Sample Research Paper on Australian Nursing task delegation

Delegation in Healthcare

Nursing practice is a multidisciplinary collaboration exercise in which individuals with different capabilities perform distinct roles. Different categories of nurses have distinct role descriptions assigned to them by the Australian code of practice for nurses. Additionally, delegation practice has to take these different levels of competency into consideration. Through case analysis, this paper presents an overview of what nursing delegation looks like and the scope of activities, responsibility, and accountability involved in the exercise.

Part A: Nursing Task Delegation

Different team members have different qualifications and responsibilities. As such, they are likely to have different tasks delegated to them depending on the case characteristics, the complexity of the case, and the duration that the case has been ongoing. The chart below shows the specific individuals who will be assigned to handle cases related to patients.

Case Cases to be handled by
1 – CARR, Dorothy (65) EN; AIN; RSN
2 – WEBSTER, Joshua (45) EN; SRN
3 – CHURCHILL, Isobel (68) EN; SRN
4 – RUBEN, Bill (43) EN; AIN
5 – Joe Black (65) AIN; RSN
6 – Peter Mendel (79) EN; AIN
7 –Marie Rossi (75) EN; AIN

From the schedule shown above, the enrolled nurse (EN) will be engaged with all the patients and will be responsible for conducting delicate procedures for all the patients. She will also be considered the supervisory personnel during the shift, with the responsibility of assigning specific roles as she deems fit. The EN has the same level of education and competency as a registered nurse, and the national government registers both. Both an enrolled nurse and a registered nurse are bound by the ethical code of conduct and would be subjected to the same level of accountability for the roles they play in inpatient care (Nursing and Midwifery Board of Australia, 2016a). However, the other team members, namely the experienced assistant in nursing (AIN) and the registered student nurse (RSN), are considered to be non-nurse personnel, and as the delegation framework says, they should work under close supervision by the RN. The RSN can never work independently even after delegation, while the AIN can work on routine procedures and medication activities as long as an RN is close by for ease of supervision.

For this shift, the EN has been scheduled to be responsible for all patients. On patients with various routine activities on which the AIN can work, he/she will work under the close supervision of the EN. The first case of 65-year-old Dorothy presents a typical example of a case that would require the contribution of both the EN and the AIN. The patient presents with various comorbidities, which require continuous monitoring (4/24); requires assistance from 2 people as she moves on a wheelchair; has a wound that requires dressing; is on medication, and has an IV cannula. The EN will be responsible for performing high specialization procedures such as the administration of the IV cannula for both patient one and patient five who need the process, and administration of medication. The AIN will provide the assistance needed in toileting, and wound dressing. In case the EN decides to delegate the medication administration, she has to be there during the actual administration process for supervision. The Australian Nursing & Midwifery Federation (2015), provides the guidelines for delegating medication tasks to non-nurse personnel in Australia. These guidelines can be applied to the different cases requiring medication, including in the case of the second patient. The EN will also perform incentive spirometry monitoring. Other roles for the EN will include food/fluid assessments, constant follow-up on patients requiring 4/24 h monitoring.

The relatively routine care procedures, such as those required by Ruben Bill and Joe Black, are assigned to the AIN. The AIN may work alone but has to be under the direct supervision of the EN, who needs to be either with the AIN at the time of performance or close by for ease of consultation. The RSN can never work alone but can work on the simpler tasks such as medication administration for different patients, as directed and under the supervision of the EN.

The roles and responsibilities of each of the team members are clearly defined with respect to the delegation. According to Marume, Ndudzo, and Chikasha (2016), the general principle of delegation is that the person to whom a task is delegated should have the capacity and qualification to handle the task. The individual delegating has to ensure that the person he/she is delegating to, is effectively qualified for the task. This general principle is followed even in the nursing delegation as reported by NMBA (2007). On the other hand, the person to whom a task is being delegated has to confirm his/her capability to handle that task and to communicate where challenges are so that a way of addressing those challenges is found (Tompkins, 2016). In the healthcare environment, delegation is even more challenging as there has to be a definite framework for the delegation process, through which the patient, who is the direct subject of the care process, has to approve of the person to whom the care task is assigned.

For this particular task, the people to whom activities are to be delegated include the enrolled nurse (EN), the registered nurse (RN), an experienced assistant in nursing (AIN), and a second-year registered student nurse (RSN). Each of these positions is associated with definite roles and responsibilities and has to follow various procedures in order to accept a delegation or to delegate care responsibilities. In order to delegate, the roles and responsibilities of the delegating members are common regardless of their position and job description. It is the responsibility of the delegating party to ensure that the person to whom a care activity is being delegated is both confident and capable of conducting that activity. The first responsibility of a delegating party is to conduct a comprehensive assessment of the patient. This assessment has to be conducted by the registered nurse in collaboration with the patient. Secondly, the delegating party confirms that the healthcare facility of operation has sufficient capacity in terms of resources, staffing, and access to additional assistance where necessary. The next role of the delegating team member is to conduct a risk assessment with the RN based on legislation, the complexity of the care scenario, the health status of the patient, the required skills and knowledge set for providing the required care, and professional standards to be followed during the care activity. From the risk analysis, the team member has the responsibility of determining the best person for the job, confirming the availability of the intended recipient of the delegation activity, confirming local policies, and confirming the possible outcomes of the delegation.

Different responsibilities are performed when delegating to different parties, depending on their qualifications and practice certifications. When delegating tasks to an EN, for instance, the RN has to ensure that the EN has the competency, education, and experience to perform the assigned task; confirm the accountability standards expected in performing the task with the EN; and confirm the level of competency, confidence, and capability of the EN. In case any of these elements required prior to delegation is missing, the task should not be delegated. Cashin et al. (2017), emphasize the importance of competency when assigning nursing roles under any circumstances. As such, delegation to non-nurses such as the AIN or SRN would require careful consideration of their capabilities and close supervision by the EN. The Nursing and Midwifery Board of Australia (2016), also points out that the delegation to non-nurses has to be after confirming their ability to maintain patient safety and provide quality care with or without close supervision depending on the circumstances under which they are to perform the assigned roles. The second responsibility of the delegating party is to validate the non-nurses readiness to take up the responsibility and to be held accountable for his/her actions. The RN should also evaluate the competency, supervision, and education of the non-nurse and confirm that they would be in a position to supervise the performance of the delegated activity. In case the RN would not be accessible for supervision, the task should not be delegated.

When accepting a delegation, on the other hand, the team member to which the care responsibility is being delegated, who may be the EN, RN, AIN, or the RSN, should first confirm that the RN delegating the task has conducted a comprehensive assessment of the patient and is able to provide effective guidelines towards patient handling. The second responsibility during acceptance of a delegation is to confirm that the task to be delegated is within the scope of the individual’s responsibilities and that he/she is competent enough to perform that task. The accepting party should also confirm his/her accountability and responsibility towards performing the delegated task. Additionally, he/she should consider his/her competence, confidence, and education towards performing the task. Finally, he/she can accept the task or refer the delegated task to a registered nurse who has sufficient skills and competency to perform the task.

Part B

A delegation framework is provided to be followed during any decision to delegate a care activity to another party. The delegation framework clearly stipulates that when an RN is to delegate a care activity to an RSN, the delegator must first confirm his/her ability to supervise the work, the competency of the delegatee, and the delegatee’s willingness to take up the assigned responsibilities. For the EN in this shift who assigned patient medication to an RSN, the liability would be in the hands of the EN as the supervisor. Robinson (2013) defined three essential components of delegation, which need to be satisfied before the delegation can be considered effective. The first of these components is responsibility.

Robinson (2013) describes the five rights of delegation. The rights include the right task, right circumstance, right person, right supervision, and right direction. According to the facts of the case, only two rights can be said to have been satisfied since the task at hand, medication, is a task that can be delegated; and the right circumstance, i.e., the need for the SRN support inpatient care. The Nursing and Midwifery Board of Australia allows only the registered nurse to delegate and supervise the delegated responsibilities to an SRN (Nursing and Midwifery Board, 2016). As such, both the right person and the right supervision were not provided in this case. The EN is not allowed to delegate tasks to the student, neither is she/he allowed to supervise the task performance by the SRN. The right protocol would have been for the EN to seek authorization from the RN in shift and then the RN to supervise the role performance. Since there was no RN in shift, no task was supposed to be delegated to the SRN.

The EN, therefore, has the professional duty to dependably and reliably provide patient care. While the RSN should have known what to do and what to monitor the patient for (penicillin resistance) and may be blamed for the mishap, he is not subject to any national nursing laws as delegation is guided by the principles described by the Nursing and Midwifery Board of Australia (2016), and the EN was not mandated to delegate any task to him/her. This implies that the EN, if truly registered, should have had the professionalism to provide care to Mr. Ruben reliably, and that goes for the work conducted under his/her supervision. The inability to supervise that work to a positive outcome implies that the EN was negligent in his/her responsibility. Russell, Williamson, and Hobson (2017), confirm that the inability to satisfactorily perform a task within a nurse’s mandate amounts to professional negligence.

When evaluating negligence, the four premises for determining whether an employee was negligent in his/her responsibilities are used. The first is to determine whether the EN had a duty of care to the patient. Since the EN had been delegated to perform the medication administration role is within his/her scope of duty, there was a duty of care owed to the patient. Secondly, there was a breach of this duty of care. Since the EN delegated a duty that was theirs to an SRN whom they should not have delegated to, they breached that duty of care. Third, the duty of care should have caused harm to the person owed. The reactions that the patient experience was as a result of the medication because it has been established that the patient was allergic to penicillin. Since the reactions resulted from the penicillin in the administered drug, the harm can be directly attributed to the breach of duty of care. Finally, the damage was a foreseeable outcome of the breach. By virtue of the result that the experienced allergic reaction is a common outcome of penicillin administration to those with allergies to it, the damage can be deduced to have been foreseeable.

Conclusion

Delegation in nursing practice requires the consideration of various roles and responsibilities of nurses with different qualifications. The delegators and the delegates have a role to play in the delegation process, making choices as to the next course of action and coming to a conclusion regarding their expectations. Registered nurses and enrolled nurses are tasked with more responsibilities and more complex tasks. They are also mandated to delegate tasks to AINs or to registered student nurses and are thus more likely to be held professionally accountable for the failure in delegated tasks.

References

Australian Nursing & Midwifery Federation. (2015). Delegation by registered nurses (Guideline). Retrieved from anf.org.au/documents/policies/G_Delegation_RNs.pdf

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., et al. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266. Retrieved from www.collegianjournal.com/article/S1322-7696(16)30003-8/fulltext

Marume, S.B.M., Ndudzo, & Chikasha. (2016). The essence of the principle of delegation of authority. Journal of Research in Humanities and Social Science, 4(6), 10-14. Retrieved from www.questjournals.org/jrhss/papers/vol4-issue6/C461014.pdf

NMBA. (2007). A national framework for the development of decision-making tools for nursing and midwifery practice. Retrieved from www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx

Nursing and Midwifery Board of Australia (2016). Enrolled nurse standards for practice. Nursing and Midwifery Board of Australia. Retrieved from www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx

Nursing and Midwifery Board of Australia (2016a). Registered nurse standards for practice. Nursing and Midwifery Board of Australia. Retrieved from www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx

Robinson, L. (2013). Delegated practice: 5 ‘rights’ of delegation. Queensland Government. Retrieved from www.health.qld.gov.au/__data/assets/pdf_file/0017/427022/ahdeltraining5.pdf

Russell, K., Williamson, S., & Hobson, A. (2017). The Art of Clinical Supervision: the Traffic Light System for the Delegation of Care. Australian Journal of Advanced Nursing, 35(1), 33+. Retrieved from link-gale-com.ezproxy.cqu.edu.au/apps/doc/A510936806/AONE?u=cqu&sid=AONE&xid=779ac0c