Overview and Summary: Delegation Dilemmas: Standards and Skills for Practice

Nurses have authority to assign selected activities of care to other qualified and competent helpers while protecting the health, safety, and welfare of every patient. Registered Nurses (RNs) determine the tasks that can be delegated; they rely on other assistive caregivers as a necessary component of safe staffing. Organizations rely on assistive workers to provide a cost-effective skill mix. Threats of nursing shortages, mandates for reportable quality outcomes, and data supporting greater RN presence as improving nurse-sensitive measures have increased the urgency to ensure appropriate RN staffing inclusive of effective delegation. Delegation unburdens the RN from unnecessary work others can do, while the RN retains accountability for care and outcomes. With increased complexity of patients, nurses increasingly must use critical thinking skills to evaluate the type of care, circumstances, and competence of assistive caregivers prior to delegation. Delegation remains an underdeveloped skill among nurses, and one that is difficult to measure. It relies on personality, communication style, and cooperation. The success or failure of delegation depends on a positive two-way relationship of mutual respect and trust between the RN and the helper who assumes responsibility for specific tasks. This dynamic exchange between the RN and the helper requires constant evaluation, feedback, and modification to achieve the results needed to meet patient care goals. The six initial articles in this topic address a variety of considerations that are important in successful delegation. These considerations include traditional and emerging thought about the common skills necessary for delegation and the unique challenges across practice settings. A number of common themes emerge in this topic. First is the importance of understanding the legal authority to delegate to other qualified individuals. In the United States (US) each state issues its own definitions and regulations regarding delegation, whereas there is no legal definition of nursing in the United Kingdom (UK), making delegation even more challenging. Additionally, in any practice setting, developing trust is a fundamental requirement for successful delegation. Nurses' delegation skills develop over time, building on critical thinking, and growing from being uncomfortable delegating to others to being confident in this delegation process. Competence in delegation is as important for the nurse as are other cognitive or psychomotor skills. This competence requires ongoing education and development. The influence of delegation on quality and safety outcomes should not be underestimated. Growing sophistication in our ability to measure nurse-sensitive outcomes creates an imperative to assess the contributions of all who contribute to care under the direction of the RN. The initial articles in this topic offer a variety of resources to help nurses develop and maintain their delegation skills. Building delegation skills starts with all nurses understanding the provisions of their nurse practice acts, and also understanding of the concepts of responsibility, accountability, and authority. In Developing Delegation Skills, Weydt walks the reader through the fundamental five rights of delegation as articulated by the National Council of State Boards of Nursing (NCSBN). These include the right task; circumstance; person; direction and communication; and supervision and evaluation. She points out two major ways delegation occurs, by simple task assignment based on job descriptions or matching a staff member's expertise to a patient's needs. Weydt stresses the need for: (a) clarity in delegation, (b) ongoing development of delegation skills, (c) assuring that the person to whom a task is delegated is qualified to perform the task, and (d) assuring the RN retains final accountability. Anthony and Vidal describe how the right communication, one of the five rights of Delegation, influences effective delegation. …