High Quality, Low Costs
Long-term care organizations must continue to achieve high quality patient care and positive patient outcomes without increasing costs. One consequence of this reality is the development of care delivery models using "nursing substitutes" or unlicensed assistive personnel (UAP).
While these health care workers fill the void created by the shortage of nurses and decrease costs of providing patient care, many dilemmas are associated with their use. As nurses maintain responsibility and liability for the actions of unlicensed personnel, it is imperative they effectively delegate and supervise to ensure UAPs are providing safe and effective patient care. Nurses act in a supervisory capacity over UAPs to whom they must delegate but are rarely taught to do so in formal educational programs, requiring managers to find ways to develop staff nurses' delegation and supervision skills.
Nurses can look for guidance to the National Council of State Boards of Nursing's "Five Rights of Delegation"
- Right Task - one that is delegable for a specific patient.
- Right Circumstances - appropriate patient setting, available resources, and other relevant factors considered.
- Right Person - right person is delegating the right task to the right person to be performed on the right person.
- Right Direction/Communication - clear, concise description of the task, including its objective, limits and expectations.
- Right Supervision - appropriate monitoring, evaluation, intervention, as needed, and feedback.
Steps in the delegation process may also be used to develop delegation expertise.
- assessment of patient needs and UAP's knowledge and skill level
- identification of tasks that may be safely assigned
- prioritization of tasks and timeframe for completion
- communication with UAP and encouragement to ask questions that may arise
- evaluation to review progress toward goals
- revision of plan as patient needs change
The use of the RN/UAP model is an undeniable reality. Nurses must develop the skills necessary to adapt to evolving professional roles and must be skilled not only as clinicians, but as leaders of the healthcare team.
References:
Sheehan, JP. UAP delegation: a step-by-step process. Nurs Manage. 2001 Apr; 32(4):22.
Kleinman, C. and Saccomano, S. Registered nurses and unlicensed assistive personnel: an uneasy alliance. J. Contin. Educ. Nurs: 37 (4):162-70