Delegation Example in a Health Care Setting

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Delegation Example in a Health Care Setting

Introduction

In a health care context, delegation is always necessary to allow a nurse manager to delegate some responsibilities to his or her junior nurses. Nurse case managers are the registered nurses (RN) who by virtue of their stature and complex responsibilities must develop the ability and skills of delegating some work to the assistant nurses (Weiss & Tappen, 2014). However, delegation is a complex nursing skill that demands final accountability and sophisticated clinical judgment. Therefore, its effectiveness depends on individual’s nursing experience, and understanding of the fundamental concepts of accountability, authority, and responsibility. Notably, RNs use Work Complexity Assessment (WCA) tool to analyze the skills and knowledge of the delegates before assigning them the responsibilities (Persily, 2013). Objectively, delegation in nursing aims at improving quality patient care and enhancing the coordination between the senior and ancillary personnel.

Undoubtedly, effective delegation is one of the most intricate and complicated responsibilities of RNs. It is imperative for RNs to understand what the patients and their families need, after which, they have the task of appropriately engaging the caregivers (Persily, 2013). As such, it is obligatory for them to develop a plan that would result to the desired patient outcomes and maximizing the use of available resources. Also, the senior nurses assign some responsibilities to nursing assistants, unlicensed assistive personnel (UAP), or licensed vocational personnel (LVP) by providing relevant directions, guidelines, and regulations (Weiss & Tappen, 2014). In order to categorically understand the whole concepts of delegation in a health care context, this paper organizes all the sections entailed. In particular, the rudiments include the delegation process, issues, stakeholders and how to choose them. In addition, it highlights the plan of action during delegation, which entails communication, conflict resolution, feedback provision, evaluation, and recommendations (Persily, 2013).

Delegation Model or Process

National Council of State Boards of Nursing (NCSBN) defines delegation as a process which involves transferring of responsibilities, directions, or guidelines of patient care to competent individuals (In Cherry & In Jacob, 2014). The RNs act as the delegators, who assign their co-workers the authority to care for the patients. The process entails selecting particular subordinate nurses to perform specific tasks, which they are well acquainted with. As a result, prior to the actual delegation, the RN must understand what the patients need and then match the needs with competent health care assistants (HCAs). However, the delegator remains accountable and responsible for the rationale of the delegation if in case something goes wrong. For example, if the UAP, HCA, or LVP administers a wrong medication to a patient, RN will also be held liable for assigning an incompetent nurse (Persily, 2013). Similarly, the nurse shall also be accountable for his or her ineptness in performing the task.

Objectively, delegation gears towards achieving quality patient care outcomes, where liable persons are held responsible and accountable. The concept is about sharing of activities with individuals who possess the appropriate authority. The sharing and collaboration herald efficiency and effectiveness in care and facilitate synergistic positive outcomes (Weiss & Tappen, 2014). Evidently, delegation has four main components namely; quality care outcomes, responsibility and accountability, sharing activities, and selection of the appropriate authority.The general procedure of delegation is summarized in the figure below

Figure 1: Shows the general procedure of delegation

Source: (Hansten, & Jackson, 2009)

Example: Delegation process

At St. Mary Hospital, Mr. Robert, a RN, had many TB Patients that he had to attend to. He, therefore, decided to call Miss Effie, a nurse assistant, who was free at that time. So, in order to follow the whole procedure, Robert first assessed the needs of the patient and the scope of the task to delegate. He then ensured that Effie was competent and well versed with the needs; thus he communicated to her about the assignment by explain all the guidelines, directions, and responsibilities. After which, Effie left to execute her task, and the RN clarified that he shall be conducting surveillance and supervision to ensure that all was well. In addition, Effie was to evaluate her patient care results and report the feedback to Robert.

Delegation Issue in the Workplace

Principally, delegation has some issues that it must comply to since the whole process is complex and involves multiple stakeholders. Therefore, it is very critical for the RN to model on what, where, how, to who to delegate a task (In Cherry & In Jacob, 2014). RNs may delegate the tasks or some elements of patient care, but the overall nursing process cannot be delegated. In addition, the delegation should not be beyond the scope or competence of HCA. Also, the process of delegation must be done in order to benefit the patient, but not merely performing it to save money or time (Persily, 2013).

When nursing assistant performs the task, he or she must keep records concerning the state of the patient. The records should be regularly submitted to the RN to monitor and supervise the conditions of the patients. In essence, as the HCAs do their assignments, they should ensure that the task is within their capacity to handle (Hansten & Jackson, 2009). If in case a complication arises, they should not assume by continuing to care for the patient, but should immediately report to the RN. The RN shall then take over the case and address the care intricacy. The point is each, and every HCA should understand his/her scope or boundary of work, anything outside that must be reported to the senior nurse (Weiss & Tappen, 2014). If so, then patient care seems to be given the priority, which ought to be the primary goal of the nurses.

Example: Knowing the Boundaries

Miss Effie, the HCA goes to care for the patient as directed by Robert. Before then, Robert assigned her to go and note all the symptoms that the patient was showing, which she actually well understood and had the knowledge. In the process of caring and noting, she realizes that the patient has some form of cardiac complications. Although Effie is competent and experienced in the basic aspects of TB, she is aware and prospects that the cardiac complication seems lethal and to treat it would mean she is working outside her competence sphere. She also knows that the complication has not been assessed by Robert, the RN.

As a result, Effie reports the case to Robert, who then takes over to care for the complication. As such, Effie is said to have acted in accordance with the guiding protocols of delegation in the workplace and is able to justify her actions. From the case, Effie has demonstrated her awareness and understanding of responsibilities and accountability towards the patient (Persily, 2013). Robert examines the patient and realizes that the complication is worsening and should transfer the patient immediately to the Intensive Care Unit. He contacts the hospital supervisor, who informed Robert to engage other health stakeholders to successfully transfer and treat the patient.

The Stakeholders and Different Health Care Roles

Because of the complexity of the health status of the patient, there was an urgent need for collaborative function of various nurse practitioners. According to the case study, the patient had to be transferred to the ICU, where nurses from Cardiac/Coronary Unit (CCU) were required. In addition, other nurse practitioners, patient’s family, and hospital administrators cooperated to ensure the safety, quality, value, and flow of the healthcare provision to the patient (In Cherry & In Jacob, 2014). The inter-professional care shall ultimately drive and result in the highest quality of patient care. Notably, every stakeholder has his or her area of competence; thus, there integrated efforts will save the patient (Hansten & Jackson, 2009). The patient’s family also has the role of receiving information and supporting the patient. Below is a list of relevant stakeholders and the roles they play.

The Stakeholders

Robert, CCU RN – As the RN, he coordinates the transfer to the CCU and collaborate with the CCU Nurses for reception and commencement of treatment by coordinating to the relevant doctors.

CCU Nurses – Ensure that the patient is received, and all the conditions are recorded. They also coordinate with Robert and doctors before, during and after the treatment.

Medical Surgery Nurses – Prepares the patient for surgery if in case the doctor recommends

Medical Laboratory Technician – Collects samples like blood, saliva, and phlegm from the patient for testing and reports the results to nurses and physicians concerned.

Respiratory therapist – Does the chest therapy to monitor that status of the TB and the reason for cardiac complication

Hospital ICU Coordinator/Supervisor – Coordinates with the other practitioners in passing information, transferring and receiving the patient and ensuring proper housekeeping

Physician/Doctors – Work with the nurses to treat the TB and the cardiac problem. They also inform nurses to communicate unfolding to the patient’s family.

Friends and Families of the Patient – Provide relational support to the patient and receive information from the nurses and doctors.

How to choose the right Stakeholders

When choosing the stakeholders, it is important to consider a number of factors and issues. For example, the patient’s case should demand the contribution of each and every stakeholder (Weiss & Tappen, 2014). In addition, their presence should increase the probability of saving the patient or offering the best quality care. Also, each and every person’s role should be integral to cumulative well-being of the patient and build a broad-based support and synergy in patient care (Persily, 2013). In sum, the choice of the stakeholders is a function of the mentioned parameters and the following considerations.

•The number of stakeholders must be kept manageable to avoid overemphasis in one patient at the expense of others. However, there should not be a loophole in competence or role in order to care adequately for the patients.

•All the stakeholders should be competent and relevant to the patient’s condition. This ensures completeness and lack of ineptness in the healthcare provision.

•The balance of interest or roles ought to be maintained so as to facilitate coordination and collaboration in the process of caring.

The contributive roles of the stakeholders should ensure improved acuity of the patient and encourage the use of UAPS and Licensed Practical Nurses (LPN). Again, RN responsibilities of management need to increase in the units of care in order to accelerate the pace of patient’s recovery.

Action plan

Healthcare plan outlines all the partners, credentials, and the procedure to follow during the delegation process. First, the overall RN must notify and inform all the stakeholders of the healthcare plan. Through coordinated information, all the relevant practitioners receive prior notification about the condition of the patient and what is expected of them (Hansten & Jackson, 2009). As such, the notification gives the stakeholders ample time to prepare and refine their tools, instruments, and skills.

Then transportation logistics is done, where the patient is transferred to the surgery department and received by the nurse in charge. Thereafter, nurses in the medical surgery prepare the samples for further test then the patient is seen by the relevant doctor for surgery and further treatments

Proper housekeeping must be maintained in the patient’s room in order to ensure sanity and proper care of the patient and the family. Notably, clean environment is mandatory when caring for patients because they are vulnerable to subsequent infections.

After the diagnostic results, the patient is immediately taken to CCU for the cardiac checkups. At this stage, all the stakeholders with relevant competence should strive and work in collaboration, with the priority of saving the patient.

After, the family of the patient has to be informed of all that unfolded. However, the mechanism of communication ought to be encouraging and respectful of humanity. The aim of communication is to give hope to the family.

Lastly, proper evaluation of the whole treatment process or record has to be evaluated and then the overall feedback is provided.

In sum, the action plan involves proper communication with the healthcare stakeholders. In the process, the practitioners resolve conflicting aspects of their operations then provide appropriate evaluation and feedback at the right time.

Components of the Action Plan

How to Communicate With the Stakeholders

The communication should be concise and clear when the RN is notifying the delegatees. The communication must clearly highlight all that is expected of the subordinate nurses. Also, all the information concerning the patient’s conditions should be given to the HCAs (Weiss & Tappen, 2014). In addition, Proper directions, authority, guidelines, and expected outcomes need to be communicated to the HCA.

How to Resolve Conflicts

By default, conflicts always occur among the health care stakeholders; therefore, there if the need to arrive at positive resolutions for the betterment of the patient. In order to resolve the conflict and possibly avert it, proper and respectful communication has to be imperative. This builds mutualism amongst the co-workers and enhances cooperation (Persily, 2013). Also, acceptable behaviors and conducts must be outlined in prior to provide the framework for decisions and roles. The conflict should also be viewed as an opportunity for improving and strengthening relationships and future cooperation (Hansten & Jackson, 2009). Thus, in case of the conflict, it should be approached head-on without postponement so as to resolve it once for all. Other measures include promoting teamwork and limiting blame games.

When to Provide Feedback

The feedback should only be provided if the information has been proved as valid and pertinent. Therefore, all the stakeholders need to append to the information to confirm its reliability and validity before the feedback is given to others or the patient families (Weiss & Tappen, 2014). Reliability of the feedback is a function of properly followed standards and protocols in accordance to the healthcare accreditation system. Also, the feedback needs to be given in time in case of inquiries and complaints from other healthcare providers, the patient, or families (Hansten & Jackson, 2009).

How to evaluate the problem solved

In order to evaluate whether the problem has been solved, the RN has to once again assess and analyze if all the procedures of delegation and stakeholder participation were followed (In Cherry & In Jacob, 2014). For example, the RN should assess and monitor the health status of the patient by considering if the principles of delegations that were followed. That is, what was the initial health status of the patients? Did the HCAs have all it required to care for the patients in relation to their care context and scope? Lastly, did the HCA execute their responsibilities using all the skills, knowledge, and competence they hold? If all the questions were positively addressed, and the patient’s outcome is positive coupled with good relationship amongst the stakeholders involved, then it is right to conclude that the proper solution was found.

Recommendations

In order to ensure proper communication, leadership, conflict resolution, feedback, and evaluation, five main rights must be followed. Effective delegation ensures that the rights are adhered to when guiding and planning for the overall process of patient care (Hansten & Jackson, 2009). Thus, the rights should act as the reference point for the entire decision-making, concept, and as a checklist for the model of assigning responsibilities and authority to HCAs and other stakeholders. The rights include:

Right Activity or Task

The RN’s professional judgment concerning the task to be delegated should be appropriate and within the scope or boundaries of the HCAs. Also, the RN ought to assess the exact health of the patient so as to delegate the right task.

Right Circumstances

The context of delegation should be appropriate in relation to the available resources, and nature of the health setting. All the situational factors should be considered in order to delegate with the available provisions.

Right Person

The RN should be the right person with skills, experience, and competence for delegation. In addition, the tasks should be assigned to the right HCAs, who understand their responsibilities and accountabilities.

Right Communication

Concise and clear illustrations of the tasks are mandatory to ensure that objectives, expectations, limits, and persons to give feedback are clearly described.

Right Direction/Supervision

The RN must accomplish his or her role in monitoring, intervention, and evaluation according to the need and time required. That will ultimately result in the best positive patient care and feedback.

Conclusion

Delegation is an important and powerful tool in a hospital setting to assign responsibilities and authority from the delegator (RN) to the delegatees (HCAs). The primary rationale for delegation is to distribute roles in relation to workers’ experience, skills, and knowledge in order to achieve efficient and effective health care provision. From the case study of St. Mary hospital, it is important to define the scope of delegation and because of the complexity; various stakeholders may be required to ensure that synergistic positive outcomes are achieved. Critical factors must also be considered when choosing the delegates and stakeholders so as to avoid inefficiencies and ineffectiveness in patient care. In sum, through the application of appropriate rights, the delegation process becomes effective in terms of communication, conflict resolution, provision of feedback and evaluations. In health care setting, delegation is complicated but mandatory.

References

Hansten, R. I., & Jackson, M. (2009). Clinical Delegation Skills: A Handbook for Professional Practice. Sudbury, MA: Jones and Bartlett.

In Cherry, B., & In Jacob, S. R. (2014). Contemporary Nursing: Issues, Trends, & Management.

Persily, C. A. (2013). Team Leadership and Partnering in Nursing and Health Care. New York, NY: Springer Pub. Co.

Weiss, S., & Tappen, R. (2014). Essentials of Nursing Leadership & Management: Concepts, Connections & Skills. Philadelphia: F. A. Davis Company.