Answers to Questions on Transition to Professional Practice
Objectives: This assessment item relates to learning outcomes 2-6, 8, 10-12 as stated in part A
Newly RN or nurses re-entering the workforce face many challenges. One of these issues is delegation. I this essay you are required to develop an in depth and detailed understanding of delegation and how it will apply to you as a newly registered nurse. You will need to critically analyze the literature to:
Define delegation and how it applies to the RN in the clinical setting
Analyze the role of the RN in relation to the responsibility of delegation
Analyze the relationship between accountability and delegation
Discuss how delegation to patient allocation
Analyze how professional competence impacts on delegation with specific reference to clinical effectiveness
Discuss the interpersonal relationships of team members when delegating within a team
You will need to demonstrate critical thinking. You should support your main points within references to the literature. It is anticipated that you will read widely around these points. It is expected that you will use subheadings in this assignment
A newly Registered Nurse (RN) enters the health care field with the main objective of serving the people. People expect nothing less than quality, safe and competent care because this is the norm as stated in the professional standards. Being a neophyte in the clinical area, a lot of challenges will come along which includes the concept of delegation. An RN may delegate or may accept a delegated task depending to one’s scope of practice and education. In the course of the delegation process, nurses work hand in hand with the members of the multidisciplinary health care team to optimize the manpower and resources offering excellent service. The focus of this paper is delegation and how integral it is in the clinical setting.
Delegation is defined as ‘conferring of authority on a person to a person to perform activities (Queensland Nursing Council 2005, p. 17 of 18). In the same way, delegation suggests that it does not only provide authority but also the responsibility to do such performance (Staunton & Chiarella 2003, p192). In relation, when delegating, the responsibility for doing the task is passed on but the accountability for the result is maintained by the delegator (Crisp & Taylor 2005, p.366). According to Kemsey (2006), in the contemporary nursing practice, one of the primary attribute of a nurse is leadership. The RNs embark on a leadership role in the collaboration and systematization of the nursing and health care intradepartmental and beyond, to promote favorable healthy results (Australian Nursing and Midwifery Council [ANMC] 2005, p2). RNs have authority to delegate duties to other nurses and health care workers (HCW). In delegation, the biggest point of concern is to be able to equate knowledge, training and skills that the delegatee possesses and the expected care they will deliver. RNs performs the assessment, planning, implementation and evaluation in cooperation with the health care team to be able to realize their objectives (Queensland Nursing Council [QNC] 2005, p. 1 of 18). Nurses are expected to afford quality, safe and competent care in the performance of their duties in the clinical setting (ANMC 2008, p.2& 4 of 15 and ANMC 2008, 1- 2 of 10). In similar note, nurses assures that the services provided is within the expected standard and will not be compromised when there is a delegation of care (ANMC 2008, p. 4 of 15 and ANMC 2008, 2 of 10).
Roles and responsibilities of delegation
Delegation was initiated to enhance ability and competence (Crisp &Taylor 2005, p.366). Combining education, experience, skill, training and professionalism are all taken into account when delegating a task and patients care (QNC 2005, p.3 of 18 and ANMC 2005, p.1 of 8). The actual needs of the client are an integral factor to reckon with and this will be matched with the capability, knowledgeability and qualification of the health care member being considered for the assignment (QNC 2005, p. 3, 8-9 of 18). The aversion for a certain activity should never be a reason for allocation because this will result in distrust, repulsiveness, poor rapport and weak correlations (Crisp &Taylor 2005, p.366).
The appropriate way to delegate stems from the familiarity of what skills are allowed to be delegated (Crisp & Taylor 2005, p. 367). Care planning and delegation of activities are solely the responsibility of a RN (QNC 2005, p. 4 of 18). This includes the assessment and its interpretation, preparation, prioritization and documentation of the care plan, the evaluation of outcomes and alterations if needs arises. Once delegated, the accountability of its end effect still remains with the RN (Crisp J & Taylor 2005, p.366). According to Kemsey (2006, p. 2-14), supervision should be continues. RNs can move autonomously while the enrolled nurse [EN], though can give some input in the care planning, cannot act independently. RNs and ENs work hand in hand and the latter having the competence and education may have a say on the decision-making. The ENs who receives an assignment cannot pass on the activity to another person because of the fact that the RNs’ the one that is standing for the quality of work to be given. HCWs are assigned to perform basic and routinary personal care duties. RNs delegate tasks to the nursing assistants using the guidelines set in the principles for delegating to HCWs (QNC 2005, p. 14 of 18).
There are five right of delegation and these are assigning the right task with the right circumstances to the right person with the right direction and communication under the right supervision. A nurse should have the critical reasoning to be able maximize and assign the limited resources she has including her staff to have a positive result (Crisp & Taylor, p. 367). Each patient has different health outcomes expected which requires different levels of care. The nurse should be able to identify and prioritize the activities and assign it to the most appropriate staff. The nurse should be able to convey and explain the care plan for that particular circumstance to the designated member and should be ready to receive any clarifications regarding the matter. There should be an assurance of supervision and evaluation of the task.
If the task assigned is beyond the scope of practice then policies on how to expand or advance the scope of practice should be employed but the main motivation is to meet the health needs of the client and health outcomes. The nurse should apply critical thinking and decision making and this should be in line with the relevant laws and standards. The RN or a health professional should ensure competence thru continues education, assessment, clinically-focused supervision. The delegatee should understand and accept the degree of accountability involved. The HCW who will work under the supervision of the nurse still accepts the responsibility of her own action and is accountable to the delegator (QNC 2005, pp 9 – 15 of 18).
Sweet (2009, p.24) suggested that to expand the horizons in the general practice ‘one has educate themselves as to the scope of their practice and what type of things are appropriate to undertake under delegation.’ Unintentionally some nurses work beyond their scope of practice and they are liable for any breach in the legislation within their profession for it is their duty to know it.
Accountability and Delegation
Implicit in the nursing profession is the accountability of action and responsibilities. As nurses, one is obligated to answer for the performance of the duty and outcomes that are expected to meet the standards and this cannot be delegated to others. If the function or undertaking is allocated to a competent individual then the delegator and the delegatee both shares the accountability (QNC 2005, p. 15 of 18). It is apparent that one of the responsibilities of each member of the health care team is to be aware, knowledgeable and accustomed to the standards, policies, procedures and legislation that are relevant to the profession in rendering services and care to the clients (Ashley 2004, p. 68). Ethically independent qualified licensed nurses are accountable for their clinical choices and judgment and have the commitment inherent in the profession to provide safe and competent nursing care (Forrester & Griffiths 2005, p. 357).
RNs and ENs have the education, qualifications and license to be individually accountable to their own actions. Delegated duties to enrolled nurses, may it be new or a usual task is also accountable to the RN. The RNs have a great responsibility and accountability for choices and decision made. First of all, they have to ensure that the standard of care to be provided is within or above the expected. Secondly, they have to assure that there is appropriate supervision, either direct or indirect. If the RN is prudent and cautious in her reasoning and judgment and followed the steps of proper delegation then she would not be accountable for any improper or unacceptable deed by the assigned care giver. ENs job are quite restrictive but later on broadened to incorporate skills like medication administration and their participation in expanded practice requires additional education and specialized skills that allows them to extend their range of duties (Blay & Donoghue 2007, p. 38).
Nursing Assistants on the other hand has also a part on accepted delegation. They assumed understanding and responsibility for their own actions. They are accountable not just to the nurse but also to the employer. All personnel, may be licensed or not , as well as management have a duty of care to render to the patients and therefore have the possibility of being sued if the performance of the task and behavior is less than the criterion set by legislation and registering authorities (QNC 2005, p 15 of 18).
Delegation versus patient allocation
Patient allocation is ‘asking another on the assumption that the required activities of consumer care are normally within that person’s responsibility and scope of practice’ (ANMC 2007, p.2 of 25 and QNC 2005, page 1 of 5). Delegation as suggested earlier is that authority is bestowed to perform the task is assigned to another but the accountability still remains to the delegator because the task is not within the normal duties, it is used to advance the scope of practice and therefore do not have the autonomy to perform such function (ANMC 2007, p.2 of 25 and QNC 2005, page 11-14 of 18). This imparts that there is a greater accountability and responsibility in patient allocation because it is normally with in his normal duty and scope of practice. On the other hand in delegation, it entails imparting of knowledge, teaching and training as well as verifying competence, and employing sensible judgment and logical decision making to make sure that the health outcomes and benefits are obtained and outweighs the risks involved. The main difference between patient allocation and delegation is the scope of practice of the staff involved. If the task is within the normal duties and is within the scope and responsibility of the person therefore it is allocation. On the other hand, if the function is new and not within the scope of practice then this will fall under delegation (ANMC 2007, p. 1).
Lumby (2000) suggested that one has to reflect on the world and contemplate on experiences in order to implement critical approach to the world. One has to develop the habit of insightful questioning so that facts and information can be reconciled then make several ideas and plans to come up with the best decision (Parker & Clarke 2000 as cited by Daly, Speedy & Jackson 2006, p. 99). Reflective practice and critical thinking must be exercised by nurses when allocating and delegating. A nurse, assuming a leadership role has staffs under her team and clients with a variety of needs to handle. (Daly, Speedy & Jackson 2006, p. 108) The nurse has to come up with a complete picture of the whole scenario then subsequently reflects on it to come up with a critical decision on nurse-patient designation. The nurse asks questions including what are my resources available. What are the capabilities of each team member? What are my client needs? How can the team best render services to meet the needs of the patients? What are my different options?
There are two levels of clinically focused supervision. One is direct where the supervisor is actually present, observes, works with and directs the person and the indirect who does not constantly observes the person but is always available and within reasonable access (QNC 2005, p17 & 18 of 18 and ‘Delegation and the responsibilities of registered nurses’ 2001, p. 19). Patient allocation entails minimal or nil supervision while delegation needs more because the duty is not within the individual’s scope of practice at the moment. Supervision and accountability is proportional which means that when you have more direct supervision, the greater is your accountability and the less direct supervision, the less you accountability for it is being shared by the person you designated to perform the task (QNC 2005, p17 – 18).
Professional competence impacts on delegation
The scope of practice framework for nurses and midwives (QNC 2005, p.3 of 18) in line with the codes of ethics (ANMC 2008, p. 2 of 15) and competency standards (ANMC 2008, p. 1 of 10), ensures that nurses render quality, safe and competence that meets by the Australian standards (ANMC 2005, p.2-8 of 8).
Initially a nurse enters the profession as a novice staff carrying with her a registering license to practice, armed with years of studying and training, expecting to exhibit beginning level competencies, including the familiarization of the laws and regulations pertinent to the nursing profession, personifying the codes and standards and understanding of the level of care to be rendered to clients (ANMC 2005, p1 of 8, and QNC 2005, p. 10 of 18). The maintenance or even advancement in proficiency and capabilities are achieved thru participating in continuing education training and development programs to enhance the skillfulness and approaches in the different milieu of the nursing practice (ANMC 2008, p2 of 10 and QNC 2005, p 16 of 18). In every occasion that there is a new delegation, which may be an advancement or expansion of the scope of practice, the required abilities and qualities to perform such task within standard is constantly evaluated. With furthering knowledge, experience and skills, there are more basis for critical thinking and making clinical decision making involved in the performance of a particular task through proper delegation leading to a more effective clinical practice (QNC 2005, p.3 of 18).
From a beginner where the professional voyage commences, the journey progresses through continues execution of complex nursing procedures, training, direction and supervision from its mentors. The novice nurse then evolves to an advance level of nursing and entails a broader scope of practice. Nurses undertake a self audit and reflective practice where a nurse contemplates on the theories and actual practices. When there is a deficit and inconsistency, one would immerse in continues learning to further its professional practice and develop into clinically effective practitioners (Daly, Speedy & Jackson 2006, p. 322).
Interpersonal relationships of team members
Goh and Watt ( 2003, p. 16) uncovered that the new graduates experience doubt in their preparedness because of the feeling of inadequacy in knowledge, deficiency in skills and high presumption of others in the work place. Experienced nurses have great expectations on novice nurses and they suppose new recruits are already highly functional and capable of any task. These have impacted the beginners unconstructively. A supportive environment conducive to learning should be developed so that effectiveness in the transition period will aid the continued improvement and enrichment of the ability and skills that translate to sense of fulfillment and contentment in their respective careers (Levett-Jones & FitzGerald, 2005-2006, p. 40). Helpful and accommodating preceptors should be accessible to newly hired nurses.
In the Transition support processes, it recognizes that a particularized system is essential for every new recruit in the practice area. It facilitates the entrance of the nurse into the health care team. It allows the integration of theoretical know how, abilities, behavior or ethical principles to the working milieu which results to rendering quality, safe and competent care to the clients. The transition process is continues as long as there is changes in the role and context of care The end result is producing confident and competent nurses (QNC 2006, p.1 of 2).
Similarly, an RN works in collaboration with the healthcare team in performing healthcare roles and producing healthcare plans to achieve positive health outcomes (ANMC 2005). The healthcare team needs to build a trusting relationship especially when delegating and receiving delegation such as having fair distribution of workloads and providing adequate activities that help each other grow professionally through exchange of knowledge and skills. In this way, all the members of the multidisciplinary health care team create a worthwhile working environment and empower each other leading to achieving better health outcomes amongst the receivers of their care (O’Connell et al. 2006, p. 4 of 7).
Delegation is proven as an important tool to take full advantage of the potential of each member of the workforce. The nurse who is the delegator and each member is expected to know within her capabilities and work on the scope of practice but is also encouraged to advance and expand her capacity through continues learning, training, direction and supervision. The workforce should be knowledgeable regarding legislation, standards and policies to negate the risk of violating the codes and laws. The nurse utilizes critical thinking and crucial decision making when delegating and allocating tasks to human resources. The preceptors and the new nurses and other staff members should work hand in hand to create a healthy working environment to facilitate the transition and assimilation into the health care team. Delegation when used properly will make service more efficient and ensures that nothing less than quality, competent and safe care is bestowed to the clients.
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