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Understanding Delegation in Nursing

Question:

Discuss about the Effective Communication during delegation in Nursing.

Communication is at the heart of the process of delegation. Timely and detailed communication between the delegating RNs and members of the healthcare team is linked to patient health outcomes and quality of care. Miscommunication that occurs between nurses has negative outcomes like medication errors, failure to rescue and even patient falls. Moreover, nurses are held accountable for any outcomes and so they have to communicate effectively during the delegation process as it directly affects patient safety and quality of care. In a research conducted by National Council of State Boards of Nursing, (2016) stated that communication issues are the root cause of deaths that is associated with delays in treatment and giving rise to sentinel events. Communication greatly shapes the process of delegation and patient safety outcomes. The way a delegated nurse explains the patient condition greatly affects the willingness of the team member to respond. Therefore, the following discussion involves the importance of effective communication pertinent to new graduate nurses in Australia to ensure patient safety and quality of care.

Delegation is multi-faceted that begins with understanding of the practice act for a nurse outlining their legal responsibility, accountability and authority for patient care. It is a core competency for the newly graduate RNs. They have the responsibility to conduct delegation process that requires sophisticated clinical judgment and accountability for patient care. RNs are considered the brokers of resources of patient care (Sonntag et al., 2016). They synthesize data that is collected by nurses in coordinating individualized care, patient safety and addressing the needs of patients and their families by maximizing the available resources. Fresh graduate RNs are new to the clinical environment and often find directing care during delegation quite challenging. Delegation is central to the nursing practice and it is expected that graduate RNs should have the skill, knowledge, judgment and personal attributes in delegating nursing care effectively in the current complex and challenging environment (Nursingmidwiferyboard.gov.au, 2018). Although, they have passed as RNs, they lack confidence and through teamwork and delegation process, they are able to perform delegation process effectively. It is important to make the new nurses in Australia understand that they are responsible for care needs assessment of patients and know the person whom they are delegating. Through the process of delegation, nurses facilitate patient’s journey to preferred health outcomes. Therefore, it is important for the new graduate nurses to perform effective delegation for better patient outcomes and ensure safety.

Principles of Delegation in Nursing


Delegation is not only an important skill rather a leadership skill directly affecting patients. According to supervision guidelines for nursing practice under Nursing and Midwifery Board of Australia (NMBA) it is stated that delegation should be done for those tasks suitable to the person’s role being supervised with their scope of competence, training and supervisee capability (Nursingmidwiferyboard.gov.au, 2018). According to Bach and Grant, (2015) there are five rights of delegation. Firstly, it is a fundamental aspect reflecting the primary commitment of a nurse towards health, welfare and safety of patients. Therefore, it is important for the new graduate nurses to be responsive to patient’s needs. Secondly, nurses should use their critical thinking skills in making clinical judgments on how to allocate resources to staffs in the delivery of patient care. The needs for care and patient condition must be considered to avoid any kind of harm and evaluate the abilities of the personnel of healthcare team to whom the task is to be delegated. Thirdly, nurses should delegate care aspects that is consistent with competencies and scope of practice of the member to how the task is being delegated. Accountability is important to retain for nurses for patient outcomes while making delegation decisions. The patient’s plan of care need to be adapted, modified or continued depending upon the evaluation of nurse of the patient’s condition. The personnel assigned with delegation duties must be responsible for the completion of the delegated task and accountable for safe task performance. Finally, the most important principle is interpersonal relationships or communication essential in the process of delegation (Birks et al., 2016).

Communication is the biggest driving factor for effective delegation process. Style of communication greatly influences interpersonal relationships and teamwork. An open, honest and direct communication is a characteristic of good delegation and therefore, the quality of delegation and ability to delegate driven by interpersonal relationships greatly influences the way the task is delegated. This statement supports the fact that the way RN performs delegation influences the responsiveness and performance of personnel who is being delegated to (NMBA code of conduct, 2018).

According to Harris (2017), critical thinking skills of nurses are important during the delegation process. As nurses work in complex clinical situations, they need to synthesize information and think in a complex manner making critical decisions about patient care during the process of delegation. The main findings suggested that ineffective communication during delegation could result in poor patient outcomes that influence the quality of care and patient satisfaction. The findings also supported the fact that establishing healthy interpersonal relationships between delegating RN and personnel can help to reduce the chances of omitted or missed routine care that directly affect patient safety. Another study conducted by Hezaveh, Rafii and Seyedfatemi, (2014) stated that novice nurses are unprepared for the delegation process in their professional role that has severe consequences for the healthcare system leading to reduction in patient care quality. The results highlighted that communicative problems are one of the main reasons for ineffective delegation hampering patient safety and care.

Communication Strategies for Effective Delegation


There are severe consequences of ineffective communication during delegation process. According to Graan et al., (2014) miscommunication results in medical errors that greatly affect patient outcomes. The quality of information is important during delegation and communication should be rightly directed being the cornerstone of delegation and instrumental in shaping safety and quality outcomes. The right communication is defined in a manner where information should be timely communicated between the delegating RN and personnel reducing the likelihood of missed, inappropriate or delayed care that may result in poor outcomes. Newly graduate nurses experience may find it challenging to integrate into the uncertain and challenging hospital environment and make sense of events and conversations made with the healthcare team members. Therefore, they may struggle to work in these complex situations like delegation and there might be breakdown in communication. As a result, there is conveying of insufficient information that can hinder provider’s ability to deliver care (Hayes et al., 2015).

In 2013, a report published by Safety and Quality, Australia, around 440,000 people die every year as a result of medical errors representing third leading cause of death (Hezaveh, Rafii & Seyedfatemi, 2014). The Joint Commission’s 2012-2013 analysis stated that communication was one of the major leading causes of sentinel events affecting patient safety resulting in permanent harm, death or any other negative outcomes.

There are several barriers to communication in nursing during the process of delegation. The first barrier is the poor interpersonal relationships between RN and personnel. Poor interpersonal relationships resist the delegating process that hampers patient safety and quality of care. The second barrier is the attitude of the nurses as attitudinal barriers can result in ineffective delegation. Conflicting attitude among the members of healthcare team create resentment and hamper delegation. There are various sources of conflict like work, age, personality, confusion and dissension. The third barrier is the absence of clear chain of command in delegation. The nurses who delegate have to witness uncertainty in the daily healthcare working environment as they continuously negotiate the boundaries of scope of practice, staff, procedures and policies. The fresh graduate RNs are new to the healthcare working environment and they face conflict between the organizations, staffing and policies of facilities. Hierarchical confusions may cause ineffective delegation that need to be removed (Redley et al., 2017).


Several communication theories have been developed in nursing that guide and explain interactions between nurses, patients as well as healthcare professionals. One such theory is Dyadic Interpersonal Communication Model that greatly focuses on interpersonal communications in the therapeutic process. Communication is a two way dynamic and interactive process between two people. The sender and recipient being the encoder and decoder greatly influence the way message being provided and processed. The model greatly highlights the fact that there should be clarity and awareness when the information is being conveyed. The encoder or sender should provide the message and the decoder or recipient should process the information conveyed. Similarly, during delegation, the delegated RN should convey the message in clear and succinct manner so that decoder or receiver is able to understand the message being conveyed (Siegman & Pope, 2016). This theory is dynamic and powerful bond between tow counterparts constantly evolving and intensifying. Furthermore, communication should be intimate between the two people and should anticipate each other’s behavior. This model helps to improve one’s role-play between speaker and listener and there is effective conveying of right information during the process of delegation. Through deepening of dyadic bond, members of the healthcare team can elevate their performance level and anticipate each other’s style and choices of work. Feedback is also important in this communication model that help to understand that message is propagated effectively to the decoder or receiver. This is important during delegation as it help the delegating nurse to understand that patient information is conveyed effectively to the receiver (Siegman & Pope, 2016). The recommendations and strategies for enhancing effective delegation is discussed in the subsequent section.

Barriers to Effective Delegation


For effective delegation, concepts of delegation should be conveyed to nee graduate RNs in a clear, non-intimidating and safe manner. The delegation nursing tasks should be demonstrated to them that are expected in their new job role. Nurse educators should explain the principles of delegation to the new RNs through stimulation-based learning promoting their confidence and increasing their assessment skills in the delegation process. There should also be increase in interaction of new nurses with the members of healthcare team through didactic instruction through active learning techniques. Effective leadership and management skills employed by nurse educators can help to bridge the gap between knowledge and competency. With these recommendations, RNs transforms from primary care to contemporary care developing the traits of intelligence, integrity, respect, trust and compassion for effective communication (Yoon, Kim & Shin, 2016).

From the above discussion, it can be concluded that effective communication and way the information is delivered affects delegation process and patient safety. Fresh graduate nurses are new to the environment and face challenges during the delegation process. Lack of understanding about concepts of delegation can result in ineffective communication posing barrier to the delegation process. Dyadic Interpersonal Communication Model explains that communication is a two way process focusing on clarity of information. Nursing educators should focus on these issues and provide learning opportunities to the newly graduate nurses so that it allows them to develop competency and confidence to execute the process of delegation.

References

Bach, S., & Grant, A. (2015). Communication and interpersonal skills in nursing. Learning Matters. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=26yICwAAQBAJ&oi=fnd&pg=PP1&dq=communication+theory+for+registered+nurses+&ots=6N_zmHmlfK&sig=rAmwLCmSCkO5XOR6aqhqK1O6Oh0#v=onepage&q=communication%20theory%20for%20registered%20nurses&f=false

Birks, M., Davis, J., Smithson, J., & Cant, R. (2016). Registered nurse scope of practice in Australia: an integrative review of the literature. Contemporary nurse, 52(5), 522-543. Doi: https://doi.org/10.1080/10376178.2016.1238773

Graan, S. M., Botti, M., Wood, B., & Redley, B. (2016). Nursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks. Australian Critical Care, 29(3), 165-171. DOI: https://doi.org/10.1016/j.aucc.2015.09.002

Harris, M. (2017). Delegation by Registered Nurses. Home healthcare now, 35(9), 523-524. DOI: 10.1097/NHH.0000000000000600

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076. DOI: 10.1111/jocn.12944

Hezaveh, M. S., Rafii, F., & Seyedfatemi, N. (2014). Novice nurses' experiences of unpreparedness at the beginning of the work. Global journal of health science, 6(1), 215.

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14.DOI: https://doi.org/10.1016/S2155-8256(16)31035-3

NMBA code of conduct 2018. Nursing and Midwifery Board of Australia - Search. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Search.aspx?q=code%20of%20professional%20conduct%20for%20nurses [Accessed 08 Feb. 2018].

NMBA Code of ethics 2018. Nursing and Midwifery Board of Australia - Search. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Search.aspx?q=code+of+ethics [Accessed 08 Feb. 2018].

Nursingmidwiferyboard.gov.au 2018. Nursing and Midwifery Board of Australia - Professional standards. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 08 Feb. 2018].

Redley, B., Botti, M., Wood, B., & Bucknall, T. (2017). Interprofessional communication supporting clinical handover in emergency departments: An observation study. Australasian Emergency Nursing Journal, 20(3), 122-130. DOI: https://doi.org/10.1016/j.aenj.2017.05.003

Siegman, A. W., & Pope, B. (Eds.). (2016). Studies in dyadic communication. Elsevier.

Sonntag, O., Plebani, M., Della, P., Jones, D., Steward-Wynne, E., Walsh, J., ... & Lee, M. (2016). Effective communication in clinical handover: from research to practice (Vol. 15). Walter de Gruyter GmbH & Co KG. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=JJrUCwAAQBAJ&oi=fnd&pg=PR5&dq=effective+communication+in+delegation+in+Australia&ots=tsOVm1NZIS&sig=KxuMbFWz73J8o97JWmsl2oh91ko#v=onepage&q=effective%20communication%20in%20delegation%20in%20Australia&f=false

Yoon, J., Kim, M., & Shin, J. (2016). Confidence in delegation and leadership of registered nurses in long?term?care hospitals. Journal of nursing management, 24(5), 676-685. DOI: 10.1111/jonm.1237

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