Introduction
This article appeared on the Massachusetts Nurses Association Newsletter. The article addresses the issue of delegation of nursing duties from registered nurses to unregistered nursing personnel. The subject of the article is a recent report by the Board of Registration in Nursing (BORN) that gives Registered Nurses (RNs) the authority to delegate some duties to Licensed Practical Nurses (LPNs). The article challenges BORN’s decision in lieu of several considerations. This paper offers a summary of this article and then a reflection of the addressed issues.
Summary
The author of this article is Kelly-Williams Donna, a member of the Massachusetts Nurses Association (MNA). The author begins by noting that her organization received a draft report from a task force that was commissioned by BORN. According to the article, the report addresses some changes to the practices of RNs and LPNs. It is noted that the taskforce was supposed to make ‘evidence-based’ recommendations to the existing BORN practices. In these changes, any licensed nurse can be able to delegate medicine administration duties to an unlicensed practitioner (Kelly-Williams, 2012). According to the author, while BORN’s decision to settle this issue using a task force is noble, its preliminary report is unsatisfactory in some areas. The article then declares MNA’s willingness to be involved in the amendment process. According to the author, the proposed wording of the new legislation is ambiguous and it is likely to subject the new laws to abuse by unscrupulous nursing stakeholders. The author notes that the new wording might be unintentional but it still needs to be changed. The article continues by noting that although BORN claims to have involved MNA in the task force’s activity, the organization has no record to that effect. The author spells out the organizations’ stand on several matters. First, MNA requests for further clarification of what constitutes ‘incidental’ care. Second, the organization does not condone the changes in the language of rules concerning delegation. Finally, the author suggests a meeting between BORN and MNA officials as well as various regional meetings across the state. All MNA officials are promised to be informed about any new developments on the issue.
Reflection
The article addresses the subject of delegation, which is usually a contentious and pertinent subject when it comes to nursing. The rules that govern delegation in the nursing practice have been subjected to several changes over the last few decades. However, most of these changes have seen nurses become more relevant in the healthcare profession. Delegation in nurses starts with doctor to nurse delegation, and then nurse-to-nurse delegation. Previously, most debate on delegation revolved around the issue of which duties doctors can delegate to nurses. However, the existence of several levels of nurse training has made it possible for nurses to have different levels of expertise. For instance, in my state of residence one has to undergo through at least two years of training before becoming a registered nurse. In addition, the certifying board will expect me to have achieved substantial work experience. This article reveals how far delegation has come through this current debate. In the issue raised by this article, BORN is contemplating giving responsibilities to the nursing staff of the lowest cadre, the unlicensed personnel.
The issues raised by the MNA reflect a mixture of valid concerns and professional insecurity. The article is written by a registered nurse and this makes the author’s opinion biased to some extent. The author of the article is disputing BORN’s intention of allowing “nursing tasks and activities to be delegated by the nurse to unlicensed personnel in settings (home care) where the nurse does not retain accountability for the care provided by the unlicensed personnel” (Kelly-Williams, 2012, p. 2). Allowing unlicensed nursing staff more responsibilities undermines the integrity of registered nursing personnel. However, the proposed delegation compromises of insignificant nursing tasks that can be carried out by any responsible adult. In my experience, most RNs prefer the more challenging duties as opposed to simple routines and they would not mind if someone else took over the simple routines. However, it is likely that the nurses are afraid that this ‘take over’ of their duties might soon extend to other significant tasks. This professional insecurity is well hidden in the nurses’ complaints.
Conclusion
This article is able to raise some important questions when it comes to the delegation trends in modern nursing practice. The author speaks on behalf of the MNA and voices valid concerns relating to how RNs and LPNs’ duties should be defined. In addition, the article reiterates the need for clear language when spelling out rules and regulations of delegation. This helps in preventing misuse of laws and protects the integrity of the nursing profession as well as the wellbeing of patients. This article is well written and uses clear and formal language when pointing out the inconsistencies in BORN’s preliminary report. However, the author’s tone seeks to acquire sympathy from the targeted audience and also expresses some form of professional insecurity. The article can be recommended to practicing nurses as well as nursing scholars who seek to understand the scope of delegation in the nursing profession.
Reference
Kelly-Williams, Donna. (2012). Be very afraid: The BORN wants to change regs on delegation of nursing tasks. Massachusetts Nurses Association, 83 (1), 2-3.