Delegation In Health Care

My second clinical day took place on September 24th, 2015 at Saint Barnabas Hospital in Livingston, New Jersey. My preceptor Maria Brilhante, MSN, RN, allowed me to observe the morning huddle that took place with all the nurse managers that are in the hospital. The purpose of this huddle was to keep the director of nursing informed about the census on each unit. I found this processed to be very uniformed and professional because the DON was engaged. The day went on with me attending meetings on how managers could implement plans to contain cost for the hospital. Maria did her daily rounds on her patients and her nursing staff. She has a folder that contains papers on how each nurse is progressing from the time they get off orientation. Her motto to the nurses is, “You are good at what you do, so when I coach don’t take offense. I am only trying to get you to be great”. This boost their confidence which I thought to be important.

Providing care to clients is more complex than just providing care. It requires the use of the nursing process, knowledge in what to do with that process as well as being able to adapt and comply with the continuous changes in rules, regulations and standards of care in health care. If all of those factors are not enough, let us not forget about the changes in the evolving nursing workforce. Many factors will influence the ability to comply with all regulations and standards. As stated in the National Center for Health Workforce Analysis report from December 2014. Some factors include: “population growth, aging of the population, overall economic conditions, aging of the nursing workforce, and changes in health care reimbursement. Therefore, delegation should be used as a tool in helping the licensed nurse, as it plays a vital role in being able to provide appropriate nursing care to the highest

This author spoke with several nurses to discuss Summa’s shared governance. There were two that had two opposing views of it. One nurse, who was younger, felt that the shared governance was just for show to achieve Magnet status. The cons she found was that the recommendations that staff nurses made were just ignored. Another problem she found was that the work that was put into it was not being reimbursed financially. Problem with shared governance is that it is believed to exist where there is empowerment, but it is has more to do with traditional board governance with some staff input. The result is that it is not founded in the actions of the staff nurse, but the actions of administration (Joseph & Bogue, 2016). The other nurse, who was older, was very excited to discuss shared governance. Her department was the first at Summa to initiate shared governance. Some of the pros were nurses had a voice and a path to follow to institute change. She explained how she

Shared governance empowers nurses by recognizing that nurses, as front line staff, are in a position to have a unique understanding of the complexities of daily patient care. Utilization of unit-based councils made up of staff nurses to solve problems and evaluate procedures ensures that evidence-based best practices are implemented (Fray, 2011). Shared decision making in nursing units increases the use of best practices through process development, sharing of successes across multi-unit areas and in the development of new nurse leaders. Unit-based councils are often chaired by younger nursing staff and nursing leaders act more as facilitators allowing these young new nurses to be

As one might predict from the articles reviewed not one eluded that the bedside nurse disagreed with an improved RN to patient ratio. At this point you may be reading this saying; so hospitals need more nurses, why don’t they hire them. The answer is hospitals do, but because of the growing number of patients in the hospitals, nurse burnout, and nurses moving from one department to another or quitting all together, there is a nursing shortage. The problem becomes how hospitals can retain nurses when there are so many opportunities elsewhere. The upper nursing management, often known as the VP of nursing, collaborate with the accountants and CEO’s of the hospitals and have pressure to save money

(2010) said delegation by RNs is a primary mechanism for ensuring that professional nursing standards of care reach the

However, if team nursing were to be fully accepted and embraced, I believe that delegating one nurse to chem strips and another to medication, etc., could be very beneficial to patient care delivery. Deutschendorf (2010) defines assignment as “the transfer of responsibility to another while retaining accountability for the outcome” (p. 441). I feel as though the execution of care hubs on my particular unit is not being fully embraced by all nurses based on the lack of trust between nurses and the worry that tasks, documentation, and care delivery will not be done properly or sufficiently, often leaving liability and accountability a fear for nurses. Additionally, I often find nurses splitting up their patient assignment based on the dedication and hard work of their co-nurse. For example, a hands-on and attention to detail nurse, may not feel comfortable working with a nurse who spends much of their shift on their cellphone or behind a computer

Analyzing case study 16, multiple patients with peripheral vascular disease need to be delegated to staff on a vascular surgery unit depending on the care and responsibilities that each patient requires. The RN team leader has the authority to delegate tasks and will distribute the workload according to each staff member’s position, scope of practice, education and experience. Another factor to consider before delegating is that the RN team leader should consider the following: risk for harm, complexity of task involved, and level of patient interaction involved.

I agree, Sydni. When working in healthcare we must learn to work as a team to accomplish goals. As you stated in your post, we simply cannot do it alone. The nurse supervisor must also understand her role in making assignments. That nurse is responsible for assigning patients to the most appropriate nurse. He or she must look at each individual patient and place them with the correct nurse. When picking a nurse for that patient the nurse must know what is within the nurse's scope of practice and whether that nurse is competent enough to effectively and safely care for that

Healthcare changes occurring today along with shrinking budgets and reimbursement rates for hospitals has forced institution CEOs to do more with less. Changes and restructuring of various health facilities require nursing leaders with flexibility and adaptability. Nurse leaders must also consider budgetary constraints, cost effectiveness, patient safety, and quality care while maintaining focus on improved patient outcome. The responsibility of ensuring patients receive safe and high quality care belongs to every employee in the hospital, including support staff such as IV therapy. In this hospital, this led to the development of a nurse director position to oversee the

Nurse administrators need to adroitly balance many aspects of their role, moving seamlessly from senior leadership meetings to assisting patients while completing walking rounds on an inpatient unit. This is what I have witnessed over the past three weeks in my practicum. The experience has been rich, and I am grateful to my preceptor, Karen Slifka for having lengthy conversations with me, as we discussed the current happenings at the hospital, and the practicum readings. Karen and I reviewed unit specific budgets, discussing both the revenues and expenses. We had continued attending meeting about the implementation of the agency’s electronic medical record (EMR). Our discussions also included civility in

The health care environment is fast- paced and hectic, and delegation is an essential part of nurses’ work. When delegating, leaders and staff must master the tools of communication to ensure that nursing care is completed safely and that unit goals are met. Fostering effective communication is accomplished by using the elements of trust, respect, and empathy (Huber, 2014-a). For this post, I will discuss the issues of the power, conflict, communication, and delegation presented in the critical thinking exercise in chapter nine.

Great post! I also agree that the nurse’s role is to promote and ensure optimal health for all our patients. I do wish that more hospitals truly cared about their patients. My facility went from a not-for- profit community hospital to a profit hospital owned by a large corporation. I thought with more money from a bigger company the hospital would flourish. Over the past 2 years, we have seen such a change and it’s for the worst. It’s all about the money. They have cut so many corners, I feel I’m working in a hospital from 20 years ago. The nurse to patient ratio is horrible. They push nurses to their breaking point where they quit and then hire new nurses with no experience for cheaper wages and do the same all over again. We have seen a drastic increase in unnecessary codes around the hospital due to lack of staff and inappropriate

Total patient care is the oldest method of patient care organization and within this system, each nurse assumes total responsibility for patient care. As cited in Fernandez et al. (2010), this model is best suited to a workplace consisting of all registered nurses and as a result, its use is slowly declining. This study identifies the advantages of this model as the potential for patients to be involved in decisions regarding their care, and that patients’ progress can be easily evaluated. Additional responsibilities, including being a mentor, preceptor, and supporter of new nurses, are generally avoided. While these decreased responsibilities could mean less stress in the workplace, it could potentially lead to new graduates receiving patients for care that

One of the biggest threats to achieving patient-centered care in the workplace is each employee believing it’s up to someone else. The front desk staff thinks it’s the responsibility of the floor nurses. The floor nurses think it’s the responsibility of the physicians. It’s an age-old game of “pass the buck.” However, for patient-centered care to be successful, everyone must take full responsibility. From treating patients with courtesy and respect to making sure all needs are met prior to discharge, everyone plays a crucial part. Your primary role is to make sure they understand