Introduction
This paper aims to explore the nursing standards in delegation between licensed nurses and unlicensed assistive personnel. Healthcare has been continuously changing and calls for changes involving the roles and responsibilities of licensed providers and assistive personnel. The ability to delegate tasks is an essential skill for every registered nurse. When certain care needs are to be delegated, it is essential that the nursing process and the state nursing practice act be clearly understood so that it is ethically and safely carried out. The American Nurses Association principles for delegation by RNs to unlicensed assistive personnel are designed to provide overreaching principles and relevant strategies for practice in cases where RNs delegate tasks to UAPs.
Importance
Delegation is an important concept in nurses; when the RNs delegate tasks, they show their staff that their contributions and talents are valuable to the team, patients, and the healthcare organization. By trusting UAPs, they are likely to take on greater responsibility and be more willing to learn new skills to improve their professional growth (Crevacore et al., 2023). If appropriately carried out, delegation can improve clinical outcomes. If delegation is unresolved, it can negatively influence patient outcomes and expose the delegator to legal action. Also, it can negatively affect quality measures and nurse job satisfaction. If the staff assigned to the tasks is not skilled, they open themselves to safety issues and mistakes. This can result in low-quality work, medical errors, and mismatched expectations.
Healthcare disparities, inequalities, and interventions
Individuals from vulnerable populations are more likely to experience adverse health events. This occurs due to the population’s inability to afford safe and quality care due to socioeconomic factors like lack of health insurance, level of education, income, and employment. If delegation is unresolved, it can result in higher risks of acquired hospital infections, pressure ulcers, sepsis, pulmonary embolism, and adverse drug events (Motacki & Burke, 2022). A healthcare resource to support evidence-based professional practice related to delegation is the American Nurse’s Organization. The ANA has provided guidelines for delegation in nursing practice, principles for delegation, and a decision tree for the delegation process by RNs. Evidence-based intervention for this identified issue is a face-to-face discussion with the nursing team that does not adhere to assigned responsibilities and those with inadequate skills (Motacki & Burke, 2022). This strategy can help to solve negative issues associated with poor delegation. Furthermore, delegation requires skills like regular training, teamwork, effective communication, supervision, and evaluation to impact the quality of care. Patient education entails educating them on their diagnosis and what to expect from the UAP.
Legal and ethical considerations and intervention challenges
Poor delegation is associated with increased risks to patient safety. The ethical principle that is more focused on patient safety is non-maleficence. This principle emphasizes that providers should prioritize patient safety; ensuring safety and preventing injury should be all providers’ goals (Walker et al., 2021).Legal consideration for patient safety is the perseveration of patient dignity, which should be attained by obtaining informed consent and providing patients with information on their diagnosis, prognosis, and chosen treatment methods.One strategy for preventing ethical dilemmas related to delegation includes interdisciplinary collaboration, as it improves shared decision-making.Interdisciplinary collaboration also enhances clear and open communication regarding treatment and helps solve moral conflicts as members can share opinions on the issue. A strategy for preventing legal consequences related to delegation is assessing the patient’s needs and deciding whether the UAP is competent enough to meet the needs (Walker et al., 2021). The tasks that require licensed nurses should not be delegated. The potential barrier to the success of preventing effective delegation is fear of losing control or trust in team members. The barrier to the success of resolving effective delegation is a lack of adequate resources and overburdening the delegates.
Participants and Interdisciplinary Approach
The 3 parties who will be involved in the implementation of effective delegation are clinicians, consultants, managers, and patient representatives. Nurses and clinicians who are responsible for identifying effective delegation strategies.Management is responsible for providing resources for the implementation of the project.Patients are a vital part of the clinical microsystem; their concerns are welcomed and acted upon.The benefits of having members outside nursing include that teams can leverage their skills, knowledge, and opinions to improve safety outcomes (Walker et al., 2021). Furthermore, the interdisciplinary model improves shared decision-making and communication between the teams. Interdisciplinary collaboration results in improved clinical outcomes, reduced workloads, and increased patient satisfaction, experience, and quality of life.
Quality improvement
Effective delegation improves clinical outcomes and a reduction in healthcare costs. Effective delegation is characterized by communication, collaboration, and trust. By evaluating and providing feedback, the RN can deliver safe and quality care that benefits patients. On the other hand, effective delegation reduces workloads among professional nurses as minor tasks are assigned to assistants. Delegation is an essential skill that enables nurses to sort out their workloads and work on more complex situations; therefore, delegation helps to free up nurses’ mental well-being so they can deliver the best care to their patients (Campbell et al., 2020). If effective delegation is carried out, nurses will experience improved morale, job satisfaction, and productivity; they will also be at lower risks of burnout and PTSD and will have a balanced nurse-patient ratio.A resource used to promote improved patient outcomes in the clinical environment is the EMR, as it reduces medical errors and missed diagnoses. EMR also helps in managing multiple chronic health issues, ensures continuity of care, follow-up, and discharge procedures, and improves provider communication (Campbell et al., 2020). Evidence-based practice helps increase professional nurse knowledge; EBP enables nurses to conduct and participate in research to improve patient care and outcomes. Since UAPs cannot use EMR, they cannot take vital signs as it is not within their scope of practice. They cannot handle medications, but they can be tasked with minor tasks like transporting blood products.
Conclusion
Nurses are accountable to the public for delivering safe, quality, and patient-centered care to patients and their loved ones. Nurses function as essential members of healthcare teams. The role of nurses is to provide care to patients regardless of age, race, or socioeconomic status. Some of the nursing tasks can be carried out by unlicensed assistive personnel. The tasks are identified according to the scope of practice. Thus, the framework for clinical practice, including delegation, is determined by practice acts and state statutes. The delegating nurse still retains accountability for the patient outcomes. Thus, it is essential to ensure that the person to whom the tasks were delegated carries them out as instructed. If effectively carried out, delegation can improve clinical outcomes, patient satisfaction, and experience; on the other hand, it reduces nurses’ workloads, thus freeing up time for nurses to focus on more complex situations. If negatively carried out, delegation can harm patient safety and result in legal issues to the delegator.
References
Campbell, A. R., Layne, D., Scott, E., & Wei, H. (2020). Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review. Journal of Nursing Management, 28(7), 1465-1472.
Crevacore, C., Jacob, E., Coventry, L. L., & Duffield, C. (2023). Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing. Journal of advanced nursing, 79(3), 885-895.
Motacki, K., & Burke, K. (2022). Nursing Delegation and Management of Patient Care-E-Book. Elsevier Health Sciences.
Walker, F. A., Ball, M., Cleary, S., & Pisani, H. (2021). Transparent teamwork: The practice of supervision and delegation within the multi‐tiered nursing team. Nursing inquiry, 28(4), e12413.
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