Transparent teamwork: The practice of supervision and delegation within the multi-tiered nursing team

Gap analysis of strategies for promoting interprofessional teams in healthcare units

PURPOSE

A healthcare unit's effectiveness largely depends on how well its interprofessional teams work together. Unfortunately, the strategies used to improve these teams often lack substance. This study analyzed these strategies and found a performance gap.

DESIGN/METHODOLOGY/APPROACH

This study took a unique mixed-method approach, systematically reviewing both qualitative and quantitative studies that identified strategies to enhance interprofessional teams in healthcare units. To gauge the effectiveness of these strategies, the researcher utilized an Importance-Performance Analysis (IPA) in four specialized clinical training centers in Hamadan province, Iran. The analysis of the IPA involved 35 experts from these centers as the statistical population.

FINDINGS

Based on a systematic review, there are seven categories: contextual, strategic, communication, organizational, individual, Human Resources Management (HRM), and environmental for promoting interprofessional teams with a total of 36 sub-indicator. Based on the IPA, the HRM aspect shows the most extensive performance gap. The individual and organizational aspects fall under resource wastage, and the environmental aspect is within the indifferent zone. Also, some critical sub-indicators, such as incentives/rewards, roles and responsibilities, financial resources, team-initiated innovation, the culture of respect, partner resources, humility, data availability, set expectations, and team availability, are in the weak areas.

PRACTICAL IMPLICATIONS

This research has identified critical areas for improvement in promoting teamwork in clinical training centers through a comprehensive gap analysis. It also presents practical policy solutions to address these weak points, providing a clear roadmap for enhancing interprofessional teams in healthcare units.

ORIGINALITY/VALUE

Improving teamwork in healthcare can be challenging, but it is possible with proper strategies and tools. One of the highlights of the recent study was the combination of systematic review studies with IPA to identify areas for improving interprofessional teamwork in clinical training centers.

Agreeing priority categories and items for inclusion in a future best practice delegation framework for musculoskeletal outpatient physiotherapy services: A consensus groups study

PURPOSE

Delegation of clinical tasks from physiotherapists to physiotherapy support workers varies considerably in musculoskeletal outpatient physiotherapy services leading to variation in patient care. This study aimed to develop consensus amongst physiotherapists, support workers and managers about what components should be included in a future framework to guide effective and safe delegation of clinical tasks to physiotherapy support workers in United Kingdom's National Health Service musculoskeletal outpatient physiotherapy services.

METHODS

A consensus study was carried out, using Nominal Group Technique. Seven physiotherapists, ten physiotherapy support workers and ten physiotherapy operational/clinical leads from 13 musculoskeletal physiotherapy services within United Kingdom's National Health Service were recruited through the Chartered Society of Physiotherapy's professional networks and social media. Three separate, role-specific consensus groups were convened, involving participants generating, discussing and rating on a Likert scale, components for inclusion in a future delegation framework.

RESULTS

32 out of 38 generated items reached consensus of ≥70%, i.e. a mean of ≥4.9 on a 7-point Likert scale, across the three groups. Items were grouped under five main categories: 1) training/Continuous Professional Development for physiotherapists and support workers; 2) need for a clear delegation process; 3) competencies 4) defining the role of support workers and 5) safety net.

CONCLUSION

Key stakeholder groups were able to reach consensus on five priority areas which will be developed into a best practice framework to standardise delegation and guide physiotherapists when delegating clinical tasks to support workers.

Improving the Recruitment and Retention of Unlicensed Assistive Personnel: A Quality Improvement Initiative

With increasing demands for unlicensed assistive personnel, strategies for optimizing recruitment and retention are paramount. The purpose of this quality improvement project was to increase the recruitment and retention of unlicensed assistive personnel in a nonprofit healthcare organization. Initiatives included expanding academic affiliations enhancing pipeline, developing a tailored onboarding program, and introducing a clinical ladder. Results indicate increases in numbers of academic affiliations and hiring, with unlicensed assistive personnel turnover rates below national averages.

Leadership skills for the multi-tiered nursing team

In a challenging global healthcare climate, new workforce models are required to address the ongoing shortfall in the number of nurses. One way of addressing the workforce crisis in the NHS has been to introduce the roles of nursing associate and assistant practitioner, which are designed to support registered healthcare professionals in their work and 'bridge the gap' between registered professionals and support workers. This article examines the leadership skills required of nurses when seeking to embed these roles in practice, and the leadership skills assistant practitioners and nursing associates themselves need to take their place in the team. The author also discusses the need for nurses to adopt a relational leadership style, hone their delegation skills and foster a climate of psychological safety for their assistant practitioner and nursing associate colleagues.

Reducing Team Burnout Through Enhanced Scope of Practice for Nursing Assistive Personnel

Persistent nursing workforce shortages, in conjunction with the COVID-19 pandemic and increased patient acuity, have led to increased utilization of nursing assistive personnel (NAP) within acute care settings. Although the work demand of NAPs continues to increase, their delegated work autonomy remains ambiguous and diverse. This lack of clarity impacts effective teamwork, collaboration, and delegation. This study successfully enhanced the scope of practice for NAPs, resulting in increased staff and patient satisfaction.

A scoping review of registered nurses' delegating care and support to unlicenced care and support workers

AIM

To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts.

DESIGN

Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA-ScR checklist.

METHODS

The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers.

RESULTS

A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers.

CONCLUSIONS

The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature.

IMPLICATIONS FOR THE PROFESSION

Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re-distribution of nurses' work.

RELEVANCE TO CLINICAL PRACTICE

Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.

Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing

AIM

To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals.

DESIGN

An integrative review.

DATA SOURCES

Database searches were conducted between July 2011 and July 2021.

REVIEW METHODS

We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546-553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments.

RESULTS

Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively.

CONCLUSION

With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice.