In any given healthcare institution where medical workers receive patients and provide them with care and treatment, it is important that efficient and effective performance of tasks take place. The schedules, workload, and stress may regularly overwhelm, but could overcome them through appropriate delegation of duties. While undertaking the treatment and care of patients visiting the institution, nurses along with other ancillary help provide an effective means of decreasing the burdens of the challenging vocation. It is for this reason that nurses should understand the apt methods for delegation of duties that ensure successful performance of tasks. The case study provided will serve as a suitable tool for learning the ways, rights, and barriers to successful delegation.
Responsibility, Accountability, and Authority in Delegation
Competent nurses bear a significant burden of undertaking numerous complex skills, one of them being delegation. The personnel should understand the integral concepts of authority, responsibility, and ultimate accountability for patient care (Weydt, 2010). The case of Ms. S identifies a 58-year-old patient reported to suffer from chest pressure and indigestion that is also associated with vomiting and nausea. Sophisticated clinical judgment of a Registered Nurse (RN) is crucial to the delegation of duties to the auxiliary help available. In light of this, the RN should take note that the emergency department (ED) personnel, during admission, performed various laboratory tests that included cardiac marker levels and a 12-lead electrocardiogram. Repeating these activities would lead to the questioning of the RN’s competence on the needs of the patient (Weydt, 2010). However, placing the client on a cardiac telemetry monitor, and observing and recording the intake and output of the patient are some of the tasks to undertake at this stance.
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Ways of Delegation
The RN may require the unlicensed assistive personnel (UAP) to perform the duties, subsequently demonstrating the two primary methods of delegation (Weydt, 2010). The simple task assignment basing on job description considers identifies the roles that UAPs undertake as ancillary help at the coronary care unit (CCU). Furthermore, matching the expertise of the staff to the needs of the patient shows the RN understands the ultimate accountability for patient care in his or her decision (Weydt, 2010). Monitoring and recording the client’s intake and output takes into consideration the client’s problem of indigestion that is also associated with nausea and vomiting. In this regard, the RN has been able to delegate a duty that effectively matches the care and treatment needs of the patient to the expertise of the UAP.
Five Rights in Delegation
The National Council of State Board of Nursing (NCSBN) provides the professionals with various aspects to consider while delegating duties known as the five rights in delegation (National Council of State Boards of Nursing, 2016). The case study shows that the client reported feeling worse and worse despite her attempts to care for herself while at her home. In this regard, it is important that the medical personnel undertake the appropriate measures to ensure relief for the patient. Prioritizing interventions is an integral aspect of delegation that incorporates the “Right task” in assigning duties (National Council of State Boards of Nursing, 2016). The RN identifies the most important objective for quality care, which in this case involves placing the client on a cardiac monitor. In this action, the nurse takes into consideration the “Right circumstance”, which notes that the symptoms presented by the patient may be a potential heart attack (National Council of State Boards of Nursing, 2016). As a result, the “Right person” to perform the care intervention is a UAP. The “Right direction and communication” along with the “Right supervision and evaluation” is another measure of ensuring successful transfer of the task (National Council of State Boards of Nursing, 2016). In light of this, the RN should understand that in the provision of care, responsibility is a two-way process for both the individual delegating duties and ancillary help accepting them.
Barriers of Successful Delegation
The professional licensure of the RN provides them with the authority of transferring nursing activities within select circumstances to qualified individuals. The influence of this concept requires nurses to exercise clinical judgment on who, how, and when to perform the interventions. In this case, the pertinent individuals in attending to the patient are integral to successful acceptance and execution of the duties (Papastavrou, Andreou, & Efstathiou, 2014). Studies on nursing delegation usually identify the importance of the practice in relieving workload and related stress of the job while improving quality of individualized care in the process. However, researches rarely take into consideration the multiple factors that may bar the actualization of these potential benefits (Papastavrou, Andreou, & Efstathiou, 2014). If the supporting staff and other medical professional have unhealthy attitudes, poor partnerships, or lack a teamwork mentality, it is impossible for the RN to ensure successful delegation of activities. In this case, the healthcare workers along with auxiliary help should maintain a collaborative relationship that guarantees positive patient outcomes (Papastavrou, Andreou, & Efstathiou, 2014). Individuals should identify the importance of their roles in the provision of care to Ms. S and her recovery in the process.
The case study, taken in the setting of a coronary care unit (CCU), identifies how delegation of tasks could lead to effective provision of individualized quality care. The nurse should first recognize that the practice is a complex skill that incorporates responsibility, authority, and accountability. Furthermore, the various ways of employing delegation of tasks should be considered to guarantee the appropriate assignment of tasks while addressing the needs of the patient. The five rights in delegation as provided by the NCSBN indicate numerous aspects of the practice that direct the decision-making process. Similar to other activities of interpersonal interaction, RNs should be aware of and address the various factors that may hinder successful transfer of duties in the clinical setting.
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7 (1), 5-14.
Papastavrou, E., Andreou, P., & Efstathiou, G. (2014). Rationing of nursing care and nurse–patient outcomes: a systematic review of quantitative studies. The International Journal of Health Planning and Management, 29 (1), 3-25.
Weydt, A. (2010). Developing Delegation Skills. Online Journal of Issues in Nursing, 15 (2), 1H. DOI: 10.3912/OJIN.Voll5No02Man01