Introduction
It is a fact that there are more tasks for nurses to accomplish than there are enough nurses to satisfy each task. Additionally, the current healthcare environment is associated with various challenges and responsibilities, which outnumber those assigned to various tasks with the aim of meeting the ever-increasing public need for quality, affordable, timely, and accessible health care (Kelly, 2010, p. 189).
Furthermore, there are many health care issues such as the greater number of patients seeking medical attention, the increasing patient illnesses, technological advances in healthcare, and complex therapies, which call for maximum utilization of available personnel and adequate delegation of various duties and responsibilities.
Here, health care workers possessing a certain level of education and experience participate in promoting the health condition of clients through their active contribution toward decision-making, policy formulation, coordinating and supervising the delivery of healthcare services, and delegation of various nursing tasks to junior nurses (NCSBN, 1995).
Accordingly, delegation is the transfer of the responsibility of carrying out certain tasks from one healthcare worker to another while maintaining answerability for the task outcome (Whitehead, Weiss & Tappen, 2009, p. 86; Kelly, 2010, p. 189). Jointly, the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) have adopted conceptual papers on nursing delegation, which include the ANA’s principles of delegation and NCSBN’s decision-making tree for Nursing Assistive Personnel (NAP).
Additionally, it is worth noting that besides the State Nurse Practice Act defining the legal boundaries of the nursing practice, different states in the US allow registered nurses (RNs) to transfer selected nursing tasks to other health care workers (Kelly, 2010, p. 189).
Considering that competent and adequately supervised NAPs are beneficial in offering quality, affordable, timely, and accessible healthcare services, there is the need to embrace nursing delegation by allowing RNs to take charge of patient-care and to determine various tasks assigned to nursing assistants who provide direct patient-care (Whitehead, Weiss & Tappen, 2009).
As a result, this paper reviews the concept of delegation by considering the premises that inform the process of delegation decision-making, the regulatory perspective of delegation, the correct use of authority in delegation, and finally the rights of delegation. Accordingly, the paper provides a strong theoretical framework that can guide future developments and studies in nursing delegation.
The Premises Underlying Delegation Decision-making
The process of delegation decision-making constitutes various premises in that all the decisions regarding delegation of different nursing tasks are based on the need to protect the health, welfare, and the safety of the greater population seeking health care services. As a result, the Boards of Nursing are charged with the responsibility of regulating the nursing practice. Here, the Boards of Nursing should communicate comprehensible principles of delegation and well-defined guidelines for the decisions made in delegation.
In that case, the RNs are given the final responsibility and answerability in the management and delivery of various nursing services through their active participation in formulating all managerial decisions, making healthcare policies, and nursing care delegation (NCSBN, 1995).
Moreover, due to the limited number of RNs that can satisfy all the available nursing tasks, there is the crucial need for unlicensed nurses or NAPs who should be competent and adequately supervised to accomplish the delivery of safe, affordable, and quality nursing services. However, it is worth noting that the NAPs are equipped to help RNs and thus, they are not authorized to replace the RNs or re-delegate any task assigned to them.
On the other hand, there is the need for licensed nurses/RNs to uphold the principles of knowledge-based nursing practice by ensuring that they employ their specialized skills, professionalism, and discretion in the delivery of nursing care (Whitehead, Weiss & Tappen, 2009). Therefore, despite that certain nursing tasks are eligible for delegation; it is obvious that other practice-pervasive duties such as assessment, nursing judgment, and evaluation should not to be delegated.
Furthermore, since all healthcare consumers are entitled to services that meet the legal standards of nursing care, there is the paramount need for both the RNs and their assistants to carry out all delegated tasks relative to the acceptable protocols, practices, and policies in nursing practice (Kelly, 2010, p. 190). Here, the RNs should determine and retain accountability for the outcome of delegated tasks because all the mistakes arising from inappropriate delegation or performance of unauthorized tasks by NAPs can lead to legal implications for both the RNs and the NAPs.
The Regulatory Perspective of Delegation
As mentioned earlier, the Boards of Nursing have the ultimate responsibility of regulating the nursing practice through setting standards and guidelines concerning the process of delegation. Thus, the Boards of Nursing provide a legal framework that outlines the managerial policies and responsibilities regarding the hiring and utilization of RNs and NAPs in nursing care (NCSBN, 1995). On the other hand, given that nurses are charged with the responsibility of determining the nursing practices that are in the best interest of their clients, there is the need for one to act as the patient’s advocate if one notes that the delegated duty is unsafe for the patient.
The correct use of authority in delegation
It is the duty of the RNs or any other delegating authority to carry out an individualized assessment of the patient’s needs and other situational circumstances, and also to evaluate the competence of the NAPs before delegating any nursing duties. Therefore, the delegation decision is reached after adequate assessment, proper planning, implementation, and appropriate evaluation. Additionally, the process of delegation decision-making depends on the skills held by the delegates, the powers given to the delegating nurse as provided by the law and the individual competence held by the nurse relative to the task in question.
The Rights of Delegation
There are five major rights of delegation, which form an integral part of the decision-making process. These rights include the right task, the right circumstances, the right person, the right directions or instructions or communication, and the right supervision. Taken together, these rights serve to facilitate delegation decision-making and therefore, ensure that safe nursing practices are followed to the letter.
Conclusion
This term paper reviews the concept of nursing delegation by considering the premises that constitute the process of delegation decision-making, the regulatory perspective of delegation, the correct use of authority in delegation, and the five rights of delegation. From the discussions above, delegation is the process of transferring a responsibility from one individual to another and retaining the answerability of the outcome.
Thus, nursing delegation allows RNs to delegate certain nursing tasks to other healthcare workers to accomplish the ever-increasing need to provide quality, accessible, timely, and affordable healthcare services without stretching the available healthcare workers to the limit.
References
Kelly, P. (2010). Essentials of nursing leadership and management (2nd ed.). Delmar: Cengage Learning.
NCSBN. (1995). Delegation: concepts and decision-making process, National Council Position Paper. Web.
Whitehead, D.K., Weiss, S.A. & Tappen, R.M. (2009). Essentials of nursing leadership and management (5th ed.). USA: F.A. Davis Company.