Delegation has become an important topic with health care costs escalating.

Certain tasks are done by unlicensed assistive personnel to decrease the high costs
associated with using registered nurses. Cherry & Jacob (2011) write about the five rights
of delegation. They are the right task, the right circumstance, the right person, the right
communication method, and the right supervision. As you can see, this is reminiscent of
the five rights of medication administration. Both have many variables, including safety,
liability, and patient outcome. Both are the responsibility of the registered nurse. In
Hawaii nurses are able to delegate tasks to unlicensed assistive personnel as long as they
are within their knowledge and skill level. The Hawaii Nurse Practice Act reiterates that
the registered nurse is responsible and accepts liability in delegating the tasks.
The article Mindful Communication: A Novel Approach to Improving Delegation and
Increasing Patient Safety discuss that the right communication is the heart of good patient
outcome, when a registered nurse delegates a task to an unlicensed assistive personnel
(Anthony & Vidal, 2010). Effective communication is the key factor in patient safety, and
patient safety is the basis of all nursing care. As a registered nurse, we are accountable for
who and what we delegate. Even though we dont do the task ourselves, we are
responsible for the outcome that task may or may not lead to. To have the right
communication, nurses and unlicensed assistive personnel must share quality information.
This is done by communicating frequently. If information is held on to the end of the shift,
it can become useless, and too late to intervene in care. Right communication is also
mindful. Mindful of relating it to the acuteness of the patients illness. If a nurse asks the
unlicensed assistive personnel to turn the patient every two hours, but does not specify it is
to increase respiratory comfort for the dying patient, the unlicensed assistive personnel
may postpone the turn if the patient is in pain thinking it is only for decrease risk of
pressure ulcers. The last component of effective communication is trust. When delegating
tasks, the nurse and unlicensed assistive personnel are depending on each other for
correct, clear, and timely information. If they dont trust each other, they cant depend on
one another and thus good patient outcome will not be the result.
Delegation has become a mainstay in the registered nurses role. As the population
continues to age, and cost of healthcare continues to increase, we may see more tasks being
delegated. An example is in Massachusetts where the Board of Registration in Nursing has
proposed that unlicensed assistive personnel be able to administer medication and
procedures such as tube feeding and wound care (Nurse Practice Act Threatened, 2013).
This has been met by resistance from registered nurses, but we must be aware that change
may be on the horizon. It is critical for nurses to be able to effectively delegate.
Id like to end with a video of how not to delegate, and the consequences of it.
http://youtu.be/WUkq1VWUMOk

Reference
Anthony, M., Vidal, K., (May 31, 2010). Mindful communication: a novel approach to
improving delegation and increasing patient safety. OJIN: The Online Journal of Issues in
Nursing, 15(2). doi:10.3912/OJIN.Vol15No2Man02.
Cherry, B. & Jacob, S. (2011). Contemporary nursing: Issues, Trends and Management (6th
ed). St. Louis: Elsevier.
Hawaii Nurse Practice Act. Retrieved September 17, 2014.
http://hawaii.gov/dcca/pvl/pvl/har/har_89-c.pdf
Nurse practice act threatened by BORN's proposed plan: changes could result in unlicensed
personnel administering meds (April 2013). Massachusetts Nurse Advocate, 84(1) 6.
Retrieved from
http://web.a.ebscohost.com.ezproxy.library.kapiolani.hawaii.edu:8080/ehost/pdfview
er/pdfviewer?sid=35bd1297-f824-48db-84a63ae85add8991%40sessionmgr4005&vid=22&hid=4212