Safe Nursing

Nursing Inquiry. 2021;00:e12413. wileyonlinelibrary.com/journal/nin   | 1 of 10 https://doi.org/10.1111/nin.12413 1  |  INTRODUCTION Global nursing and healthcare workforce shortages, increased de - mands on healthcare systems and growing healthcare expenditure have resulted in a focus on the development of strategies to pro - vide cost- effective health care (All- Party Parliamentary Group on Global Health (APPG), 2016; National Health and Hospital Reform Commission (NHHRC), 2009). As part of these strategies, skill mix and nurse staffing are manipulated to reduce costs and provide qual - ity care to patients (Aiken et al., 2013; Jacob et al., 2015; NHHRC, 2009). Adding to this, the COVID 19 pandemic has placed further strain on the healthcare system resulting in the need to build surge workforce capacity to meet the needs of patients (Al Mutair et al., 2020; Marshall et al., 2020). Healthcare organisations have been required to reframe the delivery of patient care examining options to augment and extend the nursing and healthcare workforce. A common strategy is a tiered healthcare team approach to patient care delivery based on the idea of experienced staff supervising less experienced or lower trained staff members working together to meet the patients’ needs (Al Mutair et al., 2020; Marshall et al., 2020). This may occur in situations where tasks traditionally per - formed by one worker are shifted to another worker (APPG, 2016). Prior to the pandemic, pressures on healthcare systems interna - tionally had increased the reliance on the use of unregulated nursing assistant (NA) roles in the acute hospital setting (Aiken et al., 2016; Blay & Roche, 2020; Duffield et al., 2014; Kalisch, 2011). To meet pandemic surge workforce demands, healthcare teams may be addi - tionally augmented with reassigned or redeployed staff with trans - ferable skills, healthcare staff re- entering the hospital workforce, final year students in nursing, medical and allied health courses and NA roles (Al Mutair et al., 2020). It is imperative when working in the multi- skilled/ multi- tiered nursing workforce environment that Received: 8 April 2020  |  Revised: 3 March 2021  |  Accepted: 12 March 2021 DOI: 10.1111/nin.12413 FEATURE ARTICLE Transparent teamwork: The practice of supervision and delegation within the multi- tiered nursing team Felicity Ann Walker 1,2  | Madeleine Ball 2,3  | Sonja Cleary 2 | Heather Pisani 2 1Faculty of Health, Southern Cross University, Bilinga, QLD, Australia 2School of Health & Biomedical Sciences, RMIT University, Melbourne, Vic., Australia 3School of Health Sciences, University of Tasmania, Melbourne, Vic., Australia Correspondence Felicity Walker, Faculty of Health, Southern Cross University, Gold Coast Campus, Southern Cross Drive, Bilinga, Queensland 4225, Australia Email: [email protected] Funding information Australian Government Research Training Program Scholarship Abstract Supervision and delegation are important leadership skills that nurses require when practising within the multi- tiered nursing team. In response to increasing demands globally on healthcare systems, Nursing Assistants are becoming more prevalent mem - bers of the nursing workforce in the acute care setting. An exploratory descriptive re - search design was used to examine supervision and delegation of Nursing Assistants in an acute hospital setting in Victoria, Australia. It was found that supervision and delegation in the context of a multi- tier nursing team required a complex assessment and decision- making process which was influenced by multiple factors. This research promotes developing transparent nursing practices and mutual understanding in the multi- tier nursing team to facilitate effective supervision and delegation based on in - formed decision- making and culture of openness and trust. Pre- registration education and continuing education and support for nurses are important to build transparent supervision and delegation practices and teamwork, empowering the nursing team to practice to their full scope of practice to provide high- quality patient care. KEY WORDS accountability, delegation, leadership, nurse, nursing assistant, supervision, transparency