Utilizing Delegation in Nursing
Delegation is defined as “the act of empowering to act for another” (Merriam-Webster [M-W], n.d.). In nursing, it allows a nurse to instruct a co-worker to perform specific duties in his or her place. Delegation not only allows patients to interact with more members of a staff, but also allows for the patient to benefit from the expertise of various staff members. It is a skill that requires teamwork and effective communication throughout the staff members. This essay is in response to a case study in which a nurse practitioner (NP) of a rural health care clinic failed to utilize delegation in caring for a patient, relying only on herself to provide all the education, referrals and health care for a developmentally disabled pregnant patient. Per the case study, the clinic offered a nutritionist; an RN with a BSN in community health, an LVN trained educating on labor and delivery; a social worker; and, an on-call obstetrician available for emergencies. In this setting, the NP had at her disposal a team of staff that could assist in the patient’s care and, perhaps, expand on the quality of care provided to the patient. As a primary care provider, a NP is charged with taking health histories, providing physical examinations, diagnosing and treating acute and chronic problems, interpreting test results, managing medications and other therapies, providing health teaching and counseling and referring patients to other health professionals as needed (Mayo School of Health Sciences [Mayo], n.d.). In this role, after assessing the patient’s needs and completing a physical examination, the NP creates a plan of care that includes goals and expectations to work towards during the patient’s care. The care plan may utilize delegation to other members of the clinic team to ensure the patient receives well-rounded care and support. In fact, the “Joint Statement on Delegation” lists 10 Principles of Delegation to direct the nurse in delegation. Two of these principles state that the nurse maintains the “responsibility and accountability for the nursing process” while “delegating components of care” (American Nurses Association (ANA) & National Council of State Boards of Nursing (NCSBN) [ANA/NCSBN], 2005). Simply put, a nurse may ask a peer or specialist to step in on a patient’s case to provide his or her area of expertise or specialized skills to the patient, while the patient’s care still remains the responsibility of the referring nurse. Additional principles state that delegation requires “effective communication among team members” and consistent follow-up and reassessment to evaluate the effectiveness of delegation. Regardless of who provides the duties of this patient’s care, the responsibility does not solely fall on the NP. For, there is an organizational accountability for delegation as well. “Organizational accountability for delegation relates to providing sufficient resources, including…staffing [and] documenting competencies for all staff providing direct patient care [as well as] ensuring that the [NP] has access to competence information for the staff” to whom she is delegating care (ANA/NCBSN, 2005). Here we see that the accountability for delegation not only falls on the NP for continued monitoring and evaluation, but also on the nursing supervisor to ensure staff are competent and that the NP knows which staff have shown competency in which areas. It is the duty of the nurse manager to provide training to staff, document their competencies and certifications, identify the policies and procedures for delegation and communicate all of these things to staff. Failure to do so could result in tasks being delegated to inappropriately trained staff, resulting in sub-par care, and violating their rights as a patient (American Nurses Association, 2001, prov. 3.4). Even with the same training, one person’s fresh perspective on a case can often bring in new ideas or suggestions...
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