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Nursing Delegation: Top Priorities in a Hospital ER

Career News July 5, 2013

In a joint position paper published by the American Nursing Association (ANA) and the National Council of State Boards of Nursing (NCSBN) there is at present “more nursing to be done than nurses to it.” Both organizations reason that in order to provide the best possible patient care, registered nurses must delegate some patient care tasks to non registered nurses. The staffs to which these tasks are delegated are called nursing assistive personnel (NAP).

NAP is divided into two classes, Licensed Assistive Personnel (LAP) and Unlicensed Assistive Personnel (UAP).

The assistive nursing personnel may be delegated tasks that are normally done by a registered nurse. While the task is delegated, the responsibility for the tasks correct and timely completion is on the Registered Nurse who is held accountable.

The most important aspect of nursing delegation is contained in the joint position paper:

•”The RN assigns or delegates tasks based on the needs and condition of the patient, potential for harm, stability of the patient’s condition, complexity of the task, predictability of the outcomes, abilities of the staff to whom the task is delegated, and the context of other patient needs.
•All decisions related to delegation and assignment is based on the fundamental principles of protection of the health, safety and welfare of the public.”

Few places are more hectic than a Hospital Emergency Room. Clearly, delegating important nursing tasks is the only plausible way for short staffed emergency rooms to meet the challenges of providing quality patient care.

Core Principles for Nursing Delegation

The use of NAPs increasingly demands registered nurses to delegate patient care tasks according to the principles of the ANA. These principles define nursing delegation as the “transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.” Another useful definition is ““transferring to a competent individual the authority to perform a selected task in a selected situation,” Anthony, Standing, and Hertz (2001) (p. 210).

The Principles for Nursing Delegation cited in the joint statement are:

•The registered nurse takes accountability and responsibility for the provision of nursing practice.
•The RN directs care and determines the appropriate utilization of any assistant involved in providing direct patient care.
•The RN may delegate components of care, but does not delegate the nursing process itself. The practice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be delegated.
•The decision of whether or not to delegate or assign is based upon the RN’s judgment concerning the condition of the patient, the competence of all members of the nursing team and the degree of supervision that will be required of the RN if a task is delegated.
•The RN delegates only those tasks for which he or she believes the other health care worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience and facility/agency policies and procedures.
•The registered nurse individualized communication regarding the delegation to the nursing assistive personnel and client situation and the communication should be clear, concise, correct and complete. The registered nurse verifies comprehension with the nursing assistive personnel and that the assistant accepts the delegation and the responsibility that accompanies it.
•Communication must be a two-way process. Nursing assistive personnel should have the opportunity to ask questions and/or for clarification of expectations.
•The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is:

The five rights of delegation are as follows: The right task, under the right circumstances, to the right person, with the right directions and communication, and under the right supervision and evaluation.

•Chief Nursing Officers are accountable for establishing systems to assess, monitor, verify and communicate ongoing competence requirements in areas related to delegation.
•There is both individual accountability and organizational accountability for delegation. Organizational accountability for delegation relates to providing sufficient resources, including:
•Sufficient staffing with an appropriate staff mix
•Documenting competencies for all staff providing direct patient care and for ensuring that the RN has access to competence information for the staff to whom the RN is delegating care
•Organizational policies on delegation are developed with the active participation of all nurses, and acknowledge that delegation is a professional right and responsibility.

By following these nursing delegation principles, an RN functions as a team leader with total responsibility for how the team performs. These principles help him or her delegate efficiently and diligently without abdicating a commitment to excellent patient care.

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