Delegation Process
Delegation typically entails entrusting unlicensed assistive personnel with the execution of patient care-related activities or tasks, with the one who assigns maintaining responsibility for the final result. For nurses to develop proficiency in performing nursing care, delegation is a skill set that necessitates instruction and consistent practice. Education and experience contribute to improving this process, which entails professional growth and the application of critical thinking. The delegator considers the nature of the care required, the situation, the staff’s expertise, and the functions that fall within the scope of practice of each staff member before delegating (Barrow & Sharma, 2023). For example, UAP can handle vital signs, cleanliness, and patient transport, whereas practical nurses can administer medication and care for wounds.
Registered nurses need to master delegation, assignment, and supervision. Clinical practice, including delegation, is governed by state statutes, nurse practice acts, rules, policy statements, and current professional nursing standards ((ANA & NCSBN, 2019). As such, all licensed nurses must ascertain which practices are authorized within their state to achieve safe, ethical, and effective delegation of nursing care. Whether to delegate or assign a task is predicated on the registered nurse’s assessment of the patient’s condition, the proficiency of every nursing team member, and the level of oversight that the RN will be expected to provide if a particular duty is delegated.
Regardless of the delegatee’s role, delegation allows them to perform tasks outside their usual responsibilities, provided they have acquired additional education, training, and validated competence (Barrow & Sharma, 2023). The licensed nurse retains overall accountability for the patient, but the delegatee assumes responsibility for the delegated task. However, certain aspects, such as nursing judgment, critical decision-making, and responsibilities outside the delegator’s scope of practice, cannot be delegated. The delegation process is intricate, involving administrative decisions, policy development, and continuous evaluation at the organizational level. The licensed nurse plays a crucial role in determining patient needs, deciding when to delegate, and ensuring accountability for the delegated responsibility. The delegatee, in turn, must accept tasks based on their competency level, maintain competence, and uphold accountability for the delegated activity.
American Nurses Association devised five rights that guide delegation to ensure it is secure and effective. “The right task” checks if the action is part of the delegatee’s job description or the nursing practice setting’s published policies and procedures. For instance, registered nurses assess, design, and evaluate nursing processes. A non-RN should not perform these tasks. “The right circumstance” Patient health must be stable (ANA & NCSBN, 2019). When a patient’s condition changes, the delegatee must notify the licensed nurse, who will reevaluate the situation and evaluate the delegation. For instance, unlicensed assistive professionals may feed patients who need daily life support. Delegating feeding to untrained assistance persons may be unsafe for patients at high risk for aspiration and with intricate speciality diets.
Moreover, “The Right Person”dictates that the registered nurse must know the delegatee’s job description and training before assigning a task. “The right supervision” orders the licensed nurse to oversee delegated activities, follow up with the delegatee upon completion, and assess patient results. Delegation requires the delegatee to inform the licensed nurse of patient information. The licensed nurse should be ready to act. The licensed nurse should document the activities. “The right directions and Communication” requires delegation to be patient, licensed nurse, and delegatee-specific (ANA & NCSBN, 2019). Two-way communication requires the licensed nurse to give clear instructions and the delegatee to ask questions. The licensed nurse receives data collection methods, reporting schedules, and other information in this communication. Terms must be understood and accepted for delegation. The licensed nurse has to inform the delegatee that they can only change the activity with their approval.
Communication Methods for Delegation
Clear communication is needed to ensure the assigned individual understands the work. They must understand its requirements, timeline, paperwork, patient constraints, and desired outcomes.
Direct Communication/ Face-to-face communication
Effective collaboration and safe task execution necessitate that the delegator employ direct, honest, open, closed-loop communication. Proper communication and direction are arguably the most crucial of the five rights of delegation in guaranteeing safe and high-quality results. Face-to-face communication allows all parties to hear and see body language and facial emotions, increasing comprehension of the meaning behind words. Avoiding misinterpretation, hence, prevents errors. All delegators are required to convey performance expectations clearly and concisely. Even for routine tasks, delegators should avoid assuming that the delegatee understands what to do and how to do it (Barrow & Sharma, 2023). The delegator must give additional consideration to ensure that the delegatee comprehends the assigned task, instructions, patient limitations, and anticipated outcomes before taking on responsibility. Additionally, the delegatee must understand what, how, and when must be reported back upon completing the delegated task. Time-sensitive duties also require a deadline for completion by the delegates.
Electronic Health Records (EHRs)
To keep track of duties and responsibilities, the EHR can record delegation. O’Malley et al. (2015) found that instant messaging, task management software, and the ability to create evidence-based templates for medical assistants and nurses to collect symptom-specific data from patients helped primary care teams communicate and delegate tasks.
Common Challenges with Delegation
Communication Breakdown
Communication issues during work delegation can cause misunderstanding, delays, errors, and conflicts. Rodziewicz et al., (2023) identify communication challenges, lack of hierarchy awareness, weak leadership, needing to know whom to report the problem, failing to reveal the situation, and a disconnected system without problem-solving capabilities.
Insufficient Training
Nurses may feel overwhelmed while delegating work due to a lack of training. New nurses needed to gain delegation skills. Pre-registration and career-long delegation training are required to prepare Registered Nurses to delegate. A study by Atta & Fekry (2019) found that nurses identified the following challenges to delegation related to the delegator: delegators may need more self-sufficient skills and experience and more trust in delegatees’ ability to do jobs properly.
References
American Nurses Association (ANA) & National Council of State Boards of Nursing (NCSBN). (2019, April 1). National Guidelines for Nursing Delegation. Retrieved from https://www.nursingworld.org/~4962ca/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/nursing-practice/ana-ncsbn-joint-statement-on-delegation.pdf
Atta, S. M., & Fekry, N. E. E. (2019). Barriers of Effective Delegation as Perceived by Nursing Staff in a University Hospital. International Journal of Novel Research in Healthcare and Nursing, 6(3), 899-907.
Barrow, J. M., & Sharma, S. (2023, July 24). Five Rights of Nursing Delegation. In StatPearls. StatPearls Publishing. Retrieved January 29, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK519519/
O’Malley, A. S., Draper, K., Gourevitch, R., Cross, D. A., & Scholle, S. H. (2015). Electronic health records and support for primary care teamwork. Journal of the American Medical Informatics Association: JAMIA, 22(2), 426–434. https://doi.org/10.1093/jamia/ocu029
Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2023, May 2). Medical Error Reduction and Prevention. In StatPearls. StatPearls Publishing. Retrieved January 29, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK499956/
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