The changing world has not left the healthcare industry behind. The changing events in the world have led to the introduction of unlicensed healthcare workers (UHCWs) whose role is to assist the professional nurses. The professional nurses delegate certain duties to the UHCWs. Delegation of tasks is the transfer of responsibility with regard to the performance of a certain activity but as the delegator, one is held liable for the outcome. It is a very sensitive process which should be handled with a lot of care while observing all the involved rules and procedures.
Reasons for delegation
Delegating tasks in nursing is a necessity. However, one should possess effective and efficient leadership styles. Delegation of tasks to Unlicensed Health Care Workers (UHCW) has been associated with various benefits. Delegating tasks enables nurses to have more time for their more professional roles. When a nurse delegates activities to the UHCW, the nurse is able to make sound judgements concerning their patients while coordinating the care they ought to receive. In addition, delegation of duties to the UHCWs enables hospitals to preserve profits (Ellis & Hartley, 2009).
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Delegation of tasks is done with the aim of assisting the nurse during administration of nursing care. Assistance here should not be taken to mean shared responsibility. Therefore, as a nurse, it is important to use help through delegation and not to assign responsibilities that require the attention of a professional and registered nurse.
Several reasons have led to the need to change the healthcare environment. As outlined by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA), the following are the reasons for the changes
Increasing shortage of nurses
Increased level of intelligence and keenness of patients
Therapies have become more complicated
Advancement in technology
These changes have subsequently led to the emergence need of registered nurses having to work with personnel who will assist them in their work. Delegation of tasks is important so that the nurse can have more time to critically reason, plan and coordinate healthcare given to patients. The act of delegating is attributed to the fact that, as a registered nurse, one has greater knowledge and critical reasoning ability than the assistive personnel. As a result, the RN has the responsibility of delegating, assigning and supervising the assistive personnel. According to the NCBSN and the ANA, appropriate delegation of tasks can result in effective and safe nursing care (NCSBN & ANA, 2006).
In the case study given, the recently graduated registered nurse (RN) is new in the field, thus does not have enough experience with regard to attending to six patients during the morning shift. Six patients are too many for the new RN thus, need for the UHCW. Delegation of duties as stated earlier on should be done so that the registered nurse gets enough time to complete tasks that require his or her specialized attention and knowledge. The reason why the RN has delegated the UHCW to assess the patientsââ‚¬â„¢ vital signs is so that he or she can do the final touches with regard to personal hygiene care. This reason is not professional enough in that the RN can use the help of the UHCW in completing the personal hygiene care process. The UHCW can gather up the dressing the used up dressing materials and subsequently deliver them to the cleaners for washing while the RN prepares to make sound judgement in coordinating care that is needed by the patients.
Delegation and supervision of unlicensed health care workers
Delegation comes hand in hand with supervision. During delegation of tasks to the UHCWs, it is very important to employ a model that will guide the nurse while delegating activities. The following is an example of a conceptual model for delegation known as the rights of delegation. It outlines and discusses each right and its role in delegating activities. An outline of the rights is as follows:
The right task
The right person
The right circumstances
The right communication
The right feedback
As a RN, it is important that you delegate a task (the right task) that is not included within the scope of nursing practice. Each task should be delegated to a person who has the capability of accomplishing that task successfully hence; the right person. A task can be delegated if it frequently recurs during the daily care of patients where sequential steps and an anticipated outcome prevail. As an eligible nurse, it is important to communicate concisely and clearly to the UHCW about the task and expectations of the task. During communication, it is important to confirm your availability as the nurse so as to offer guidance and provide support if need be. In addition, the nurse should ascertain that the UHCW accepts the delegated task and associated responsibility.
Providing the right feedback is very important. This way, the worker will learn of their mistakes thus, avoid repetition in future. Evaluation of outcome is considered in relation to predicted responses and risks. Evaluating the outcome entails looking at execution of the task to satisfactory levels. It also looks at the role of the nurse with regard to timely and effective communication. This way, the nurse is able to know how to improve on his or her skills to delegate tasks to the UHCW (Ellis & Hartley, 2009).
According to Clark, 2009 p. 188, UHCWs should not be assigned directly to a group of patients. Despite the fact that UHCWs can assess vital signs, it is recommendable that a RN takes vital signs for patients who are critically ill. The surgeon points out a patient whose medical condition is not improving. While applying the conceptual model above and recommendable policies within the nursing practice, the RN should not solely entrust the role of assessing vital signs to the UHCW (Clark, 2009).
Supervision is part of the delegation process as earlier stated. It entails monitoring and evaluation of tasks delegated so as to ensure that the tasks are carried out successfully as delegated (Huber, 2006). However, during delegation, it is important that the nurse thinks like a UHCW while maintaining the nursing personality. The supervision process is meant to guide and not criticize the UHCW. The RN in the scenario given does not employ the right procedures during delegation of the task to the UHCW. The RN sends the UHCW without assessing his or her level of competence. In addition, the RN does not supervise what the UHCW does.
The characteristics of effective delegation
According to Sullivan, & Decker (2005), effective delegation begins with critical thinking of the tasks to be delegated to the assistive personnel. As a nurse doing the delegation, it is important to deliberate over some questions like:
Is the patient going to get quality nursing services if delegation of the task takes place?
Is there real need to delegate the task?
Is the delegate able to execute the task based on prior assignments?
Such questions are fundamental in delegating tasks. This way, the nurse is able to delegate tasks in the right way. The scenario presented indicates the delegation of tasks by the newly RN without critically thinking of the issues involved.
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Effective delegation is characterized by several things. Effective delegation makes use of an appropriate conceptual model that is meant to guide the RN in delegation of tasks. The five rights discussed above are an example of a model that a nurse could use during delegation of tasks. Supervision is also needed so that the RN detects a mistake once it emerges. In the scenario given, the RN does not employ any model during the delegation process and he or she does not supervise what the UHCW does ((Tomey, 2004)).
Effective delegation is characterized by effective and efficient leadership qualities. As a person who possesses recommendable leadership qualities, it is important to accompany delegation of tasks with guidance, monitoring and ability to influence the morale of the UHCWs. Therefore, in the scenario presented, the RN lacked effective leadership styles because he or she does not show commitment in guiding and monitoring the performance of the UHCW.
The process of delegation requires the nurse to make perfect judgment with regard to the duties that are to be delegated. This process makes use of both critical thinking and valid decision making in relation to nursing. The delegation of duties by a nurse should be in line with the state laws and the policies of the hospital. This way, the nurse is aware of the duties that can be delegated and those which should not be delegated. With reference to the given scenario, the newly RN has not followed the legal framework on delegation of duties to the UHCW. This is because; a UHCW ought to perform a certain task on a particular patient at a time while under supervision (Tomey, 2004).
Delegation of clinical tasks is a directive process with a certain time frame and requires periodic reviewing from the very onset until the task is complete. The delegation process will be effective if both the registered nurse, who is the delegator, and the UHCW (delegate) agree on the time frame, task and circumstance. Subsequently, arrangements are made on how to deliver the feedback. It is important for both the delegator and the delegate to make sure that written instructions follow up a verbal directive. This way, understanding is enhanced and the task is carried out effectively and successfully (Sullivan, & Decker, 2005).
Role of UHCW
According to Ellis & Hartley, 2009, tasks that fall within the nursing process such as assessment, planning, implementation and evaluation of care given to patients should not be assigned to the UHCWs. These activities require clinical decisions that have to be made by the nurse. In addition, the tasks that are assigned to a UHCW are with regard to patients who are not critically ill and do not require consistent care of the nurse.
Giving personal hygiene care to patients is one of the responsibilities that can be delegated to a UHCW. In the case given, the UHCW is involved in giving personal hygiene care to patients. This should include gathering all the materials required for the personal hygiene care process at the beginning and at the end. When the RN asks the UHCW to take the vital signs while he or she finishes the personal hygiene process, it is apparent that the UHCW does not fully and effectively execute the duties that he or she should. Instead of the UHCW finalizing on the personal hygiene care process which entails cleaning, he or she has been directed to monitor the vital signs of all patients assigned to the RN irrespective of their status. Consequently, the RN lacks enough time to supervise and evaluate the performance of the UHCW.
The major role of the UHCW in the scenario given is to assist the RN. It is apparent that the UHCW assists the RN during personal hygiene care of clients. The RN then directs the UHCW to assess the vital signs of the patients as he or she completes the personal hygiene care process. The UHCW has been given the responsibility of checking and noting the results of the various vital signs but no follow up as required is evident.
The UHCW is required to check and note the patientsââ‚¬â„¢ body temperature, heart rate, respiratory rate and blood pressure. Measuring the vital signs is based on mere observation and does not require the UHCW to make any decision. Unfortunately, there is no directive on the kind of patients whose vital signs should be assessed. UHCW should be given the responsibility of taking care for those patients who are in the recovery process.
The patient whose diastolic pressure is high and is experiencing decreased urinary output was not supposed to be put under the care of the UHCW. This is due to the fact that; manifestation of a high diastolic pressure and decreased urinary output of the patient is an indication that he or she was not recovering and therefore required specialized attention from the RN. If the RN had taken up responsibility for this patient, by the time the surgeon required details on the vital signs, the RN would have had them and he or she would not have been caught by surprise.
Delegation of tasks is part of the nursesââ‚¬â„¢ responsibility. However, it is important for the nurse to possess great leadership and management styles that will guide him or her in delegating responsibilities to the UHCWs. Effective and successful delegation is very important so that, in case of a law suit, the nurse is not held accountable. It is very important for a RN to understand the tasks that should be and those that should not be assigned to a UHCW. Follow-up of what the UHCW does is very important so as to detect any flaws and foster improvement for future.
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