Introduction
Today, more than ever before, it is evident that the capability to delegate tasks to others is increasingly becoming a fundamental competency for nursing professionals in various practice settings. Owing to the convergence of factors such as the proliferation of sicker and older patients, shortage of registered nurses (RNs) in practice settings, increased daily workload and numerous cost and budgetary constraints, nursing professionals are expected to delegate some of their roles to unlicensed assistive personnel (UAP) with the view to assuaging some of the stress arising from these factors (Craftman, von Straus, Rudberg, & Westerbotn, 2012; Saccomano & Pinto-Zipp, 2011). The present paper investigates the concept of delegation in professional nursing practice, including its description and components, tasks and relationships, legal authority for delegation, and complexity of decision-making related to delegation.
Delegation: Description and Components
The American Nurses Association (ANA), cited in Saccomano and Pinto-Zipp (2011), has defined delegation in terms of “the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome” (p. 523). Available literature demonstrates that delegation has not only been described as an art and a skill, a management conception, a legal construct and a decision-making process (Plawecki & Amrhein, 2010), but also as a process of assigning work to others and a condition of mutual understanding by both parties of what specific outcomes are expected and how these outcomes can be attained (Potter, Deshields, & Kuhrik, 2010).
Drawing from this exposition, it is evident that the most important components of delegation for registered nurses and other nursing professionals in various practice environments across the United States include supervision, monitoring, evaluation as well as follow-up. According to Eaton (2009), supervision basically entails availing directions and comprehensible anticipations regarding how the delegated task is to be performed, scrutinizing the performance of the delegated task to ensure compliance with conventional standards of practice, intervening according to specific situations and contexts, as well as ensuring appropriate documentation of the task. Evaluation entails the assessment of the client, appraisal of the performance of the delegated task, as well as provision of feedback. Within the domain of delegation literature, monitoring entails the process of ensuring the delegated task or role is being completed safely and competently in the manner that is required, while follow-up entails further observation of the situation to ensure task acknowledgement and review (Eaton, 2009; Saccomano & Pinto-Zipp, 2011).
Tasks and Relationships
Owing to the fact that professional nurses must remain accountable to the task or role being delegated to the UAP, it follows that the UAP must demonstrate adequate competency and skills in fulfilling the delegated role to the highest expectations (Saccomano & Pinto-Zipp, 2011). This implies that nurse professionals are supposed to first evaluate the task at hand against the skills and competencies of the available UAP, before making a decision on the best UAP to handle the task according to the skills required to ensure successful patient outcomes and quality of care. In the same vein, available nursing scholarship acknowledges that the execution or collapse of delegation is largely reliant on a constructive dual relationship of mutual respect and trust between the nursing professional and the particular UAP charged with the responsibility of overseeing the delegated task (Potter et al., 2010; Saccomano & Pinto-Zipp, 2011). In delegating the roles, therefore, nursing professionals such as RNs should consider the UAP who not only demonstrates the capacity to work in closer collaboration with the professionals, but also exhibits the willingness to respond in a timely and appropriate manner (Craftman et al., 2012).
Legal Authority for Delegation
Available literature demonstrates that delegation is a legal conception that refers to the transferring to a competent person the authority to perform a specific nursing role in a particular context (Craftman et al., 2012); that the delegating RN is professionally accountable to the UAP and is legally obliged to follow the prevailing code of conduct informing such delegation (Eaton, 2009); and that the RN is professionally and legally liable in the event of delegating responsibility to an incompetent UAP (Potter et al., 2010). As acknowledged by these authors, most states and nursing associations in the United States authorize RNs to delegate nursing roles to the UAP.
Consequently, it can be argued that RNs get the legal authority to delegate tasks and activities to the UAP from state nurse practice acts and legislations which are to a large extent responsible for defining the legal considerations for nursing practice. However, most of these acts are clear that (1) the RN must ensure the proficiency and proper management of the UAP to facilitate the delivery of affordable, quality health care, (2) the RN should allocate or delegate roles based on the needs and condition of the patient, possibility for harm, consistency of the patient’s condition, involvedness of the delegated role, predictability of the outcomes, capabilities of the staff to whom the role is delegated and the context of other patients’ needs, and (3) the RN must always ensure that all decisions related to delegation are grounded on the deep-seated doctrines relating to the protection of the health, safety and welfare of the public (Craftman et al., 2012; Plawecki & Amrhein, 2010). Overall, in delegation, RNs and other nursing experts must always remember that they are professionally accountable for the delegated task and legally liable for the resulting outcomes or consequences.
Complexities of Decision-Making in Delegation
It is indeed true that RNs are often faced with competing and contradicting complexities in their attempt to delegate tasks to the UAP. For example, in making a decision on the suitability of a task for delegation, RNs may face difficulties as they attempt to prove that the task is within the scope of practice of the delegating UAP, or if there are any regulatory requirements and restrictions for the task. Similarly, in making a decision on the competencies and skills of the UAP, RNs often face difficulties in proving if the UAP has current and appropriate skills, knowledge and education to delegate. Additionally, RNs are often not provided with the resources and time needed to monitor the UAP in the performance of delegated tasks, not mentioning that the RNs are not facilitated with an enabling environment to evaluate all the factors and associated risks that need to be considered before making a decision on delegation (Eaton, 2009; Saccomano & Pinto-Zipp, 2011). It is important to note that all these complexities bear professional and legal connotations for the RN, implying that caution should be taken in addressing them to avoid further challenges.
Conclusion
This paper has successfully addressed the concept of delegation in professional nursing practice, including providing detailed accounts on, among other things, the description and components of delegation, the tasks and relationships influencing delegation to a specific individual, the legal authority for delegation, and the complexity of decision-making related to delegation. Overall, it appears that RNs need to be empowered further to become effective in delegating tasks to the UAP in an arrangement that will in turn ensure the delivery of quality and patient-centered care in the healthcare setting.
References
Craftman, A.G., von Straus, E., Rudberg, S.L., & Westerbotn, M. (2012). District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulation and practice. Journal of Clinical Nursing, 22(3/4), 509-578.
Eaton, J. (2009). Delegation: A powerful tool in the right hands. Learning Disability Practice, 12(8), 30-31.
Plawecki, L.H., & Amrhein, D.W. (2010). Legal issues. A question of delegation: Unlicensed assistive personnel and the professional nurse. Journal of Gerontological Nursing, 36(8), 18-21.
Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered nurses and nursing assistive personnel. Journal of Nursing Management, 18(2), 157-165.
Saccomano, S.J., & Pinto-Zipp, G. (2011). Registered nurse leadership and confidence in delegation. Journal of Nursing Management, 19(4), 522-578.