The Delegation Process
The use of the RN-NA care delivery model is likely to continue as organizations strive to contain costs and maintain quality. In this model, nurses must be competent with the delegation process. Nurses are faced with increasingly complex delegation decisions. Berkow et al reported that the delegation proficiency of newly licensed nurses, who comprise more than 10% of a typical hospital’s nursing staff, was ranked lowest among 36 competencies by frontline nurse leaders. Both novice and experienced nurses may have an unclear understanding of their accountability for implicitly delegated tasks in the NA job description.
Ineffective delegation practices resulting in negative patient outcomes have been reported. The larger number of actual or potential negative patient outcomes resulted from lower level tasks such as ambulating, toileting, bathing, feeding, and
skin care. Factors leading to negative outcomes, such as falls, were most often related to RN-NA direction/communication or RN supervision. These basic care activities are so routine that NAs may become complacent in carrying out these activities, and RNs may become less vigilant in supervising these activities. Whereas nurses must have a clear understanding of their accountability for delegation at the RN-NA microsystem level, the chief nursing officer has the
ultimate accountability for compliance with delegation standards.