Delegation refers to the assigning of the responsibilities of a particular nurse to another nurse or supporting staff. The responsibility is usually accompanied by some authority. The person who delegates retains the final accountability for the actions of the one delegated to though (Antony & Vidal, 2010).When deciding which task to delegate, the nurse must consider the resource availability to meet the needs of the patients, expected outcome of the activity delegated, patient’s stability, and complexity of the task. Most importantly, the task should be delegated to a nurse with required training and who is competent to undertake the task (Dolansky & Moore, 2013). Inappropriate delegation occurs when the above factors are not considered and this can jeopardize the safety and quality of patient care.
Delegation, quality, and safety of care are inextricably connected. Inappropriate delegation can lead to missed or inappropriate care and consequently, adverse outcomes for patients, staffs, and organizations involved. With regards to patients, ineffective delegation can lead to medical errors and adverse patient outcomes. For staffs, ineffective delegation can lead to feelings of guilt and harsh disciplinary actions being taken against staffs involved. For organizations, they might have to cover the financial costs of adverse patient outcomes. The occurrence of adverse outcomes in a healthcare organization also affects the reputation of an organization. This is because all healthcare organizations are mandated to publicly report their performance with regards to adverse events (Antony & Vidal, 2010).
A good example of the negative effect of inappropriate delegation occurred in a hospital ward that had a total of 24 patients. Four of the patients were due for surgery at different time of the day and there were two post-op patients. The nurses in the ward were very busy. The Registered Nurse (RN) who was also the team leader decided to delegate the administration of medications for some of the patients to a junior nurse. One of the patients had been reviewed by a physician in the morning who had ordered IV Amphotericin B. The nurse administered the drug without giving a test dose to the patient to assess for any adverse reactions. The test dose requires that a patient be given 0.5mls of Amphotericin B subcutaneously to rule out any reactions to the drug. Unfortunately the patient reacted and started having fevers, chills, irregular heartbeats, cramps and myalgia, nausea and vomiting, blurred vision and convulsions (seizures). The patient was subsequently admitted to the intensive care unit. The RN who had delegated the task was dismissed from her job. This is because investigations revealed that the junior nurse did not possess the necessary knowledge and skills to correctly administer the medication.
The above example illustrates the adverse effects inappropriate delegation has on the quality and safety of patient care. In spite of advances in the knowledge on the structure of delegation, it is still a remotely developed skill among a majority of nurses. It largely depends on personality, cooperation, and also communication (Barnsteiner et al., 2012).
References
Antony, M. K. & Vidal, K. (2010). Mindful communication: A novel approach to improving delegation and increasing patient safety. The Online Journal of Issues in Nursing, 15(2), 2.
Barnsteiner, J., Disch, J., Johnson, J., McGuinn, K., Chappell, K., & Swartwout, E. (2013).Diffusing QSEN competencies across schools of nursing: The AACN/RWJF faculty development institutes. Journal of Professional Nursing, 29(2), 68-74.
Dolansky, M.A. & Moore, S.M. (2013).Quality and safety education for nurses (QSEN): The key is systems thinking. The Online Journal of Issues in Nursing, 18 (3), 1.
Weston, M. & Roberts, D. (2013). The influence of quality improvement efforts on patient outcomes and nursing work: A perspective from chief nursing officers at three large health systems. Online Journal of Issues in Nursing 18(3), 1-12.
