Question

Which nursing theory relates to RN delegation to an Unlicensed Assistive Personnel?

Answer 1

Ans .-  Delegation is the transfer of responsibility for the performance of an activity. Personal liability defines each person's responsibility and accountability for individual actions or omissions.

the services of unlicensed assistant personnel (UAPs) were introduced into nursing teams in hospitals for the provision of direct nursing care. This development was in response to increasing hospitalization costs and the global nursing shortage combined with patients' expectations of receiving immediate, high-level nursing care.

Essential Components of Delegation

Responsibility

Based on individual states’ nurse practice acts, registered nurses have a professional duty to perform patient care tasks dependably and reliably.

Authority

Authority refers to an individual’s ability to complete duties within a specific role. This authority derives from nurse practice acts and organizational policies and job descriptions.

Accountability

Accountability within the nursing context refers to nursing professionals’ legal liability for their actions related to patient care. During delegation, delegators transfer responsibility and authority for completing a task to the delegatee; however, the delegator always maintains accountability for the task's completion. The registered nurse is always accountable for the overall outcome of delegated tasks based on each state's nurse practice act provisions.

Possible legal and ethical constraints arise regarding delegation in nursing. Therefore, the American Nurses Association developed the five rights of delegation to assist nurses in making safe decisions.

Five Rights of Delegation

• Right task
• Right circumstance
• Right person
• Right supervision
• Right direction and communication.

Right tasks

First, Mark needs to determine which tasks are right to delegate. Some questions he may ask at this time would include • which tasks are legally appropriate to delegate and • can I delegate these tasks based on this organization’s policies and procedures? Correctly answering these questions will require familiarity with institutional and nurse practice act guidance. Generally, registered nurses are responsible for assessment, planning, and evaluation within the nursing process. These actions should not be delegated to someone who is not a registered nurse.

Right circumstances

After determining the right tasks for delegation, Mark considers the right circumstances of delegation. In so doing, Mark may ask the following questions: (1) are appropriate equipment and resources available to perform the task, (2) does the delegatee have the right supervision to accomplish the task, and (3) is the environment favorable for delegation in this situation? To appropriately answer these questions, it is imperative that Mark completes an assessment on each client. Patients who are or may become unstable and cases with unpredictable outcomes are not good candidates for delegation.

Right person

If a task and circumstance are right for delegation, the next “right” of delegation is the right person. Mark needs to consider if the potential delegatees have the requisite knowledge and experience to complete delegated tasks safely, especially concerning the assessed patient acuity. Before delegating a task, the registered nurse must know the delegatee’s job description and previous training. Mark may be unsure about his potential delegatee’s qualifications. Therefore, he might ask the following questions before delegating a task: (1) have you received training to perform this task, (2) have you ever performed this task with a patient, (3) have you ever completed this task without supervision.

Right supervision      

The right supervision must be available in all delegation situations. Nurse practice acts require the registered nurse to provide appropriate supervision for all delegated tasks. In the case study, Mark must be sure that the delegatee will provide feedback after the task is complete. Following task completion, Mark is responsible for evaluating the outcome of the task with the patient. Registered nurses are accountable for evaluation and the overall patient outcomes.

Right direction and communication      

Finally, the delegator must give the right direction and communication to the delegatee. All delegators must communicate performance expectations precisely and directly.[3] Mark should not assume that his delegatee knows what to do and how to do it, even for routine tasks. Mark must consider whether the delegatee understood the assigned task, directions, patient limitations, and expected outcomes before the delegatee assumes responsibility for it. The delegatee also must comprehend what, how, and when to report back after the delegated task is complete. Delegatees also need a deadline for task completion for time-sensitive tasks.

Reasons Delegation is Necessary for the Modern Health Care Environment

Improper Delegation

Improper delegation can negatively impact patient care while also potentially exposing the delegator to legal action. All members of the health care team have valuable contributions to make toward safe, effective patient care.

Essentials of Communication

While employing the five rights of delegation in nursing practice, it is important to remember that the way the delegator asks the delegatee to perform a task can make a big difference. The delegator must use direct, honest, open, closed-loop communication to encourage teamwork and safe task performance. Of the five rights of delegation, the right communication and direction are arguably the most important in ensuring good quality and safety outcomes. Common delegation deficiencies for registered nurses occur when delegating tasks to unlicensed assistive personnel. These include unclear delegation directions from the registered nurse, a lack of retained accountability and follow-through, and the failure of the registered nurse to obtain the agreement of the unlicensed assistive personnel.

Unlicensed assistive personnel (UAP) are unlicensed health care providers trained to function in a supportive role by providing patient/client care activities as delegated by the RN. The term includes, but is not limited to nurse aides, orderlies, assistants, attendants, or technicians.

Importance of Delegation in Nursing

Nurses have a variety of duties and, in many cases, a large number of patients in their care. Because patient care requires many time-consuming tasks, delegation is a vital tool to helping nurses spend their time in the most productive ways possible.

The responsibilities and duties of a UAP include: Observing, documenting and reporting clinical and treatment information, including patients' behavioral changes. Assisting with motion exercises and other rehabilitative measures.