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.16-18 In this model, nurses must
be competent with the delegation process. Nurses
are faced with increasingly complex delegation decisions.
Berkow et al19 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.16,20
Ineffective delegation practices resulting in
negative patient outcomes have been reported.20,21
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.20
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.
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.16-18 In this model, nurses must
be competent with the delegation process. Nurses
are faced with increasingly complex delegation decisions.
Berkow et al19 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.16,20
Ineffective delegation practices resulting in
negative patient outcomes have been reported.20,21
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.20
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.
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