Persistent workforce shortages and healthcare budget cuts are making delegation a critical component of contemporary health care delivery (Lee et al., 2015). The health care sector is responding to the various pressures by embracing the support of unlicensed assistive personnel to allow nurses to focus more on patient care and coordination (Wojciechowski, 2019). Assigning some tasks to the non-nurse personnel creates potential liability risks associated with wrongful delegation to the patient, registered nurses, other healthcare providers, and even the health care facility.
A colleague at my workplace, a registered nurse, faced a situation where this practice raised serious concerns. The allowed an unlicensed support worker to provide care to a high-risk stroke patient. The assistive personnel lacked the relevant knowledge, skills, and experience to perform the assigned task – feeding the delicate client. Besides, the colleague did not assess the patient to establish whether the client was able to swallow food, leading to severe complications, including persistent coughing, choking, and drooling of saliva. Therefore, the caregiver failed to demonstrate accountability and responsibility by allowing an unqualified person to attend to a patient with special care needs.
Several missteps could have improved the delegation process and its outcome. First, she failed to assess the support worker to determine whether the assistive staff was qualified to perform the assigned task. Lee et al. (2015) emphasize that only “appropriately trained and supervised support workers” are allowed to help registered nurses to provide medicine and perform other related basic tasks especially to older high-risk patients (p.460). According to National Council of State Boards of Nursing (NCSBN) guidelines, effective communication is critical to safe delegation (NCSBN, 2016).) Registered nurses have a responsibility to describe clearly the assigned task in terms of its goals, expectations, and boundaries (Wojciechowski, 2019). Providing the right direction and communication to the assistive personnel could have improved the delegation process.
Second, assigning the right task would also have ensured a safe process. Existing guidelines allow nurses to shed specific care-related responsibilities which do not require clinical skill or judgment (NCSBN, 2016). For example, assistive workers may feed, ambulate, turn, groom, and dress patients, collect data on vital signs and simple specimens and perform essential medicines support tasks (NCSBN, 2016; Lee et al., 2015). The nurse acted contrary to applicable guidelines because the patient required special attention. Feeding a high-risk stroke patient is a complex task as it necessitates particular nursing expertise (Wojciechowski, 2019). The nurse should have allowed her assistant to perform basic functions such as dressing the client, collecting and reporting vital signs, and restocking supplies. Both the nurse and the assistive staff ought to mutually understand and trust each other and fulfill their responsibilities (Mueller & Vogelsmeier, 2013). Therefore, delegating the complex task to someone with advanced experience and training would have improved the process.
Finally, providing appropriate supervision to the support worker would have helped the registered nurse to avert wrongful delegation. Every nurse is expected to closely monitor, evaluate, and supervise all the tasks they assign to assistive staff (NCSBN, 2016). Mueller and Vogelsmeier (2013) emphasize that nurses are required to demonstrate accountability for safety, progress, and other patient care outcomes. Proper supervision would have created a good opportunity to assess the patient to know if he can swallow safely and foresee possible harm to the client before assigning the task. The assistive personnel could not make such advanced clinical determination. Therefore, providing close supervision before and during the delegation could have improved the outcome of the process.
In conclusion, delegation allows registered nurses to focus on more important duties and responsibilities. The assignee can help in administering basic tasks that do not require specialized knowledge, skills, and experience. However, this practice raises serious concerns because failure to adhere to established guidelines can expose the patient, registered nurse, support worker, and even the healthcare facility to severe risks. Therefore, healthcare providers should remain responsible and accountable for the tasks they assign to unlicensed assistive personnel.
Lee, C. Y., Beanland, C., Goeman, D., Johnson, A., Thorn, J., Koch, S., & Elliott, R. A. (2015). Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study. BMC health services research, 15(1), 460. Web.
Mueller, C., & Vogelsmeier, A. (2013). Effective delegation: Understanding responsibility, authority, and accountability. Journal of Nursing Regulation, 4(3), 20-27. Web.
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. Web.
Wojciechowski, M. (2019). The risks of wrongful delegation. Daily Nurse. Web.