delegate, among other responsibilities. Finally, the delegate has to accept the responsibilities, maintain competence, communicate with the licensed nurse in charge, and be accountable for the delegated responsibilities.
Application in The Nursing Process
In most cases, nurses must make quick decisions while prioritizing their tasks. Such an attribute to their job description leads them to operate in an environment characterized by high pressure. Partially, this is due to the nature of their work and the current demand for more skilled practitioners within the nursing profession. Unfortunately, research has determined that the shortage of nurses is expected to shorten throughout the United States, instilling more pressure on the available RNs. Even though a single institution, the delegation of roles at an individual level cannot solve the major challenge, which helps to ease the burden on RNs and improve the patient experience. The involvement of assistive personnel helps in reducing stress as well as improving efficiency, which makes the process a crucial one within the nursing environment. Considering that nurses play a vital role in promoting the safety of their patients, patient experience should always come first. The RNs must also balance patient experience with other administrative requirements, such as competing priorities. The delegation process also provides a substantial platform for assistive personnel to contribute positively to patient outcomes while minimizing the cost of hiring new employees.
Relatively, delegation differs significantly from assignment. The task must be aligned with the assignee’s training and education and job description for the assignment. This means the assignee must confer the skills required to complete that task effectively. On the other hand, delegation entails administering functions categorized outside the delegate’s job description if the process does not violate hospital policy and the delegate is well-informed about the task. Another significant distinction is that the assignees bear full responsibility for the task, whereas the person delegating responsibility is ultimately responsible for the task’s outcome (Kennedy et al., 2014). This means the RNs must be actively involved in a supervisory capacity. The short-term benefits of delegation are allowing the RNs to increase efficiency and have sufficient time to focus on other activities. In the long-term, it builds necessary skills for the assistive personnel, making them competent enough for future responsibilities.
A practical example in which delegation applies is the case where a licensed nurse is attending to multiple patients simultaneously, all of whom require special attention considering that they are suffering from severe ailments. The nurse is not only tasked with looking after these patients but also following up on their progress, keeping records of their recovery rates and ensuring they have taken their medication and undergone treatment as advised by the doctor, as well as ensuring the patients have acquired everything they need. In such a case, the nurse would require assistance from unregistered but competent personnel. This means that nurse has to delegate some duties to an assistive person who would act on their behalf and ensure the safety and satisfaction of the patient.
The nurse has to focus on evaluating the assistive personnel’s skill levels, professionalism, past experiences and abilities, among other vital aspects. The nurse incorporates the five rights of delegation approach in selecting suitable assistive personnel. First, the nurse has to determine the policies applicable in delegating responsibilities to another individual while aligning his confidence with the person so that they can complete the task safely and correctly. Second, the nurse is obliged to the right circumstances whereby he determines whether the appropriate resources, equipment and a conducive working environment are available for the delegate. This allows the nurse to delegate more accommodative responsibilities in that he cannot refer a patient with unpredictable outcomes to another individual (Henry et al., 2016). After considering the first two steps, the nurse engages the right person with the requisite experience and knowledge to complete the task competently. The fourth step is offering the right supervision since the delegate has to provide feedback after completing the task. It is the nurse’s responsibility to evaluate the overall patient outcomes after completing the task. Finally, the nurse offers the right direction and communication to the assistive personnel. He must not assume that the delegate is aware of what is required of them, but he has to ascertain that they have understood the expected outcomes, directions, and patient limitations.
Delegation in nursing is used to increase the efficiency of operations and promote quality care and safety for the patients, considering that the RNs are tasked with high-pressure responsibilities that require quick decision-making and the prioritization of tasks. The delegation process is complex and sophisticated as it requires crucial clinical judgment and the understanding of authority, responsibility and accountability from the involved practitioners. In addition, the decision leading to a delegation of duties has to be founded on the fundamental principle of safe and quality care and public protection. The licensed nurses must familiarise themselves with the states’ laws on what is allowed and what is not to ensure compliance with the relevant policies, rules and regulations. Despite delegation’s effectiveness, licensed nurses must be thorough in determining the most suitable assistive personnel to delegate their duties and responsibilities.
- Henry , Norma Jean E, et al. (2016). Nursing Leadership and Management. 7th ed., ATI Nursing.
- Kennedy, A., Rogers, A., Bowen, R., Lee, V., Blakeman, T., Gardner, C., … & Chew-Graham, C. (2014). Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: a qualitative study. International journal of nursing studies, 51(8), 1103-1113.
- National Council of State Boards of Nursing. (2016). National Guidelines for Nursing Delegation. Journal of Nursing Regulation, 7(1): 1-11. Retrieved from: https://www.ncsbn.org/NCSBN_Delegation_Guidelines.pdf