Nursing Leadership

Delegating

Inappropriate staffing is one of the major threats to patient safety and the well-being of nurses in a hospital setting. Nursing Councils all over the world have always insisted on the importance of appropriate staffing to provide an adequate match in relation to the needs or the patient and the nurse abilities. In fact, Aiken, Clarke & Sloane (2002) note that the rate of health complications and death rises when there is a disproportionate in the number of registered nurses care for patients. Unfortunately, health care is continuously changing including the roles and responsibilities of qualified and licensed medical personnel. Similarly, the number of licensed care providers such as registered nurses or licensed practical nurse is limited in some areas prompting care to extend to unlicensed assistive personnel. When various aspects of nursing care are delegated beyond the licensed caregivers, it is imperative to understand the delegation process and the state nursing practice act so that the process can be executed safely and effectively.

Registered Nurse Delegating to Unlicensed Assistive Personnel

In Florida, Chapter 64B9-14 delegation to unlicensed assistive personnel asserts that the delegator must use their nursing judgment to evaluate the suitability of the task or activity being delegated (Florida Board of Nursing, 2007). Some of the factors to consider before delegating tasks include, the complexity of the task, potential harm to the patient, predictability on the outcome based on the status of the patient, the level of interaction and communication with the patient, and resources in the patient setting. The Registered Nurse should delegate the standard daily assignment of the Unlicensed Assistive Personnel as per the institution or agency job description. During the delegation process, the Registered Nurse, who is the delegator will communicate to the UAP, and identify the tasks, the desired outcome, the limit of authority, estimated period of the delegation, and nature of supervision needed. It is also the responsibility of the Registered nurse to verify the qualification of the delegate alongside their understanding of the assigned role. Allocation of tasks, periodic assessment of the accomplished work, and nursing care responsibility remains with the Registered Nurse transferring or assuming the supervision role. Among the duties and activities the registered nurse can delegate, Section 464.003(3) (b), F.S prohibits the delegation of the following tasks. Some of these include tasks, not within the scope of practice of the delegating nurse and activities that require the nursing process, specialized knowledge, the judgment of a qualified nurse or skills of registered nurse. For instance, activities that require initial or subsequent nursing assessments, determination of nursing diagnosis and interpretation, the establishment of nursing care goals, and evaluation process are some of the activities that cannot be delegated to the UAP.

Delegating in the ICU Unit

Driven by economic necessity, the use of UAP personnel has substantially increased in the health care system. Nevertheless, compared to a general medical-surgical unit, the ICU is a highly complicated and stressful unit, with high levels of workloads. The ICU is intended for critically ill patients, who require specialized care and constant surveillance to stabilize their health (Martinez, 2016). In this context, the ICU unlike the medical-surgical unit demands extreme caution when delegating tasks to Unlicensed Assistive Personnel. Thus, it is important for the registered nurse delegating tasks to understand that they remain accountable for all the needs of the patient despite their delegation. In case the registered nurse delegates aspects of patient care outside the scope of practice of the Unlicensed Assistive Personnel, the patient’s health is in potential risk as this is not something the UAP is prepared to undertake. The practice is also illegal because it jeopardizes the life of the patient and the reputation of the hospital.

Personal Reflection

Perhaps, one of the most challenging responsibilities, when I was starting as a Registered Nurse, was delegating tasks to others and especially to Unlicensed Assistive Personnel. Although the state nursing board and the hospital management is clear on delegation, I was a bit skeptical. In fact, I felt that the same amount of time spent explaining to someone was equal to the time I needed to complete the task. Unfortunately, for me, this always left me with so much work to do at the end of the day leaving me extremely exhausted. However, with time, I realized that delegation is a very useful management tool when done right. It not only relieves the registered nurse to attend to complex issues affecting the patient but also helps the assistive personnel develop their nursing skills. From experience, I now find it easier delegating certain tasks to others. Nonetheless, I must admit that although I have significantly improved my ability to delegate tasks, I tend to under-delegate activities. Part of major concerns emanates from the fact that delegation errors are some of the primary factors in malpractice lawsuits against registered nurses. My constant worry is that the UAP might make a mistake and compromise my nursing license.

Personal Experience

One busy evening, as a Registered nurse together with my colleague we were assigned the responsibility of caring for ten hospital patients in the general medical-surgical unit. Unfortunately, my partner was summoned later by a surgical doctor to assist with surgery in the emergency room, leaving me alone. However, my colleague recommended that I could take Ruth, an unlicensed assistive personnel who was not busy in another department to come and help me out. At first, I was a bit hesitant and wished a qualified nurse was available. Eventually, I had to delegate her to assist me around the unit before my colleague completed her task in the emergency room. Beyond assessing Ruth’s abilities to perform, as a legal protection act, I was not in a position to know whether Ruth was competent enough working without supervision. It was also not possible to ask my colleague as she was already in the emergency room. My only option was to delegate and ensure close supervision and proper communication from both of use before she undertook any task.

Style of Communication

Cultural Misconceptions due to Differing Styles of Communication

Communication and culture equally influence each other. The culture where individuals are raised influences the way they communicate as well as communication can change their culture. According to Giri (2006), culture provides people with implicit knowledge on how to behave in various situations and how to perceive other people behavior. Unfortunately, sometimes communication and personal values may present a problem alongside differing expectations and priorities across the divide. Especially, concerning the case study, working in an organization where language is a problem, cultural misconceptions are likely to occur due to differing communication styles. People are more likely to misunderstand each other and react in ways that can prevent an otherwise promising collaboration. Another major misconception that is likely to occur is due to non-verbal communication. Some people may mean one thing, while the other group interprets a very different thing from simple gestures, facial expressions, sense of time, personal distance, seating arrangements among others.

Handling Cultural Misconceptions and Communication Styles

Helping others to understand our cultural frames and references, knowledge of other people cultural differences are equally significant. The first step to handling cultural misconceptions is appreciating other patterns of cultural differences, which can assist in processing how it feels to be different in a respectful manner. According to Kiss (2005), when confronted with an interaction that is hard to interpret, it is important to take control of the situation to avoid being construed as discriminative of others. Another thing that can eliminate cultural misconceptions is collaboration across cultural lines both as individuals and as a community. Knowing of other people’s cultural differences does not have to divide us, rather it should be a way of exploring our similarities and recognize our differences as we figure the way forward. Learning about other people’s cultures has the potential to show us about our weaknesses and challenge us to change our attitude and come up with new ways to solve problems. 

Case Study Analysis

Amy is a new hire with only one-year nursing experience and has been assigned to a preceptor on second shift. Although she is extra quiet, she is eager to learn and become part of the Emergency Department. The facts that her preceptor does not talk to her, direct, or do relegate her responsibility towards Amy as a preceptor implies there is a problem. From a personal view, it seems that the two have severe communication problems or some other problems. It is my responsibility as a manager to ensure that the receptor is thorough in her duties and that Amy gets the relevant training. Firstly, a preceptor is an experienced practitioner who acts the role of a supervisor in a clinical setting. Their work is to facilitate the transfer of theory into practice for staff learners of a student nurse. Usually, the preceptor works together with the learner for a designated period to assist the trainee in acquiring competency necessary for safe, ethical, and quality practice. In this case, confrontation may not be the best approach as it may demoralize the preceptor causing more troubles for Amy in the future. The best way to approach the issue is by initiating communication. Start by asking the preceptor how about Amy and the progress of her training. Is Amy showing any positive response and is she showing interest? Most likely if it is a problem with Amy, the preceptor is likely to open up and raise their concerns. If it is her problem, an effective leader should be able to analyze her attitude and plan the next step. In case the preceptor fails to open up, the only option left is to confront the receptor. The manager has the responsibility to ensure that proper training is passed on to the trainee and they adhere to the training offered. As it is, it is clear that Amy is already getting along with the Registered Nurses from second shift. Practicing alongside Registered Nurses is one way for Amy to acquire first-hand practical experience on various ways to handle patients and offer quality care. By allowing Amy to continue working with the Registered Nurse alongside the guidance of her preceptor will provide the best orientation for her.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), pp. 23-30.

Florida Board of Nursing. (2007). Nurse Practice Act: Rules of the Board of Nursing. Florida Department of Health. Retrieved from: https://phsc.edu/sites/default/files/program/files/Nurse-Practice-Act.pdf

Giri, V. N. (2006). Culture and Communication Style. Review of Communication, 6(1-2), pp. 124-130.

Kiss, Gabriella. (2005). Managing cross -cultural communication challenges toward a more perfect union in an age of diversity. Communications, 4(2), pp. 215-223.

Martinez, P. L. V. (2016). The Health Care System and Training Specialist in Intensive Care Medicine and Emergency in Cuba. Journal of Intensive and Critical Care, 2(3), pp. 1-8.