Health Care Assignment: Delegation in Nursing Management

Question

Task: Scenario 1 Case details
You are the recently graduated registered nurse working on a unit that practices patient-focused care. The particular unit practices a version of patient-focused care consisting of one registered nurse, one enrolled nurse, and one nursing assistant for a group of patients.

You as the registered nurse, delegate tasks to the nursing assistant and assigns care that the enrolled nurse is permitted to do according to the registering bodies in Australia. The nurse completes report at 0730. The nurse has the following assignment for the 0700 to 1530 hrs shift:

Bed 1: Mr. R is 42 years of age and is a male patient who is legally blind. He is S/P (status post) lithotripsy for renal calculi. He is ambulatory with assistance. He needs to strain his urine when he voids, and he needs to drink 2 to 3 litres of non-caffeinated liquids during the shift. He also needs ice packs applied to his right flank. The next ice pack is due at 0730 hrs.

Bed 2: Ms. M is 85 years of age and is a female patient diagnosed with new onset atrial fibrillation (AF) that is being monitored by remote telemetry. She is on an IV medication that requires titration. She also has Alzheimer’s disease and has a tendency to wander off. She needs constant direction during bathing and needs to be reminded to eat during meals.

Bed 3: Ms. S is 65 years of age and is a female patient who is S/P abdominal hysterectomy who needs a blood transfusion. The blood bank called and stated that the first unit of packed red blood cells will be sent at 8 AM. She has an initial dressing change that will need changed when the surgeon rounds at 8 AM. She currently has an IV of NS at 125 ml per hour via an infusion pump. She has multiple IV medications ordered. She has a 20-gauge IVC site on her right forearm that is flushed and capped and available for the blood transfusion. She has just called to the nursing station that she is nauseated and in severe pain.

Bed 4: Mr. J is 70 years of age and is a male patient who is S/P transurethral resection of the prostate (TURP), done yesterday. He is going to be discharged home at 1000 hrs. He needs discharge teaching.

Bed 5: Mr. T is 72 years of age and is a male patient who is scheduled for a transurethral resection of the prostate at 1100 hrs. He needs preoperative teaching.

Bed 6: Ms. A is 50 years of age and is a female patient who is scheduled to go to the hemodialysis unit at 0800 hrs. Someone from the health care team will need to take her via wheelchair.

Bed 7: Ms. B is 55 years of age and is a female patient who is scheduled to go to the OR at 1400hrsfor a vaginal hysterectomy. She should return from the post anaesthesia care unit at 1700 hrs. She has received patient teaching.

Bed 8: Mr. H is 60 years of age and is a male patient who is going to be discharged home at 0800 hrs after a 23-hour hold for pain management related to renal calculi. He passed the two calculi seen on diagnostic testing. He has received his discharge instructions.

In order to prepare this health care assignment, consider the above case scenario and address the following points: Before leaving the handover room, what tasks would you consider delegating to the nursing assistant?

Which patients should the registered nurse care for during the shift and which patients should be assigned to the enrolled nurse and why?

Using the 5 principles of delegation identify what tasks you might delegate to each staff member and why.

Your rationale should be supported by evidence, particularly relevant in Australia.

Answer

Introduction:
According to the investigation carried on this health care assignment, nursing is a professional category that is responsible for the delivery of care and treatment for the sick, wounded, impaired, and suffering conditions. Nursing is indeed important in clinical and environmental contexts for promoting the welfare of patients, families, and societies (Gassas, Mahran&Banjar, 2017). Nurses play an important role in healthcare, administration, policy development, and caring for patients. Nurses who are merely in their training period are also self-sufficient in delivering health care primarily and specialist services to patients, households, as well as neighbourhoods. Nursing professionals work individually as well as collaboratively with several other health care providers such as doctors. Nursing professionals monitor the practice of limited-qualified nurses and are often in charge of supervising the work of nurse practitioners in a variety of environments. In the health care sector, nursing is the most popular, complex, and well-respected amongst other professionals. Nursing has already become quite popular, and forecasts indicate that it will become even more so in the near future. Developments in medical advances, increasing patient needs, and reorganization of health care facilities necessitate an increase in the number of highly trained practitioners.

Principles of Delegation:
To conduct well-planned handovers, one must first determine what details to provide and prioritize, and besides, one cannot have a lot of time to go through a lot of valuable details, especially if it is vital to an individual's wellbeing (Auberry, 2018). The next group of professionals must decide how to direct their efforts first. It is also important to maintain a balance between extensive and disproportionate coverage. One must be able to set up all of the relevant details accurately enough that professionals can better understand and retain them without being confused (Khadim et al., 2018). Perfecting handovers whilst being flexible at how to plan them can assist one in doing this. It is necessary to consider the following three main areas when delivering a successful handover such as the environment and the time, the delivery, and contents. Delegation however is a set of skills that nursing practitioners must learn and employ in order to be competent in using it in the administration of healthcare services. It is a method that requires career learning and critical thought, and it progresses with practice and education (Lynn, 2018). Delegation capabilities are acquired and refined over time. The registered nurses are personally responsible for improving critical thought capabilities. The following guidelines direct and advise medical professionals' delegate decisions:

• The structure and standards of every nursing practice is known to be determined by the respective nursing community.
• The registered nurses are accountable and held responsible for the distribution of effective nursing care.
• When providing care and treatment, the registered nurses guide to provide significant amount of attention and decides the best use of available supports and resources.
• The registered nursesare capable of assigning tasks or parts of significant treatment, and not just the treatment process themselves.
• The registered nurses acknowledge facility or organizational rules and processesalong with the expertise and skills, preparation, diversity knowledge, and experience of any person with whom the registered nurses can assign aspects of treatment.
• The registered nurses' choice to delegate is focused on the valuation of the prescribed treatment of the patient and their complexity, the accessibility and expertise of the person undertaking the delegation, and the form and degree of supervision needed.
• The registered nurses recognize that delegation is a social phenomenon involving reciprocal respect.
• Registered nurses are answerable for evolvingcourses in order to evaluate, track, authenticate, and interconnect current expertise standards in delegation-related fields.
• The management is accountable for delivering enough services to provide for appropriateassignment.
• The organization is known to be responsible for making sure that the registered nurses have admittance to documented competence-based data for professionals to the registered nurses delegated duties.
• Registered nurses are known to actively contribute in the progress of organizationalpolicies on delegation.

Nursing staff often work in high-pressure situations where they often prioritize assignments and quickly make choices. This is partly due to the essence of the practice, but it is also influenced by the ongoing shortage of qualified staff in the nursing field.

Scope of Practice of an Enrolled Nurse and a Nurse Assistant:
As mentioned by Schiller, Pesut, Roussel, andGreig (2019), Registered nurses care for a wide range of patients, from the sick and wounded to those who are well and want to continue that way. Most nurses specialize and mostly deal with certain categories of patients, like newborn infants or people suffering from certain medical problems, such as cancer (Rubio-Navarro et al., 2019). The one most patient interact with on a regular basis is a registered nurse. It is their responsibility to provide medical attention, address queries, and report any complaints to the nursing supervisor. Their role's specific duties may vary based on the specialization and job environment; however, they may include the following:

• Monitoring and documenting the patient's actions (Hughes, 2017).
• Physical examinations and diagnostic testing
• Patient health histories are being gathered.
• Patients and their relatives are counseled.
• Patients are being informed of their medical options.
• Medication administration, wound management, and other recovery services
• Where applicable, interpreting medical knowledge and making recommendations on important behavior.
• To assess the appropriate recovery options for patients, consult with nurse managers and doctors.
• Supervising and guiding the treatment of other healthcare practitioners, such as licensed nurses, qualified nursing assistants, or nurse aides.
• Researching how to boost medical quality and clinical systems.

As opined by Pohan, Waluyo, Irawaty, andMansyur (2017), usually, registered nurses serve in hospital institutions. Moreover, several licensed nurses serve in schools, health centers, workplaces, and patients' homes. Certain registered nurses, classified as traveling nurses, may not have a specific workplace. Rather, they go to places where registered nurses are scarce. Since delegating customer services to members of the nursing staff, the registered nurse's role is far from over (Auberry, 2017). The assigned treatment must be checked upon, and members of staff should be monitored when providing care. The registered nurse is still in charge of and accountable for the consistency, suitability, correctness, and punctuality of all treatment provided. Tracking the treatment given by others entails supervising the care, training and encouraging the professional who is delivering the care, helping the member of staff with priority setting and management skills related to time, as shown, teaching the professional about the correct care provided, as noted by an expertise or skills shortage, and encouraging and positively reinforcing the staff for their performance (Abrams et al., 2018).

An enrolled nurse is basically a newly graduated nurse who is not so frequent with handling patients and taking care of them. Treatment can be allocated depending on the level of training of the specific team member, based on the simple entrance educational readiness discrepancies within these members of the nursing team (Davis, 2018). Furthermore, team members vary in their experience, talents, capacities, and qualifications. A newly licensed qualified nursing assistant cannot be trusted to perform patient care duties with the same degree of competence, ability, and proficiency as a more seasoned nursing assistant or registered nurse. New graduates need time to polish the knowledge they acquired over time. So, basic duties such as checking, giving rounds, and addressing the issue of patients to their superiors must be given to enrolled nurses. Tasks Delegated with evidence:

Rights associated with delegation are-
Right task- Questioning oneself what duties are constitutionally permissible to assign, and should these tasks be delegated in accordance with this company's procedures and policies. Answering these questions correctly would necessitate familiarity with institutional and nursing practice act guidelines. In general, licensed nurses are in charge of appraisal, preparation, and review as part of the nursing process (Zaccagnini, 2019).

Right circumstance- Patients that are or might be unstable, as well as situations with uncertain consequences, are not suitable for delegation. Unlicensed assistive personnel, for instance, might also be necessary to feed patients who need help with tasks of daily life. Moreover, if a patient is at severe risk to develop and has a complex specialty diet, feeding should not be assigned to unlicensed assistive personnel. Right person- If the mission and circumstances are appropriate for delegation, the next “right” of delegation is the appropriate individual. Before delegating a role, the licensed nurse should be aware of the job requirement and prior experience of the delegate. It is equally important to consider the qualification and potential of the delegate as it might be of use later to assign tasks. Until assigning the mission, ask the UAP the following main questions:

• Have you had some training for this task?
• Have you ever seen anything like this for a patient?
• Have you ever completed this mission without supervision?
• How certain are you that you can complete this mission correctly?
• What issues have you had in the past with this task?

Right supervision- In all delegate cases, appropriate oversight must be present. The licensed nurse is required by law to provide adequate oversight over all assigned duties under the Nurse Practice Act. Registered nurses are responsible for health assessment and overall patient care. Nurses must provide adequate oversight, diagnosis, involvement, and supervision on all activities assigned to them. It is equally essential to consider that nurses are responsible for the patient's result and health. Right direction and communication- Eventually, the delegator should provide appropriate guidance and contact to the delegate. Quality goals must be communicated precisely and explicitly by all delegators. The delegate must therefore understand when, how, and when to report back after the mission has been completed. For time-sensitive assignments, delegates often need a deadline for mission completion.

Risks to delegation and actions to mitigate these:
According to Visovsky, Maguire, Zambroski, and Palacios (2017), the registered nurses often lament having too much work and very little time to complete them. If goes untreated, this feeling causes depression and poor management. Supervisors can significantly mitigate their stress in several situations by exercising a vital management skill – delegation. One of the most essential organizational skills is delegation. The delegation that is successful saves energy, improves subordinates, nurtures a successor, and helps to motivate. Poor delegation can result in dissatisfaction, demotivation, and inability to complete the mission or accomplish the goal. Usually, training the successor is the only way to advance. As a result, the superior may take on a different job or voluntarily take on more difficult duties without losing effectiveness. So, clearly, delegation increases productivity but does not relieve managers of their responsibilities.

1. The dread of being disliked.
2. The inability to transfer control in a case.
3. Lack of ability to decide whether and to whom to assign.
4. Previous experience of the delegation did not go well.
5. Lack of faith to advance above the status of beginner nurse.
6. The proclivity to detach oneself and choose to perform all things on one's own.
7. Lack of trust in delegating to professionals who were formerly colleagues.
8. Thinking of oneself as the only one capable of completing a mission correctly.
9. Inability to form working partnerships with other members of the team.
10. Lack of understanding of personnel skills, such as competency, expertise, experience, education level, role description, and so forth (Magnusson et al., 2017).
11. Fear of being seen as incapable of caring for patients on their own.
12. Staff refusing to complete assigned duties is a source of concern.
13. Inadequate logistical assistance
14. Communication capabilities are lacking.

Delegation barriers can be resolved by implementing the following strategies:

1. Accept that delegation is necessary- When supervisors are unable to delegate since they prefer to do everything directly instead of the delegate to subordinates, they must recognize the need for delegation. In reality, the more delegation a firm has, the more competitive it would be.

2. Develop trust in subordinates- Instead of believing that professionals are incapable of taking responsibility such that the delegator may not take the chance of delegation, the delegator must realize that an individual learns by failures and that even if he makes mistakes, he should still attempt to solve the issue (Yoost, 2019).

Conclusion:
Nurses have the right to delegate specific care duties to other eligible and experienced caregivers while ensuring each patient's health, protection, and welfare. Registered Nurses (RNs) decide which duties to be assigned and they depend on other assistive nurses as an integral part of secured staffing. Assistive professionals are used by businesses to provide a cost-effective experience mix. Nursing vacancies, requirements for modifiable quality resultsand research supporting expanded registered nurses' involvement as strengthening nurse-sensitive interventions have enhanced the need to ensure adequate registered nurses staffing, including successful delegation. Delegation relieves the registered nurses of the extra labor that others should perform while also holding the registered nurses accountable for treatment and results. With growing clinical sophistication, nurses will have to use analytical thought abilities to assess the type of treatment, conditions, and ability of assistive caregivers before delegating as this is still a poorly developed ability amongst nurses, and it is difficult to assess.

References:
Abrams, R., Wong, G., Mahtani, K. R., Tierney, S., Boylan, A. M., Roberts, N., & Park, S. (2018). Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocol. BMJ Open, 8(11), e024876. Auberry, K. (2017). Intellectual and developmental disability nursing: current challenges in the United States.

Auberry, K. (2018). Intellectual and developmental disability nursing: current challenges in the USA. Nursing: Research and Reviews, 8, 23-28.

Davis, D. S. (2018).School nursing practice for the 21st century: Assessing scope of practice in the current workforce (Doctoral dissertation, Georgetown University).

Gassas, R., Mahran, S., &Banjar, H. (2017). Nurse managers’ attitude and competency towards delegation in Jeddah City. American Journal of Nursing Science, 6(2), 72-79.

Hughes, M. E. (2017). Nurses storied experiences of direction and delegation.

Khadim, H. A., Ali, A., Ijaz, M. S., &Rooman, N. (2018). Nurse manager’s attitudes and preparedness towards effective delegation in a tertiarycCare Public Hospital Lahore. Natl J Heal Sci, 3, 99-106.

Lynn, P. (2018). Taylor's clinical nursing skills: a nursing process approach. Lippincott Williams & Wilkins.

Magnusson, C., Allan, H., Horton, K., Johnson, M., Evans, K., & Ball, E. (2017). An analysis of delegation styles among newly qualified nurses. Nursing Standard, 31(25).

Pohan, V. Y., Waluyo, A., Irawaty, D., &Mansyur, M. (2017). Development And Application Of ‘Relactor’Nursing Delegation Modelin Indonesia. PROCEEDING UMSURABAYA, 1(1).

Rubio-Navarro, A., Garcia-Capilla, D. J., Torralba-Madrid, M. J., & Rutty, J. (2019). Ethical, legal and professional accountability in emergency nursing practice: an ethnographic observational study. International emergency nursing, 46, 100777. Schiller, C. J., Pesut, B., Roussel, J., &Greig, M. (2019). But it’s legal, isn’t it? Law and ethics in nursing practice related to medical assistance in dying. Nursing Philosophy, 20(4), e12277.

Visovsky, C., Maguire, D. J., Zambroski, C., & Palacios, L. (2017).Bringing evidence-based practice to Latin America: Transforming nursing education and practice.The Journal of Continuing Education in Nursing, 48(11), 512-516.

Yoost, B. L., & Crawford, L. R. (2019).Fundamentals of Nursing E-Book: Active Learning for Collaborative Practice. Elsevier Health Sciences.

Zaccagnini, M., &Pechacek, J. M. (2019).The doctor of nursing practice essentials: A new model for advanced practice nursing. Jones & Bartlett Learning.