[NRSKarenRN]

From Nursing Spectrum
Lorraine Steefel, RN, MSN, CTN
Monday April 9, 2007


Nurses Need to Learn the Art of Delegation

Nurse Smith* is a proponent of the "I'd rather do it myself" syndrome. No matter how busy she becomes on the med/surg unit, Smith won’t delegate tasks to unlicensed assistive personnel (UAP) — individuals trained to provide patient care in an assistive role to RNs.

“I want to make sure the care of my patients isn’t compromised,” Smith says. “And I don’t want to jeopardize my nursing license.”

In this era of nursing shortage and cost containment, delegation to UAP is a given. With an understanding of the basics and some practice, nurses can transform delegation into an art form — assuring patients’ quality of care while avoiding malpractice issues.

“By following the true meaning of delegation, RNs will facilitate safe, effective care for patients,” says Leo-Felix Jurado, RN, CNA, APN,C, PhD(c), president of the New Jersey Board of Nursing...

[pickledpepperRN]

If I remember this is not substantially changed.
It is good but the real problem is with uncertified and unlicensed personnel whose competency the RN is not certain of.
When I float at my hospital I know who is a certified nursing assistand (CNA) and that they are competent to take vital signs, ambulate patients, and keep track of I&O if it is oral intake and urine output.
I'm one who would rather do it myself if it is a person unknown to me who is not even certified. Once a UAP told me, "I can't count the pulse."
It was over 100 and she couldn't count that fast. I appreciate her honesty because I've known some who make up vital signs.

We need to remember the RN assigned to the patient is responsible for assigning tasks not delegating responsibility.
A licensed person (LVN/LPN) or certified caregiver (CNA) is responsible for performing the task correctly.

I personally think that in a hospital all personnel caring for patients should be licensed or certified. Then their minimum competency is known and a background check is done.

[DusktilDawn]

Originally Posted by spacenurse

If I remember this is not substantially changed.
It is good but the real problem is with uncertified and unlicensed personnel whose competency the RN is not certain of.
When I float at my hospital I know who is a certified nursing assistand (CNA) and that they are competent to take vital signs, ambulate patients, and keep track of I&O if it is oral intake and urine output.
I'm one who would rather do it myself if it is a person unknown to me who is not even certified. Once a UAP told me, "I can't count the pulse."
It was over 100 and she couldn't count that fast. I appreciate her honesty because I've known some who make up vital signs.

We need to remember the RN assigned to the patient is responsible for assigning tasks not delegating responsibility.
A licensed person (LVN/LPN) or certified caregiver (CNA) is responsible for performing the task correctly.

I personally think that in a hospital all personnel caring for patients should be licensed or certified. Then their minimum competency is known and a background check is done.

Lack of certification and licensure can leave big questions for the delegating nurse regarding the education, training, and competency of those they delegate to. Not only should they all either be licensed or certified, they should be responsible and accountable for their own actions AND reporting appropriately. This lack of responsibility and accountability towards those we delegate is part of the issue. WE ARE RESPONSIBLE FOR WHAT WE DELEGATE, which makes delegating a catch-22 for nurses. You can be darned if you do and darned if you don't.

You brough up a good point, regarding working with staff that you know are competent to do their job. I certainly becomes an issue when you are put into a position where you are not familiar with the staff and therefore do not know their competency. It really should be an employer's responsiblity to ensure and validate the competency regarding the staff THEY hire as assistive personel. Certification and licensure would be one way to do this.

[yajaira]

These are all good points...I think as nurses we are also in a position to educate staff we work with in order to promote a aura of competency "on the clock".

I think this is easier to do than adding on more work, it instills confidence in the crew and a sense of rapport. This also establishes an abilty for nurses to trust those who work under them.

Though I think the institution should have hirer standards for thoose they hire.

[bethem]

Originally Posted by DusktilDawn

responsible accountable responsibility accountability RESPONSIBLE responsiblity

Recent post-grad study has highlighted to me that while responsibility can be delegated, accountability cannot. We are accountable for the actions of the ones we delegate to, but if we delegate a task such as getting the vital signs, they are responsible for ensuring it is carried out and ensuring that they are competent to perform do it. They are accountable if they accept a task that they do not feel competent to perform and do it anyway, with potential adverse effects. Accountability is increased as autonomy and authority are increased and, as I said, cannot be delegated, while responsibility can be passed on.

Although it's all just semantics, I certainly agree with the spirit of your post.