Delegation In Nursing
Case scenario 2.
It was a busy evening shift in your ward. Your medication round is behind time and you wanted to speed up the process. You place each patient’s pills in a cup and then, one at-a-time, handed the cup to a student in the medication room to take to the patient. Each of the patients for which she does this is able to swallow the pills and a little water.
Every organization exists to do work, from large hospitals and even to the wards. Work has to be coordinated and performed through the planning of individuals who have the responsibility to ensure the various tasks and different aspects of work are completed. In other words to say, managers have to assign work appropriately to the competency of their staff. “The organizational structure is a formal plan for arranging people in order to their Authority and Responsibility to achieve defined objectives.” (Grohar-Murray & DiCroce, 1992). Based on the scenario, the staff nurse did not assess the student’s ability and competence before delegating the task. There was also poor supervision and wrong direction of what should have been done.
In the next few paragraphs I will resolve the problems and demonstrate how it shouldn’t have been a problem at all. Also, define what delegation is and point out how effective delegation applies to the case scenario. …show more content…
Delegation is “transferring to a competent individual the authority to perform a selected nursing task in a selected situation.” (National Council of State Boards of Nursing, 1995).
First of all, serving of medications is a skill learnt in year 2. The staff nurse in the given scenario just handed out the medicines to the student without even assessing the level of knowledge, experience and competence the student has. “Delegation is sometimes done blindly without envisioning a clear match between a role description and the actual capabilities of the worker.” (Kleinman & Saccomano, 2006). This student could be a year 1 student on his/her first attachment and is ignorant to how the proper technique of serving medications is performed. The staff nurse might have given the wrong task to the wrong person, and the best option for the nurse was to check and ask for around if her fellow colleagues who are of the same seniority or higher are free to help. But based on this scenario, it was a busy evening and of course most of the other staff nurses are busy with their own medication rounds. A better alternative could be giving this task to a more experienced student nurse. At least a third year student has the relevant knowledge and maturity and is able to perform the skill of serving medications using the proper techniques and follow the 5 rights of serving medications. Yet, the staff nurse still has to guide the student or at least observe him/her, regardless of how much the student knows, or how busy the ward is. It is irresponsible for the student to misinterpret his/her abilities, or to carry on unsupervised with a task that he/she is not fully capable of doing well. It is unfair to the patient as there are unnecessary risks involved.
Therefore, delegating the right task to right person is important when it comes to effective delegation. Making sure the nature of the task fits the competency of each student nurse, and not just picking one out of convenience sake.
Secondly, there was poor or even no supervision over the student. The staff nurse actually permitted the student to perform a skill with the least supervision. Grohar-Murray and DiCroce (quoted in IOM, 2001) mentioned that “medical errors kill more people in the United States per year than AIDS, breast cancer, and more motor accidents combined, an approximate 200,000 per year.” The above statement without a doubt proves that medical errors are inevitable. Also, the occurrence rates are at such high numbers. Even trained professionals of much experience make mistakes every now and then; therefore it is very important that the staff nurse ensures the student nurse does not make any mistakes. This is done only if the staff nurse could accompany him/her to the patients’ bedside, or the least is to observe so nothing can go wrong.
The fundamental of serving medicines is to bring the In Patient Record (IMR) along to patient and check against his/her wrist tag for confirmation to prevent any medication errors. Yet, the student did not fulfill this. Neglecting these 2 major factors doesn’t really mean a lot to nurses, but is a great deal to the patients.
Grohar-Murray and DiCroce (quoted in Standing, Anthony, & Hertz, 2001) mentioned that “nearly 14% of care lapses were due to the RN not providing optimal direction or delegation and nearly 12.5% were dues to inadequate supervision of the delegated tasks.”
Proving the point why it is very important that there is a need for close supervision over students.
What should have been done was to guide the student along as the staff nurse dispenses the medicines into the cups and teach the student the appropriate way of following the IMR. Although the best is for the staff nurse to follow the student, the least the staff nurse should do was to observe from the medication trolley while the student brings the IMR to the patient, and ensures the patient swallows it. This ensures that the student performs the required checks and gives the right medication to the right patient. Thus, fulfilling 1 of the ‘5 rights’, which is right supervision.
There was also a mistake on the student’s part as he/she was being a blind follower doing the task.
Instead, the student should have clarified with the staff nurse on the tasks he/she is able to perform at his/her level. This is important as it is the responsibility of the student to make sure to know what is to be done and how it is to be done before going to the patient. Any other doubts of the student should also be clarified by the staff nurse.
Thirdly, there was wrong direction and communication. As what was mentioned in the above paragraphs, the student did not bring the IMR along and check the patients’ identification. This is how wrong direction and communication comes into play as it is the staff nurse’s responsibility to instruct the student to do so, regardless the student knows that or not.
The student also might have failed to evaluate the patient’s condition and the effect of drugs. This proves the incompetency of the student as he/she followed the wrong practice. As the student followed blindly, there definitely were no objective gains. Proving the student had no chance to learn of the right way of dispensing medications according to proper protocols.
As the student may be new to the ward setting, what should have been done by the staff nurse was to give a clear concise description of the task verbally or better, written ones. Although it was busy, instead of just handing the cup containing the medication to the student, the staff nurse should have explained the drug briefly, instructed the student to check the IMR accordingly and identity and why that particular patient needs it. This way, the student also gets to learn and know the action of each drug and ensures the right medication goes to the right patient. The staff nurse has to ensure this is done immediately and instruct the student to report back to him/her once it is completed. What the student has to do is to make sure the patient has taken the medication and report to the staff nurse if there are any changes.
Hence, this fulfils the last right of delegation, which is right direction.
In conclusion, delegation plays an important role in the clinical setting.
The manager, or seniors have to assess and identify each staff thoroughly before delegating the task to the appropriate persons, being the novice, the newly qualified nurse, the competent nurse, the proficient nurse and the expert nurse. This is known from Patricia Benner’s model of From Novice to Expert (Benner & Benner,1984). This model effectively demonstrates how each task has to be delegated to the appropriate persons of the appropriate level of competence. This model further emphasizes on what was mentioned in the earlier paragraphs, mainly the importance of careful
delegation.
I have also defined delegation and used it appropriately in this case scenario. The problems identified were also resolved. Showing what ought to have been done and stating the best options for the staff and student nurse.
The staff nurse should have guided the student along properly, and the student should enquire if there was anything unsure of and in need of clarification. Proper direction and supervision as in clear instructions are to be given and followed by respectively, thus preventing any errors or putting any patients at risk. Following these proper delegation methods, this scenario wouldn’t have been a problem at all.
Also pointed out the effective methods of delegation, mainly the 5 rights were also discussed and applied to the scenario.
Therefore, delegation is indispensable, be it the hospitals or the wards.
It was a busy evening shift in your ward. Your medication round is behind time and you wanted to speed up the process. You place each patient’s pills in a cup and then, one at-a-time, handed the cup to a student in the medication room to take to the patient. Each of the patients for which she does this is able to swallow the pills and a little water.
Every organization exists to do work, from large hospitals and even to the wards. Work has to be coordinated and performed through the planning of individuals who have the responsibility to ensure the various tasks and different aspects of work are completed. In other words to say, managers have to assign work appropriately to the competency of their staff. “The organizational structure is a formal plan for arranging people in order to their Authority and Responsibility to achieve defined objectives.” (Grohar-Murray & DiCroce, 1992). Based on the scenario, the staff nurse did not assess the student’s ability and competence before delegating the task. There was also poor supervision and wrong direction of what should have been done.
In the next few paragraphs I will resolve the problems and demonstrate how it shouldn’t have been a problem at all. Also, define what delegation is and point out how effective delegation applies to the case scenario. …show more content…
Delegation is “transferring to a competent individual the authority to perform a selected nursing task in a selected situation.” (National Council of State Boards of Nursing, 1995).
First of all, serving of medications is a skill learnt in year 2. The staff nurse in the given scenario just handed out the medicines to the student without even assessing the level of knowledge, experience and competence the student has. “Delegation is sometimes done blindly without envisioning a clear match between a role description and the actual capabilities of the worker.” (Kleinman & Saccomano, 2006). This student could be a year 1 student on his/her first attachment and is ignorant to how the proper technique of serving medications is performed. The staff nurse might have given the wrong task to the wrong person, and the best option for the nurse was to check and ask for around if her fellow colleagues who are of the same seniority or higher are free to help. But based on this scenario, it was a busy evening and of course most of the other staff nurses are busy with their own medication rounds. A better alternative could be giving this task to a more experienced student nurse. At least a third year student has the relevant knowledge and maturity and is able to perform the skill of serving medications using the proper techniques and follow the 5 rights of serving medications. Yet, the staff nurse still has to guide the student or at least observe him/her, regardless of how much the student knows, or how busy the ward is. It is irresponsible for the student to misinterpret his/her abilities, or to carry on unsupervised with a task that he/she is not fully capable of doing well. It is unfair to the patient as there are unnecessary risks involved.
Therefore, delegating the right task to right person is important when it comes to effective delegation. Making sure the nature of the task fits the competency of each student nurse, and not just picking one out of convenience sake.
Secondly, there was poor or even no supervision over the student. The staff nurse actually permitted the student to perform a skill with the least supervision. Grohar-Murray and DiCroce (quoted in IOM, 2001) mentioned that “medical errors kill more people in the United States per year than AIDS, breast cancer, and more motor accidents combined, an approximate 200,000 per year.” The above statement without a doubt proves that medical errors are inevitable. Also, the occurrence rates are at such high numbers. Even trained professionals of much experience make mistakes every now and then; therefore it is very important that the staff nurse ensures the student nurse does not make any mistakes. This is done only if the staff nurse could accompany him/her to the patients’ bedside, or the least is to observe so nothing can go wrong.
The fundamental of serving medicines is to bring the In Patient Record (IMR) along to patient and check against his/her wrist tag for confirmation to prevent any medication errors. Yet, the student did not fulfill this. Neglecting these 2 major factors doesn’t really mean a lot to nurses, but is a great deal to the patients.
Grohar-Murray and DiCroce (quoted in Standing, Anthony, & Hertz, 2001) mentioned that “nearly 14% of care lapses were due to the RN not providing optimal direction or delegation and nearly 12.5% were dues to inadequate supervision of the delegated tasks.”
Proving the point why it is very important that there is a need for close supervision over students.
What should have been done was to guide the student along as the staff nurse dispenses the medicines into the cups and teach the student the appropriate way of following the IMR. Although the best is for the staff nurse to follow the student, the least the staff nurse should do was to observe from the medication trolley while the student brings the IMR to the patient, and ensures the patient swallows it. This ensures that the student performs the required checks and gives the right medication to the right patient. Thus, fulfilling 1 of the ‘5 rights’, which is right supervision.
There was also a mistake on the student’s part as he/she was being a blind follower doing the task.
Instead, the student should have clarified with the staff nurse on the tasks he/she is able to perform at his/her level. This is important as it is the responsibility of the student to make sure to know what is to be done and how it is to be done before going to the patient. Any other doubts of the student should also be clarified by the staff nurse.
Thirdly, there was wrong direction and communication. As what was mentioned in the above paragraphs, the student did not bring the IMR along and check the patients’ identification. This is how wrong direction and communication comes into play as it is the staff nurse’s responsibility to instruct the student to do so, regardless the student knows that or not.
The student also might have failed to evaluate the patient’s condition and the effect of drugs. This proves the incompetency of the student as he/she followed the wrong practice. As the student followed blindly, there definitely were no objective gains. Proving the student had no chance to learn of the right way of dispensing medications according to proper protocols.
As the student may be new to the ward setting, what should have been done by the staff nurse was to give a clear concise description of the task verbally or better, written ones. Although it was busy, instead of just handing the cup containing the medication to the student, the staff nurse should have explained the drug briefly, instructed the student to check the IMR accordingly and identity and why that particular patient needs it. This way, the student also gets to learn and know the action of each drug and ensures the right medication goes to the right patient. The staff nurse has to ensure this is done immediately and instruct the student to report back to him/her once it is completed. What the student has to do is to make sure the patient has taken the medication and report to the staff nurse if there are any changes.
Hence, this fulfils the last right of delegation, which is right direction.
In conclusion, delegation plays an important role in the clinical setting.
The manager, or seniors have to assess and identify each staff thoroughly before delegating the task to the appropriate persons, being the novice, the newly qualified nurse, the competent nurse, the proficient nurse and the expert nurse. This is known from Patricia Benner’s model of From Novice to Expert (Benner & Benner,1984). This model effectively demonstrates how each task has to be delegated to the appropriate persons of the appropriate level of competence. This model further emphasizes on what was mentioned in the earlier paragraphs, mainly the importance of careful
delegation.
I have also defined delegation and used it appropriately in this case scenario. The problems identified were also resolved. Showing what ought to have been done and stating the best options for the staff and student nurse.
The staff nurse should have guided the student along properly, and the student should enquire if there was anything unsure of and in need of clarification. Proper direction and supervision as in clear instructions are to be given and followed by respectively, thus preventing any errors or putting any patients at risk. Following these proper delegation methods, this scenario wouldn’t have been a problem at all.
Also pointed out the effective methods of delegation, mainly the 5 rights were also discussed and applied to the scenario.
Therefore, delegation is indispensable, be it the hospitals or the wards.