Question

How do the principles associated with delegation and supervision figure into this case? How would you decide this case?

N520- Legal and Ethical Issues in Health Care

Answer 1

Ans. Delegation, simply defined, is the transfer of the nurse's responsibility for the performance of a task to another nursing staff member while retaining accountability for the outcome. Responsibility can be delegated. Accountability cannot be delegated. The delegating registered nurse remains accountable for all client care despite the fact that some of these aspects of care can, and are, delegated to others.

Proper and appropriate assignments facilitate quality care. Improper and inappropriate assignments can lead to poor quality of care, disappointing outcomes of care, the jeopardization of client safety, and even legal consequences.

For example, when a registered nurse delegates aspects of patient care to a licensed practical nurse that are outside of the scope of practice of the licensed practical nurse, the client is in potential physical and/or psychological jeopardy because this delegated task, which is outside of the scope of practice for this licensed practical nurse, is something that this nurse was not prepared and educated to perform. This practice is also illegal and it is considered practicing outside of one's scope of practice when, and if, this licensed practical nurse accepts this assignment. All levels of nursing staff should refused to accept any assignment that is outside of their scope of practice.

The "right" person

The "right" task

The "right" circumstances

The "right" directions and communication and

The "right" supervision and evaluation

In other words, the right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct the person doing the task or job. The nurse supervises the person and determines whether or not the job was done in the correct, appropriate, safe and competent manner.

The client is the center of care. The needs of the client must be competently met with the knowledge, skills and abilities of the staff to meet these needs. In other words, the nurse who delegates aspects of care to other members of the nursing team must balance the needs of the client with the abilities of those to which the nurse is delegating tasks and aspects of care, among other things such as the scopes of practice and the policies and procedures within the particular healthcare facility.

Some client needs are relatively predictable; and other patient needs are unpredictable as based on the changing status of the client. Some needs require high levels of professional judgment and skill; and other patient needs are somewhat routinized and without the need for high levels of professional judgment and skill. Some client needs are acute, ever changing and/or rarely encountered; and other patient needs are chronic, relatively stable, more predictable, and more frequently encountered.

Based on these characteristics and the total client needs for the group of clients that the registered nurse is responsible and accountable for, the registered nurse determines and analyzes all of the health care needs for a group of clients; the registered nurse delegates care that matches the skills of the person that the nurse is delegating to.

For example, a new admission who is highly unstable should be assigned to a registered nurse; the care of a stable chronically ill patient who is relatively stable and more predictable than a serious ill and unstable acute client can be delegated to the licensed practical nurse; and assistance with the activities of daily living and basic hygiene and comfort care can be assigned and delegated to an unlicensed assistive staff member like a nursing assistant or a patient care technician. Lastly, the care of a client with chest tubes and chest drainage can be delegated to either another registered nurse or a licensed practical nurse, therefore, the registered nurse who is delegating must insure that the nurse is competent to perform this complex task, to monitor the client's response to this treatment, and to insure that the equipment is functioning properly.