Decision-Making Process in Nursing Delegation

INTRODUCTION  

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 have to ensure that the patients are attended to while promoting quality services as well as 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 with the aim of completing a particular task while ensuring to adhere to the standards of quality services as well as accountability. The process of delegation is complex and sophisticated as it requires crucial clinical judgment as well as 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 leading to delegation of duties has to be founded on the fundamental principle of safe and quality care as well as public protection. In this regard, the process of delegation is vital across the nursing environment as it allows nurses to operate efficiently under high pressure while also making quick decisions and prioritizing tasks thereby increasing the level of competence within the industry.

OVERVIEW

 The process of delegation is based on the sole intention of providing clear standardization and direction from the employer while maintaining the patient care perspective with the aim of safely executing the nursing responsibilities. The intended users for this approach are health care facilities, nurse educators, professional associations, and licensed nurses among others. It is important to understand and adhere to the respective state laws when practicing this technique. It is upon the licensed nurse to familiarize with the states’ laws on what is allowed and that which is not in pursuit of ensuring compliance with the relevant policies as well as rules and regulations.

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Primarily, there are three individuals involved in the delegation process; the employer or nurse leader, licensed nurse, and 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 also promoting a positive work culture and environment that promotes a smooth delegation process (National Council of State Boards of Nursing, 2016). On the other hand, the licensed nurse is required to 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 given, 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 are required to make quick decisions while also prioritizing their tasks. Such an attribute to their job description leads them into operating in an environment that is characterized by high pressure. Partially, this is due to the nature of their work and also because of the current demand for more skilled practitioners within the nursing profession. Unfortunately, research has determined that the shortage of nurses is expected to shorten further throughout the United States, which instills more pressure on the available RNs. Despite the fact that a single institution, the delegation of roles at an individual level, cannot solve the major challenge helps to ease the burden on RNs as well as improving 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 the nurses play a vital role in promoting the safety of their patients, patient experience should always come first. The RNs are also obliged to balance patient experience with other administrative requirements such as the competing priorities. The process of delegation also provides a substantial platform for the assistive personnel to contribute positively to the patient outcomes while minimizing the cost of hiring new employees.

Relatively, delegation differs significantly from assignment. For assignment, the task must be aligned with the assignee’s training and education as well as job description. This means that the assignee must confer the necessary skills required to effectively complete that task. On the other hand, delegation entails the administration of tasks that are categorized outside the delegate’s job description if the process does not violate any hospital policy and the delegate is well informed about the task itself. Another significant distinction is that the assignees bears full responsibility of the task whereas the person delegating a responsibility has the ultimate responsibility of the task’s outcome (Kennedy et al., 2014). This means that the RNs have to be actively involved in supervisory capacity. The short-term benefits of delegation are offering the RNs the ability to increase their efficiency and having sufficient time to focus on other activities. In the long-term, it builds necessary skills for the assistive personnel thereby making them competent enough for future responsibilities.

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 A practical example in which delegation applies is the case where a licensed nurse is attending to multiple patients at the same time, 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 that they need. In such a case, the nurse would require some 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 the suitable assistive personnel. First, the nurse has to determine the policies applicable in delegating responsibilities to another individual while aligning his confidence to the person in such a way 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 and equipment as well as a conducive working environment are available for the delegate. This allows the nurse to delegate responsibilities that are more accommodative 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 who must have 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 the completion of the task. It is the nurse’s responsibility to evaluate the overall patient outcomes after the completion of 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.

CONCLUSION

Delegation in nursing is used to increase the efficiency of operations as well as 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 process of delegation is complex and sophisticated as it requires crucial clinical judgment as well as the understanding of authority, responsibility and accountability from the involved practitioners. In addition, the decision leading to delegation of duties has to be founded on the fundamental principle of safe and quality care as well as public protection. It is upon the licensed nurse to familiarize with the states’ laws on what is allowed and that, which is not in pursuit of ensuring compliance with the relevant policies as well as rules and regulations. Despite the effectiveness of delegation, the licensed nurses have to be thorough in determining the most suitable assistive personnel to delegate their duties and responsibilities.

References

• 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