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When Delegating Assignments to Your Team Members
According to the code of ethics of American Nurses Association (2010), any delegation of duties is based on the Registered Nurses’ judgment concerning competency of the nursing team, patients’ conditions, and the degree of supervision required for Registered Nurses (RN). The RN should consider five rights of delegation when delegating duties. These include: right task, right circumstances, right person, right direction/communication, and right supervision/evaluation. To support the above rights, delegating of roles requires Registered Nurses to analyze and make decisions basing on the needs of patients, competency of team members accepting the delegation, complexity of the work and time the work is expected to have been done. For example the patient in Bed 2: Mrs. Lighthouse, who is 45 years, and works at the college of nursing. She is well conversant with what she expects from the facility, hence the need to assign a competent RN to assist her.
In addition, when considering whom to assign to the task, delegation requires that they should be timely informed regarding the patient while defining specific expectations and clarification of any adaptation of the task. The RN should consider context of the individual situation before providing the needed guidance and support by a delegated Licensed Practical Nurse (LPN) or Personal Care Aide (PCA). To support this factor and consider the patient in Bed 4: Mrs. Rowing, who is 70 years old, arrived from the skilled nursing facility. This patient has had increases in confusion, hence the need to continuously monitor her situation and relay information timely to the team leader for quick response in case of any expectations.
When delegating duties, RNs should consider the ultimate accountability for outcomes and processes of care (Marquis, & Huston, 2012). It means that the RN retains the outcomes even of those he/she has delegated. It should be considered when delegating the patient of Bed 1: Mr. Jones, who is 80 years, is complaining of rib pain and shortness o breath. Due to the fact the team members have diagnosed him, they should be accountable for any eventuality, even if there is the option of delegating him to another RN or LPN.
Issues That Determine Tasks to Be Delegated
Delegation being the client-specific should be considered and held with accountability. RNs, LPNs, PCAs can only perform the delegated duties for that client. It means that the activities delegated are directed to those clients with predictable outcomes. Clients with minimal risk and uncertainties do not require any application of nursing procedures. When the client’s outcome is less predictable, the nurse has no obligation but to delegate this patient to higher health care providers. The delegation also should take place only within the client’s best interest, hence it determines to whom should be delegated the task.
In case of emergencies, or when the delegate has no necessary formal expertise, RN can delegate the tasks if he/she believes that the client is at the risk greater than of not being delegated to the other RN, LPN, or PCA. In this case, the Chief RN will be required to provide supervision and appropriate instruction until the situation is contained. Other issues that determine the delegation of task include the overall outcome of intervention, the delegate’s knowledge, judgment, and sufficient skills to accept the delegation. Competency should also be considered effectively, ethically, and safely, in respect to the agency procedure and policy in performing intervention (Weydt, 2010).
Role of the RN in the Emergency Room
In respect to the Registered Nurses in the emergency room, they are the stewards of healthcare resources; hence promote cost containment for health care providers. Through delegation, RN maximizes the available human resources in the interest of demanding patients, while working effectively to alleviate rising patient acuity and increased need of therapy. It is the role of RN to care through providing and determining what can be delegated to the teamm members. When RNs are skilled delegators, PCAs and LPNs’ technical expertise can be maximized for the benefits of patients. Concerning this, RNs should understand the concept of time management, leadership, responsibility, authority, and accountability.
Responsibility in this case infers that every other team member is liable and answerable for the actions of another. It involves liability for desired performance when assigned a specific role, hence a two way process that involves both an accepted and allocated role. It means that any personnel or team member accepts responsibility when they agree to perform it.
Accountability, on the other side, involves retrospective reviewing, which includes critical thinking in determining the action that is appropriate in giving answers to what has already occurred. RNs should demonstrate accountability at any time in emergency rooms when answering for themselves and for others concerning the issues of care. It also includes verification that the receiving person accepts delegation while accompanying responsibility at any time.
Authority is another prerequisite for Registered Nurses in the Emergency Room. Authority in itself is a virtue that entails professional licensure, hence RNs have the authority to transfer some selected roles and activities to the competent team members. RNs have the right to act in the areas they are given in the Emergency Room, hence the need of accepting responsibilities. The role of RNs in regard to authority is to analyze assessment, legitimate power, plan nursing, exercise the nursing judgment, and evaluate it.
Finally, in delegation process, accountability is bestowed within the domain of RNs, while responsibility rests within their performance in respect to a particular task. When the Registered Nurse delegates roles to PCAs and LPNs, they should be accountable for administration and safely performing the task, according to the established standards and regulations for completing the activity. Registered Nurses can delegate work to the team members without being held for their deeds and actions.
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