• Who makes you accountable for the delegation that you use in your organization, as well as on a state and national level?
From a narrow perspective, the authority and responsibility to delegate using particular practices and or approaches is usually determined by the administrators in a specific healthcare institution or organization. Rules and regulations regarding delegation differ from one healthcare facility to the next, influenced by the particular practice setting of the facility. For instance, depending on the institution and its practices, nurses can be made accountable for their delegation practices to the human resource manager, administration manager or general manager of the health institution(s). It is however notable that from a general perspective, the rules, regulations and practice of delegation among nurses is influenced by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA). The NCSBN and ANA as mandated by Nurse Practice Act and the Administrative Rules provide detailed clarification on the specific responsibilities of nurses. This includes responsibilities and accountability associated with delegation of nurses belonging to different levels of nursing licensure. The NCSBN and ANA aim at standardizing the nursing delegation process by providing national guidelines that influence the delegation practice and procedures adopted in different states by different healthcare facilities.
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It is however important to note that the accountability of what duties nurses can delegate and what they cannot in their specific practice setting is different for different states and regions. The accountability for delegation practice that is used in different healthcare organizations rests on the State Nurse Practice Acts and organization policies and procedures (P&P). The State Nurse Practice Acts and Organization P&P determine the state laws and rules that differentiate the delegation strategies used by different nurse leaders in different healthcare institutions, for different states. The state law and rules regarding delegation include the manner in which assessments are analyzed and how nurse leaders exercise nursing judgment, engage in plan nursing care and evaluate nursing care, so as to delegate. Other than their employers and the regulatory authorities, the nurses are also accountable to the patients that they treat and the general public. This is mainly because delegation activities have profound impact on quality of care.
• Are there ways you could initiate greater collaboration with the health care team by using delegation?
Greater collaboration with health care team can be enhanced through facilitating effective communication networks and channels during delegation. Efficiency in the delegation process through operative communication has the ability to facilitate greater collaboration among health care teams. The effectiveness of appropriate operative communication is that it guarantees that the healthcare practitioners who the duties are delegated to do not work in isolation, but in teams where they get to assist one another in service delivery. It will also ensure that the individuals do not make standalone clinical judgments as this may have negative outcomes.
Another way through which greater collaboration with health care team can be achieved through delegation is through provision of training for the health teams on how to as well as the importance of working in teams. With training on how to perform their duties as well as how to work well with others, the teams will be able to develop effective synergy that will facilitate success in collaborative efforts. This shows that it is important to have ongoing development to guarantee that the competency of the team as well as their engagement in collaborative efforts is maintained.
• What is the purpose of the National Council of State Boards of Nursing delegation decision-making tree?
The main role of the NCSBN with regards to the delegation decision making tree is first and foremost to guarantee that public protection is promoted and maintained. The NCSBN functions to guarantee that the responsibilities of the nurse leader or employer, delegatee, and licensed nurses facilitate the wellbeing of patients within different states. It also ensures that appropriate and relevant information regarding delegation process is achieved and that the practitioners to whom duties are delegated to are competent and that they receive appropriate and adequate training and education, to facilitate quality care services, to achieve the NCSBN overall role of guaranteeing public safety.
• What is the long-term implication related to health care cost if the patient or patient population continues to have poor outcomes related to cost containment?
The long-term implication related to healthcare cost when patients accrue poor outcomes related to cost containment is that the cost of healthcare will continue to go up. This would mean that the government as well as healthcare institutions will have to incur greater costs in the future. Cost containment restricts the extent to which quality healthcare can be achieved and this in turn means that the patient population will not receive effective healthcare treatment in the short-term and this in turn means that their health issues will gradually increase and this will require greater levels of funds to mitigate. Therefore, the poor health outcomes related to cost containment will only result in healthcare becoming more costly and when the costs become higher in the long-term, it will become more difficult to achieve positive health outcomes among the patient population, which is also likely to grow.
• How can you address cost within your organization, as a nursing leader, and how is this related to patient outcomes?
Cost is a sensitive issue because it determines the ability of a health institution to secure adequate and appropriate facilities and resources to guarantee quality healthcare service provision. It also influences the affordability of healthcare services to the general patient population. As such, it would be prudent to address the issue of cost by focusing on the symmetry of the cost. This simply means ensuring that cost is approached from the perspective of the most appropriate cost which will ensure that the health organization achieves its objectives of providing quality healthcare through affordability to adequately pay health staff while at the same time affords to acquire relevant resources and equipment. This is will also include the consideration of the affordability of the care provision to the patients. Patients are integral in healthcare service delivery because healthcare services are directed to them. This means that if they do not afford healthcare services then healthcare organizations are not meeting their objectives. It is with this regard that I would approach the issue of cost from the perspective of achieving equilibrium between the costs that patients incur or afford, and the costs that facilitate the organizations objective of quality service delivery.
- Brown, C., Bornstein, E., & Wilcox, C. (2012). Partnership and empowerment program: A model for patient-centered, comprehensive, and cost-effective care. Clinical Journal of Oncology Nursing, 16(1), 15–17.
- Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd edition). Clifton Park, NY: Delmar.
- Mueller, C., & Vogelsmeier, A. (2013). Effective Delegation: Understanding Responsibility, Authority, and Accountability. Journal of Nursing Regulation Volume 4, Issue 3, Pages 20–27; DOI: http://dx.doi.org/10.1016/S2155-8256(15)30126-5.
- Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco: Jossey-Bass.
