Nurses' Beliefs About Their Abilities to Delegate Within Changing Models of Care

Delegating and supervising unregistered professionals: the student nurse experience

BACKGROUND

Changing models of healthcare have resulted in the need for registered nurses to be competent in delegating and supervising the unregistered health care assistant. However research evidence suggests nurse education does not prepare students for the practicalities of this role.

OBJECTIVES

This paper reports on undergraduate student nurses' level of preparation when working with health care assistants (HCA). It is part of a large scale project, undertaken between 2005 and 2011, which explored pre-registration student nurses' perceptions of the role of the HCA and how this affects their clinical learning.

DESIGN

A sequential transformative mixed method research design was adopted.

SETTING

One higher educational institution in the United Kingdom.

PARTICIPANTS

Forty-five pre-registration nursing students took part in phase one and 662 participated in phase two.

METHODS

Phase one used focus groups (n=32) and interviews (n=13) and phase two used a semi-structured questionnaire.

RESULTS

Whilst most students reported that they were familiar with the role of the health care assistant, findings showed that nurse training did not initially prepare students for the realities of clinical practice, however as students progressed they became more aware of such issues. For some such skills were learnt on the job and they identified a number of barriers they faced when delegating tasks such as fear of causing conflict. Overall the lack of initial preparation was perceived by participants to be a hindrance to meeting the goals of clinical learning and to understanding the dynamics within the nursing hierarchy.

CONCLUSIONS

Students in this study highlighted gaps in their educational programme and clinical experiences regarding their preparation for a delegatory and/or supervisory role. Given the importance of such skills, it is imperative that universities provide pre-registration student nurses with the education necessary to develop delegation strategies and to adapt to their evolving professional role.

Components and Strategies of Nurse Residency Programs Effective in New Graduate Socialization

Patient needs and practice conditions demand that clinical nurses in acute care hospitals engage in a unique professional practice role—care and management of clinical situations for multiple patients, simultaneously. Nurse Residency Programs (NRPs) facilitate the integration of Newly Licensed Registered Nurses (NLRNs) into this professional practice role through competency development in seven management areas. Purpose of this study was to identify effective components and strategies of NRPs in each area. A sample of 907 nurses in 20 Magnet hospitals with NRPs operative for at least 3 years participated in individual or small group interviews and 82 participant observations. All interviews were digitally recorded, transcribed, and analyzed thematically. Effective strategies were identified for all but one of the seven management areas. Suggestions for improvement in NRPs to better meet NLRN professional socialization needs, patient outcomes, and challenges of the health care system today are offered.

Staff perceptions of leadership during implementation of task-shifting in three surgical units

BACKGROUND

Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting.

OBJECTIVE

This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses.

METHODS

Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey.

RESULTS

Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses' opinions of leadership.

CONCLUSION

Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting.

IMPLICATIONS FOR NURSING MANAGEMENT

Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.

Nursing delegation and medication administration in assisted living

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

Delegation Guided by School Nursing Values: Comprehensive Knowledge, Trust, and Empowerment

As health care institutions in the United States respond to shrinking budgets and nursing shortages by increasing the use of unlicensed assistive personnel (UAP), school nursing practice is changing from providing direct care to supervising activities delegated to UAP. Therefore, delegation is a critical area of concern for school nurses. The purpose of this qualitative research study was to explore values guiding the delegation of health care tasks to UAP in school settings from the perspective of the school nurse. An inquiry focus group was conducted with 64 Florida school nurses. Values guiding delegation were comprehensive knowledge, trust, and empowerment. These values provided a framework for guiding the delegation process.

Nurse preparation and organizational support for supervision of unlicensed assistive personnel in nursing homes: a qualitative exploration

PURPOSE

Nursing supervision of the routine daily care (e.g., grooming, feeding, and toileting) that is delegated to unlicensed assistive personnel (UAP) is critical to nursing home service delivery. The conditions under which the supervisory role is organized and operationalized at the work-unit level, taking into account workloads, registered nurse/licensed practical nurse staffing, and role expectations, are not well understood. The purpose of this paper is to describe the organizational, managerial, and nurse-level factors associated with the nurse's role as supervisor of UAP in nursing homes.

DESIGN AND METHODS

An ethnographic approach to data collection included 31 interviews, 170 hr of observation, and organizational document review at three nursing homes. Analysis included micro-coding and content analysis.

RESULTS

Findings revealed (a) considerable variation in organizational resources, systems, and processes to support organization and operationalization of the supervisory role; and (b) limited evidence of nurses' estimation of the potential benefits of training and organizational systems to support supervisory practice and the complexity of the supervisory role.

IMPLICATIONS

Delivery of high-quality nursing home care is a matter of national importance, and these findings offer a call to action for nursing home leaders in policy, academia, and ownership and management positions. Nurses must be equipped with competencies and skills that reflect the complex organizational environments in which they work. Additionally, nursing home administrators and managers must be equipped with the competencies and skills needed to effectively and efficiently organize and operationalize care delivery practices to support nurses' role enactment.

Registered Nurses and Unlicensed Assistive Personnel: An Uneasy Alliance

To meet challenges of continuing change in the health care industry and maintain organizational viability in increasingly competitive markets, the use of the registered nurse--unlicensed assistive personnel model is an undeniable reality that fills the void created by the current shortage of nurses and decreases the costs of providing patient care. Although much has been published about the need for nurses to delegate and supervise patient care-related activities, little has been written about the skills needed to do this effectively or how these skills may be learned. Academic and clinical educators must find ways to facilitate the development of delegation and supervision abilities as nurses increasingly work with nonprofessional staff. Continuing education is an effective way for nurses to learn the skills required by changing models of patient care delivery and evolving professional roles.

Effectively delegating nursing activities in home care

Delegating appropriate portions of nursing care to LPNs and home health aides is an essential RN skill and critically necessary in PPS. This article examines the concept of delegation and shows clinicians how to assess, plan, and evaluate delegation tasks to increase productivity.