Introduction Nursing is an excellent career and one that is in very high demand. Many times, the workload required of nurses is too much and it is often necessary to delegate tasks to others in order to provide the best care possible for a patient. However, before the nurse can delegate any task to a UAP (unlicensed assistive personnel), he/she needs to make sure the assistant is competent in performing the desired task.
There are five rights of delegation that must be met. These rights include the right task, circumstance, person, direction/communication, and supervision (Potter, Perry, Hall, & Stockert, 2017). This paper focuses on these rights of delegation, requirements associated with delegating, how and what to delegate, and related patient safety concerns. Definition and Principles of Delegation The American Nurses Association (ANA) defines delegation as “transferring responsibility for the performance of an activity or task while retaining accountability for the outcome” (ANA, 2015, p. 7). Throughout the years, delegation has become very important in the nursing profession. It is vital for a nurse to understand how to delegate to others efficiently without compromising patient safety. This can sometimes prove to be a harder task than one might think, especially for a new graduate who has little to no experience with delegation. However, there are certain guidelines set in place that, if followed, will enable novice RN’s to delegate tasks safely, properly, and help avoid any legal implications. These principles include the fact that the process must always be in the best interest of the patient, ensuring the assistive personnel is adequately trained to carry out the task, clear guidelines and protocols are in place, and document written evidence of competence assessment.
These principles are critical to the success and effectiveness of the delegation process (ANA, 2015). Effective and Ineffective Delegation Practices Delegation, when done effectively, is one of the most powerful tools a nurse can use. However, broken delegation can lead to disaster for the nurse, the client, and the employer.
Appropriate delegation begins with knowing which skills can be delegated. For example, nurses cannot delegate the steps of the nursing process to unlicensed assistive personnel. These steps include assessment, diagnosis, planning, implementation, and evaluation (ADPIE). Common activities that can be assigned to UAPs are activities of daily living, hygiene, feeding, and ambulation. When delegating a task to another individual, the five rights of delegation must be considered. The first right, the right task, takes into consideration whether it is within a person’s scope of practice to perform the task being delegated.
The right circumstance addresses whether delegation is appropriate in the situation. The third right, right person, verifies that the person delegated to do the task is competent to complete it. The right direction/communication includes identifying the patient clearly, the objective of the task, time frames, and expected results. Lastly, the fifth right is the right supervision/evaluation. This is used to provide supervision and evaluation of the patient and the performance of the task (Black, 2017). Using good communication techniques is essential for effective delegation between nurses and assistive personnel. Research related to patient safety names communication breakdown as the number one factor leading to errors.
The right communication/direction is arguably the most important right in ensuring good quality and safety outcomes. The delegator must use direct, open, closed-loop communication to encourage teamwork and safe task performance (Barrow, 2018). One of the biggest barriers to delegation is the perception that a nurse does not have enough time to either adequately explain the task or teach the UAP the skills necessary for a task. Even though it may take the nurse less time to complete it now, where does that put him/her the next time the task must be completed? One of the main reasons for delegation is to save time. Taking those few extra minutes to teach the assistive personnel could save many more in the future.
Another barrier to delegation is the mentality of “I can do it myself”. This is when nurses think they can get everything done without the help of others and believe they will do a better job at the task. This may be true, but it will ultimately slow the nurse down when other important duties arise throughout the workday. There is a principle of delegation that says managers should delegate tasks that can be done by others. Legal and Ethical Aspects of Delegation There are both legal and ethical aspects associated with delegation. When a nurse delegates, he or she must also supervise. Supervision is defined by the NCSBN as “the provision of guidance and direction, oversight, evaluation and follow up by the licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel” (LaCharity, Kumagai, & Bartz, 2014, p. 3). This states that the nurse must be aware of what the UAP is doing and oversee that the task was done proficiently. If the nurse assigned someone to perform a task and something went wrong, the nurse who delegated the task would be liable and could be sued for unintentional negligence. One legal issue that is continuing to expand in the healthcare setting is “the role expansion of UAP or limited licensed (LPN/LVN) personnel” (Black, 2017). Nursing assistants are being substituted for nurses, creating greater risks to patients and increasing the liability of nurses, who supervise their work.
This substitution jeopardizes quality of care and places the RN at increased risk for patient injury liability because of acts performed or omitted by UAP. Professional nurses “must consider the legal implications of practice and be willing to and capable of conforming to prevailing professional standards and all legal expectations” (Black, 2017, p. 113). Delegation is an important liability and one that is not fully appreciated by many nurses. The nurse’s primary legal and ethical consideration must be the patient’s right to safe, effective nursing care.
This goes back to the five rights of delegation. A nurse must always know whether to delegate something to a UAP or even to a Licensed Practical Nurse (LPN). Needing to verify that the UAP/LPN is competent enough to do the task is very important in making sure that the patient is safe and there was no negligence done and that continuity of care was continued. Both the nurse and the assistive personnel must agree when delegation happens. The UAP/LPN must know what he/she can and cannot do and speak up if feeling uncomfortable with the assignment and ask questions. Doing this will enable the care of the patient to be continued responsibly and to make sure the patient is getting the best care possible (Black, 2017). There are, however, a number of effective strategies that nurses can use to limit the possibility of legal action.
First, practice in a safe setting. The nurse should know the policies and procedures on the unit, keep the equipment in working order, and orient new employees to the unit. Communication is another strategy for protecting oneself from legal problems. Asking questions about unclear or inaccurate prescriptions, keep good patient records, and just communicate with other health professionals, patients, and families. Everyone will know what the plan is and will trust that continuity of care is being given.
The final strategy is meeting the standard of care. The nurse, UAP, or LPN “should know the limits of his or her own education and expertise and the provisions of the nurse practice act” (Black, 2017). Staying within those limits may require asking for help from more experienced personnel but is in the best interest of the patients. Accountability The definition of accountability is “to be answerable to oneself and others for one’s own actions” (Battié & Steelman, 2014). Registered nurses retain accountability for acts delegated to another person. The RN is responsible for determining that the delegated person is competent to perform the delegated act. The nurse remains liable, however, for the tasks given to the assistive personnel. If the UAP is not able to do the task, then the task should go to someone else who will be fully capable of completing it. One good way for the nurse and UAP to achieve both of their goals is to conduct rounds together.
The nurse can assess each patient as the assistive personnel attends to the patient’s basic needs. The nurse is also able to make sure the task that was delegated is done right and can evaluate what and how the UAP did (Potter et al., 2017). Patient Safety Concerns Patient safety is the most important aspect of any nursing career, whether it’s from a nurse, UAP, or LPN standpoint. That is why it is vital for nurse’s to delegate efficiently. With delegation, providing adequate supervision is important. The AMA states that, “if you are responsible for supervising staff, you must understand the extent of your supervisory responsibilities, give clear instructions about what is expected and be available to answer questions or provide help when needed” (AMA, 2015). If the RN cannot do those things, patient safety is a concern.
Just giving the UAP a task and not giving clear instructions on what to do is ineffective communication and could result in patient harm (Potter, et al., 2017). Conclusion It is very important as a nurse to consider all parts that go into delegating tasks to others. When all the principles and guidelines are followed, and the five rights have been used, delegation can be a great tool that nurses can use.
The floor will run smoothly, and nurses will be able to more efficiently care for their patients. It is vital that health care providers put the care and needs of the patients first when making decisions that could affect their treatment and ultimately their lives. References ANA. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org. Barrow, J. M. (2018). Nursing, Five Rights of Delegation. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519519/ Battié, R., & Steelman, V. M. (2014). Accountability in Nursing Practice: Why It Is Important for Patient Safety. Retrieved January 12, 2019, from https://aornjournal.onlinelibrary.wiley.com/doi/abs/10.1016/j.aorn.2014.08.008 Black, B. P. (2017). Professional nursing: Concepts & challenges. St. Louis, MO: Elsevier. LaCharity, L., Kumagai, C., & Bartz, B. (2014). Prioritization, Delegation, and Assignment. St. Louis, MO: Mosby/Elsevier. Potter, P. A., Perry, A. G., Hall, A., & Stockert, P. A. (2017). Fundamentals of nursing. St. Louis, MO: Mosby Elsevier.
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