Roles of the Professional Nurse
A nurse should be responsible enough to manage and understand delegation,
rules and principles of delegation to improve the quality of care and promote patients’
safety this case study is designed to critically analyze the roles of professional nurse in
delegation.
A. Promoting Interdisciplinary Care
The term “Interdisciplinary care” which is synonymous with “interdisciplinary
team”, refers to the integration of different disciplines for the purposes of a single
consultation. Integration of different disciplines involves incorporation of a patient’s
medical history record, disease assessments, diagnosis and symptoms, intervention
approaches and short/ long term medical goals. The involvement of the patient is very
important in all meetings, discussions and care plans (Jessup, 2007). In this case,
interdisciplinary care can be promoted through improvement of the quality and
continuity of care. New nurses should establish short and long term goals for the patient
on the basis of the patient’s history.
Fluent communication between personnel of different disciplines and the patient
is important. Ms. W. may fail to communicate properly with Ms. R (patient) because Ms.
R is a Latina woman fluent in Spanish while Ms. W native language is English. In this
case, the new nurse, also a Latina fluent in Spanish may be best placed to
communicate Ms. R in best way and can explain her about parenting, labor and delivery
and family care methods. She should act as an intermediary in the communication
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between Ms. R and Ms. W to convey each other’s messages and will create awareness
for Ms. R about her health, baby’s health, parenting issues and ways to tackle to them,
possible risks, available resources and advantages to get delegation from hospital. Ms.
W and the new nurse both have a duty and a responsibility to encourage Ms. R for the
purposes of improving the quality of care she receives and consequently, her
health(Rejman, 2001).
B. Delegation and Teamwork
Delegation is the assigning of a nurse’s tasks to someone capable of handling in
best way. Delegator (a nurse from staff) should consider themselves a team in
collaboration with Ms. W and patient (Ms. R) until patient is able to fulfill her care
responsibilities herself (Weydt, 2010).Delegation and teamwork works effectively in
improving patient’s care when needed the most. Ms. R is 19 years old single pregnant
patient without close relatives and her boyfriend is unavailable as a result of work when
she needed them most. Ms. W is aware of this situation and is worried for Ms. R’s
health problems and her carelessness. She is unaware that team work is required to
meet standards of care through efficiency and consistency.
The new nursing supervisor should approach Ms. W in a friendly manner and
note that she has noticed the problems that she has encountered in approaching Ms. R.
she should then propose a meeting when both of them are free for them to discuss this
issue while reassuring her that she has committed no wrong. The supervisor should
then allow Ms. W to express her sentiment concerning her experience with Ms. R and
then assure her that there are alternatives through which these problems can be
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handled. She should them propose delegation of some tasks and introduce Ms. W to
the various individuals within the institution that are competent enough to handle Ms. R
when Ms. W is not in a position to do so. The supervisor may show Ms. W by example
through allocating some tasks concerning Ms. R to the other professionals as a start.
She should then advise Ms. W to follow up on their work and to report any difficulties
that may be encountered. Last but not least, she should recommend resources for the
purposes of making Ms. W more familiar with the concept of delegation. All this should
be executed with fluent communication, respect and efficiency (Rejman, 2001).
B1. Responsibility
Ms. R has been Ms. W’s patient since she was 30 weeks pregnantand they have
developed a strong nurse client relationship. It is the responsibility of Ms. W to arrange
delegation, supervision and referrals for Ms. R to achieve good results. Ms. W is worried
about Ms. R because she is very young (19 years) pregnant, single women living with
boyfriend who have no time to provide care to her while Ms. R is indifferent; having no
concern with medical meetings, medicines and her health. Ms. W is looking for some
referral that can assist and care her in last weeks of pregnancy and after the delivery as
she knew that Ms. R will not get care from any relative or from her boyfriend. She will
delegate Ms. R’s responsibilities to a community member or nurse who will care for her
in best possible way. She has a choice of community resources and social workers and
in this case she will ensure the care, who should be under supervision, be kind and
sincere to Ms. R. Ms. R is Latina and cannot communicate freely with Ms. W because
she is not fluent in English. In this case, the nursing manager (new nurse) will intervene
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as she is fluent in Latin. However, Ms. W has full responsibility of Ms. R’s health,
delegation, supervision and arranging referrals for her health (Rejman, 2001).
B2. Recommended Resource
The nursing supervisor can be a good resource to Ms. W for learning about
delegation in nursing. Ms. W. does not consider her location’s staff members as sources
of help and she thinks her only option is another local hospital which may not able to
provide individual care to Ms. R. Ms. W is genuinely concerned and worried about Ms.
R. Every professional health care organization hires staff members with specialization in
different disciplines like nutrition, parenting care and precautions guide among others.
The nursing supervisor is an important resource. He or she is a good source of
information and guidance for Ms. W to learn more about delegation practice in nursing
(Rejman, 2001).
Delegation as far as nursing is concerned is somewhat regulated by nursing
organizations and may vary according to state. For example, the Texas Board of
Nursing regularly issues rules concerning delegation in nursing such as Rule 224
Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed
Personnel for Clients with Acute Conditions or in Acute Care Environments which
concerns delegation to unlicensed personnel and Rule 225 RN Delegation to
Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living
Environments for Clients with Stable and Predictable Conditions among others. Others
include Conflict Resolution Model, Delegation and the Advanced Practice Nurse,
Delegation of CPAP and BiPAP Procedures, Links to Delegation Resources, Rule 224 –
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Flow Chart, Rule 225 – Flow Chart, The Five Rights of Delegation, Delegation Don’ts,
Rule 225 – Professional Nursing Assessment Grid, with case examples and Rule 225 –
Quick Reference Guide. Ms. W should find out the resources available from her local
nursing organization at state level and utilize them.
If her local nursing organization does not publish guidelines on delegation among
nurses, she should consult the local branch of American Nursing Association (ANA)
which publishes guidelines concerning delegation addressing topics such as the
terminology used in delegation, the policies that are considered in the course of
delegation, the principles of delegation and delegation in the course of providing nursing
care among others.
B3. Delegation Opportunities
In the course of the delegation process, registered nurse (Ms. W) compares
patient’s requirements with staff’s skills and the person with the best match in skills will
be selected for delegation (Weydt, 2010). Delegation is assigning a task to someone
from delegator’s practice (person from staff). In this case, nursing supervisor has some
staff members having different skills. Ms. W has opportunities to compare staff
member’s skills with requirements of Ms. R and will assign delegation rights to staff
member having maximum similarity. On comparison, Ms. W. found that there is a
licensed vocational nurse (LVN) who is capable of provide education to client/ patient
about delivery and labor, parenting skills, infant care tips and routine prenatal care, on
the other side these was requirements of Ms. R (patient). So nurse (Ms. W) has
opportunities to select delegate from within the clinic (Rejman, 2001).
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References
Jessup, R.L., (2007). Interdisciplinary versus multidisciplinary care teams: do we
understand the difference?Australian Health Review.31(3). Pg 330 to 331.
Rejman, K., (2001).A Difficult Pregnancy: A Nurse Practitioner Looks for Answers.
National Center for Case Study Teaching in Science.
Weydt, A., (2010). Developing Delegation Skills. The Online Journal of Issues in
Nursing. 15(2).