One of the expectations of professionals is that they know how to delegate work in such a way that they are effective and more work is done in a timely manner. That is what we are about to look at now.
Several things should be considered when one is making a decision about delegation. They all can be summed up in these questions: [Read slide]
The biggest question to answer is, “Why delegate?” If you are able to accomplish all of your work in a reasonable time, why would you want to delegate? [Some possible answers are to spend more time with patients, to use time to research best practices, to make time available to work with other challenging patients, and to increase skills in holding others accountable and in communicating what is needed for patients.] Few positions exist in most healthcare organizations for which delegation is not a needed skill.
Obvious times to use delegation are when you clearly cannot provide all of the care needed by assigned patients, when the delegatee is highly competent at various tasks that represent a portion of the care your patients require, and when you are ensuring care for another group of patients, such as when a colleague is away from the clinical unit. [Note that this is not a valid statement for staff nurses in California, where the staffing levels must remain the same even during breaks.]
Not so obvious times might be when no reason is apparent for you to use the skills of an assistant. However, practicing delegation during these times allows you to think about how to assess individual skills quickly, how to communicate messages about the help you need, and how to plan for yourself to hold others accountable to you for delegated acts.
Basically, registered nurses work with two types of people to whom they can delegate nursing tasks. These are licensed practical/vocational nurses (called different names based on the state of practice) and unlicensed nursing personnel (who are also known by various names).
Remember that the delegating professional remains accountable and that person cannot delegate a patient to another, only a portion of care. As a result, knowing those with whom you work is really critical to successful delegation.
Several important facts and views about the person to whom you may delegate something should be considered. The best two indicators to start with relate to what the organizational policy is regarding delegation. If the organization makes clear through policy that delegation of certain tasks is unacceptable, it is important to know this before you are in a situation where delegation is possible. The next thing to know is what the position description for a given person is and if any exceptions are noted. For example, an LPN (LVN) might be in a peer assistance program and unable to administer medications, even though the position description may indicate that such is possible. Some institutions provide great detail about tasks UAPs may perform; other institutions speak in generalities about performance.
Next, it is important to know how specific individuals perform and what other responsibilities they have. You won’t be delegating to a position; you will be delegating to a person.
Once you know that someone is trustworthy and available, the next thing to consider is the individual’s knowledge, skill, and attitude in relation to the tasks you are assigning. This does not mean that you will assign only those tasks that someone else wants to do. What it does mean is that you may need to provide greater supervision for some aspects of care.
[Read slide] If you are working with an individual who is assigned to work only with you, you know what that person is involved in and you can convey what to report throughout the day. If you and others are working with an individual, you may need to negotiate with someone else for time when the individual delegatee can work with you. It is not likely that the person will be communicating with you throughout the shift because he has many other people with whom he or she is working. If such is true and you really need help monitoring a particular patient, ask the delegatee to call you immediately if he or she notices specific behavior while passing by this particular patient’s room. In this way, you are expanding the watchfulness for a particular patient even though insufficient assistive staff are available to work directly and only with you.
[Read slide] Remember that the bottom line regarding delegation is safe patient care.
Delegation happens differently in different organizations. For example, in a hospital ICU, where staff may be stable and most care is visible from many vantage points, delegation is easy to implement. The delegator can see what the delegatee is doing. In a community clinic, however, the number of professional staff may be very limited and the opportunity to see what any one delegatee is doing is unpredictable. In this type of situation, it is very important to know what the skills and abilities of each staff member are. Although a rural hospital may also have limited numbers of professional staff, the delegatees tend to be fairly stable. They are members of the community, and they are typically not moving on. The delegator is likely to be the one who taught the delegatee how to perform certain skills, so the delegator has few questions about the nature of the delegatee’s abilities. This is in sharp contrast to major healthcare organizations, where it is likely that a separate department orients and trains new employees. In some large organizations, staff change from one unit to another happens as often as is permitted. Thus, knowing the requirements for positions as the benchmark for holding individuals accountable is critical. The focus of the day-to-day work, then, needs to be on the individual’s performance.
Proper delegation has many benefits for nurses. Delegatees do not substitute for professional nurses; they do expand nurses’ availability for the work that only registered nurses can do.
