Throughout my time in nursing school, on into assuming the role of a nurse, delegation in nursing was definitely a very important topic to master in a society where legal matters and considerations always abound. With nursing gradually evolving into a very autonomous profession, it's great to see just how much control has shifted from Physicians, to nurses. Gone are the days where physicians would walk into a room, and all the nurses were just expected to immediately rise from their chairs; standing at attention, with pristine uniforms, shoulders square, and all other mannerisms absent except in recognition of a clear superior authority. This is just one, of many, stories that my nursing professors would relay to me regarding just how much the profession of nursing has evolved since they endured the rigorous demands of their nursing curriculum "back in the day".
With time, and a wealth of research providing a solid foundation for nursing practice in our profession, delegation in nursing is just one of the many hallmarks of operating within the confines of such an autonomous field. Proper delegation in nursing does require a degree of mastery, however, that goes beyond the basic material presented in nursing course textbooks and NCLEX preparatory books. This mastery begins with one's exposure to the world of nursing, most likely in a hospital setting, during one of their university's required morning clinical rotation. Most students, by the time they become seniors, have already been exposed to a plethora of information regarding the fundamentals of communication, legal and ethical issues, as well as, delegation in nursing.
While these are all very important issues to master, unfortunately, they come with practice, which requires time. Just as your communication skills will become molded with each new patient that you care for, as you continue to operate in the clinical setting, you will become more and more accustomed to the many healthcare professionals that will practice directly under your supervision. Whether they be Licensed Practical Nurses (LPNs) or CNAs (Certified Nursing Assistants), you will develop a collaborative, working, relationship established on a strict adherence to professionalism, that you will also have with your immediate supervisors.
Just like how you will have your own scope of nursing practice, as a registered nurse, so also will they have a clearly defined scope of practice that you must understand, in order to ensure safe delegation of even the most simple tasks. Your patients, or residents, will essentially become paying customers, and will submit to your solid knowledge base, as well as, your fully competent holistic care. Effective delegation in nursing is directly related to your autonomy and will be a critical element in your ability to manage care, especially when faced with oftentimes seemingly overwhelming nurse to patient ratios in the clinical environment.
When discussing delegation in nursing, a registered nurse must understand that they ultimately remain accountable for the safe and effective deliverance of nursing care. This is true no matter what the setting of practice may be. On the other hand, whenever a task is delegated, the transference that occurs is one of responsibility and authority, while the registered nurse does maintain all accountability. For this reason, it is imperative that the registered nurse be ever cognizant in ensuring that the appropriate task is delegated to the appropriate people, at the appropriate times, or legal recourse could certainly be grave.
With responsibility being an element of delegation, this transference includes an obligation to complete a given task that is passed on from the registered nurse to whoever may be given the assigned task. As we spoke about earlier, while responsibility and authority for the completion of a task may be transferred, accountability, although it may be shared at times, typically always lies on the shoulders of the supervising registered nurse. For this reason, it is imperative that the registered nurse really know his/her LPNs and CNAs that they will be supervising.
Another element of delegation in nursing requires a registered nurse to only delegate tasks for which they are responsible for. While this may be a no brainer, one too many times has a nurse gotten into trouble for delegating a task that doesn't really fall within their own scope of practice. The inverse could possibly be true if a registered nurse delegated a task that only fell within their scope of practice, rather than that of an LPN or CNA. Flushing with Heparin is just one, of several, tasks that should really only be done by a registered nurse.
When approaching the subject of delegation in nursing, one must realize that there are ultimately 6 criteria that must be met. In order for delegation to occur, a task must satisfy the six rights that have become well-known consistently from nursing textbook to nursing textbook:
#1)The Right Task – There a certain tasks, in the clinical arena, that are simply outside of the scope of practice of a Licensed Practical Nurse or a Certified Nursing Assistant. Regardless of how comfortable they may feel in performing a particular task, the Registered Nurse can be held liable if a task is delegated that otherwise shouldn't have been delegated.
#2)The Right Person – A task must only be delegated to a person who has the knowledge, skills, and ability to perform the task in a safe and effective manner.
#3)The Right Time – Delegation in a crisis is typically frowned upon because of the unstable nature of the situation, however, one of the benefits of being a registered nurse is that, with such a solid foundation in education, that you will make an appropriate nursing judgment regarding this criteria.
#4)The Right Information – Even though a task may be delegated to another, the registered nurse does maintain accountability for the safe and effective deliverance of care. For this reason, it is always imperative that the registered nurse not only provides correct information regarding how a task is to be conducted, but that they also ensure competency and ability and that they maintain this supervision at all times.
#5)The Right Supervision
#6)The Right Follow-Up – Satisfying this particular criterion may take many forms from a verbal to a written follow-up.
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