Nurses play a vital role in healthcare by providing quality patient care that guarantees better patient outcomes. However, the nursing profession is faced with the challenge of shortage of nurses due to the high number of people seeking patient care as well as the increasing aging population with chronic illnesses in the United States. Therefore, the current healthcare environment with high demand for nursing care stretches nurses to greatest limits. As result, nurses have to work effectively with the assistive employees through delegation in order to meet the high demands of quality care using the few available nurses (National Council of State Boards of Nursing, 2005). Therefore, nurses should be in possession of abilities and competencies to delegate and supervise the assistive personnel. The American Nurses Association (ANA) and the National Council of States Boards of Nursing (NCSBN) approved papers on delegation in 2005 which recognized delegation as a basic nursing skill (National Council of State Boards of Nursing, 2005).They also came up with a joint statement to help practicing nurses use delegation in patient care effectively and safely.
According to ANA and NCSBN, delegation is defined as the process by which a nurse directs another individual to execute nursing tasks and activities. They also define it as the transfer of authority or responsibility by a registered nurse to another person who is not licensed to perform such tasks (National Council of State Boards of Nursing, 2005). However, ANA and NCSBN stress the point that in delegation, registered nurses maintain the accountability for delegation. Moreover, my state’s (Kentucky) nurse practice act describes delegation as the process of a nurse directing a capable individual to carry out chosen nursing tasks and then supervises him/her as provided for in the administrative regulations (Commonwealth of Kentucky, 2017). The Kentucky’s nurse practice act also spells out the criteria nurses should follow in the process of determining which tasks to delegate and the amount of supervision needed. The act also states that the accountability and responsibility of care to the patient such as assessment, preparation, evaluation and documentation are retained by the nurse delegating the tasks.
As a registered nurse working in a healthcare organization, on some occasions, I have been confronted with the need to delegate some of my responsibilities to unlicensed assistive personnel. One of such scenario is when I was caring for Mr. J, a 65-year-old patient admitted to our orthopedic unit after undergoing a left hip surgery to correct a deformity sustained after falling at home. I decided to delegate activities of daily living (administration of pain relieving drugs) of the patient to the assistive personnel after having observed the patient for three days and ensured that his condition was stable and predictable. As such, administration of nonsteroidal anti-inflammatory drugs (NSAIDs) was the only needed intervention to help the patient ease the pain while he recuperated from the surgery.
The decision on which health care provider to delegate the task was based on the educational and competence levels of the assistive personnel. I gave the task to the assistive personnel because she was competent enough and had received additional education on assisting patients with activities of daily living. Moreover, the task within the scope of assistive personnel and is included in her job description. In delegation process, I followed the Kentucky’s practice act guidelines by ensuring that the needs of the patient were clearly determined before delegating the task. Secondly, I ensured that the assistive staff was competent enough to perform the nursing task delegated (Knox, 2013). Lastly, I adhered to the act guidelines by adequately and appropriately supervising the assistive personnel performing the intervention. By carrying out the delegation properly as stipulated by ANA, NCSBN and Kentucky’s nurse practice act, patient risk such as medical errors and excessive pain due to failure to administer NSAIDs on time were greatly reduced (Commonwealth of Kentucky, 2017). Some of the liabilities that might have resulted from improper delegation include putting the patient at risk of under dose or overdose of the NSAIDs. As such, patient outcomes and satisfaction would be affected and the patient could institute a legal process to get redress and possible compensation due to unnecessary suffering caused by improper delegation. This would adversely affect my reputation and career for failing to adhere to the nurse practice act.
References
Commonwealth of Kentucky. (2017). Delegation of Nursing Acts to Unlicensed Persons. Retrieved from http://kbn.ky.gov/practice/Pages/delegation.aspx
Knox, C. (2013). The Five Rights of Delegation | Essentials of Correctional Nursing. Retrieved from https://essentialsofcorrectionalnursing.com/2013/01/03/a-case-example-the-five-rights-of-delegation/
National Council of State Boards of Nursing. (2005). Joint statement on delegation: American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN).
