Delegation: Evidence-Based Practice Change Project

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Table of Contents

Discovery
Summary
Translation
Implementation
Evaluation
References

Discovery

The topic and the nursing practice issue

To a greater extent, registered nurses (RNs) delegate their responsibilities to the patient care technicians (PCTs), the certified nurse assistants (CNAs), or the unlicensed assistant personnel (UAPs) to undertake the necessary patient care. However, most PCTs decline such assignments in most cases by saying that the victims are not under their consignment or they are incapable of executing their duties (National Council of State Boards of Nursing, 2016). In the healthcare setting, the issue of delegation results from seasonal nursing assistants’ failure to undertake assigned tasks.

The rationale for the topic selection

Even though RNs serve as critical members of the healthcare team, they should apply their delegation and critical thinking capabilities for the adequate execution of secure victim care. The rationale for selecting this practice problem is due to how delegation affects RNs, which may cause deteriorated patient satisfaction (Aburumman & Sadig, 2020). The RNs are highly scared to discipline and communicate the problem of healthcare assistants neglecting to implement their delegation responsibilities. The lack of implementation delegation by the nursing assistants highly renders patients at risk due to improper attendance.

Summary

The practice problem and PICOT question

In nursing, delegation is essential as it ensures accountability maintenance and assigning activities to staff members aiming to improve patient care. The delegation absence creates uncertainty regarding patient safety since the sufferer lacks adequate assistance in their activities of daily living (ADLs), including mobility, bathing, and eating (Motacki & Motacki, 2017). The following PICOT query is connected with the delegation practice problem.

P- Nursing staff (RNs, PCTs, and LPNs)
I- Inadequate delegation
C- Victim safety
O- Escalate patient care and satisfaction
T- Nursing healthcare members will have sufficient delegation abilities within three months

The formulated PICOT question is: How can the nursing healthcare members escalate patient care and satisfaction within three months by adjusting their insufficient delegation skills?

The systematic review

National Council of State Boards of Nursing. (2016). National guidelines for nursing regulation. Journal of Nursing Regulation, 7 (1), 5-14. Web.

This review assesses the impacts of delegation of duties on patient overall care and safety. The acceptance of the healthcare assistants to agree on executing assigned jobs escalates RN’s control, which influences health results, including increasing patient satisfaction due to the effective ADLs services provided.

Other sources used for data and information

Another scholarly source was deployed to reinforce the systematic review for effective research of the delegation issue.

Aburumman, N.Z., & Sadig, M.S. (2020). The legal delegation of medical responsibility: A comparative framework. Journal of Legal, Ethical and Regulatory Issues, 23(4), 1–9.

This study review indicates the essentiality of victim safety, critical thinking, and delegation in the healthcare setting. In addition, this review embeds the crucial element of patient safety consideration and undertaking adequate legal measures while assigning duties to other nursing assistants.

The other optional peer-reviewed article used for the project trial deployed to supplement the systematic review is as follows:

Motacki, B., K., & Motacki, K. (2017). Nursing delegation and management of patient care (2nd Ed.). Elsevier.

The main findings from the systematic review and the strength of the evidence

To a greater extent, the systematic review study pinpoints the essentiality of delegation among the human nursing resources and the purpose of comprehending several responsibilities each workforce member performs. Another notable finding is that delegation has multiple rights, including circumstance, task, conveyance and guidance, supervision, and assigned correct individual.

Evidence-based solutions for the trial project

For the trial project, I would highly embrace one evidence-based solution: having a face-to-face meeting with the nursing healthcare workforce that does not adhere to the assigned responsibilities and those with inadequate delegation abilities.

Translation

Care standards, practice guidelines, or protocols to support the intervention planning

At first, several RNs portray considerable grievances that the PCTs do not adhere to the assigned activities, and their negative attitude impacts patient care. The protocols followed include attending the bi-weekly meeting with the hospital clinical director.

Stakeholders, their roles and responsibilities in the change process

The first stakeholder is the PCTs, who do not follow the assigned activities of RNs, thus neglecting victim security and care. In the healthcare setting, the PCT assists nurses in their duties, including checking the patient’s blood sugar and offering ADLs.

The registered nurse (RN), who is me, is responsible for delegating tasks to the PCT to ensure adequate patient safety and care provision. The RN assists with surgical procedures and administers medication to the patient.

On the other hand, the clinical coordinator controls the whole nursing staff unit, assigns tasks to the RN, charge nurse, and PCT, and implements disciplinary actions.

Finally, the charge nurse is responsible for supervising the nursing workforce and delegating available healthcare activities to the PCT and the RN.

The nursing role in the change process

In the change process, my nursing responsibility includes undertaking follow-up and reporting to the clinical director and the charge nurse of any prevailing insufficient conveyance and delegation between the nurse and the PCT. My other role is to adequately establish a proper method to assign activities to the PCT without any arguments.

Stakeholders by position titles

The chosen and essential stakeholders for this trial project include the charge nurse, the PCT, the clinical director, and the RN. They are all important as they entirely engender patient security, contentment, and care. In the healthcare setting, these members enhance the well-being of the victims (Motacki & Motacki, 2017). Finally, the members helped implement the meeting to equip the nursing staff with much-needed delegation skills.

Type of cost analysis needed prior to a trial

Before the project’s commencement, a cost-effectiveness analysis will be required to examine how the intervention of eliminating ineffective communication and delegation improves the health outcomes of the patients, including reducing risks. The people needed to be involved in the process include the RN, the PCT, the clinical coordinator, and the charge nurse.

Implementation

The process for gaining permission to plan and begin a trial

At first, a meeting between the PCT and the RN facing the delegation issue is necessary. They should accept participating in the trial project, knowing that their information would be forwarded to the clinical nurse and the charge nurse. Lastly, the clinical coordinator should authorize the process and make appropriate decisions by meeting with the RN and the PCTs to determine the scope of the delegation problem.

The plan for educating the staff about the change process trial

The staff will be educated regarding the plan during the nursing shift changes. The charge nurses will ensure the entire workforce knows what the schedule entails. All the members will be asked to participate directly in the meeting scheduled by the charge nurse. Finally, there will be an evaluation of the PCTs and the RNs concerning their communication and delegation skills improvement. They will be impacted positively by attending the meetings as the assessment will ask them whether their gained abilities influence patient care.

The implementation timeline for the change process

For the change process, the executed timeline would be three months, from July 1, 2022, to September 30, 2022, with bi-weekly meetings. Along the timeline, the initial step includes pinpointing the RNs and PCTs with insufficient communication and delegation capabilities. Another phase involves acquiring feedback from the charge nurse, RNs, clinical coordinator, and the PCT regarding ways of fixing the practice problem. Finally, there will be separate meetings of RNs and PCTs with the clinical directors to avoid bias while voicing their opinions.

The measurable outcomes based on the PICOT

The measurable outcome of the PICOT would be following the PCTs and RNs during the nursing shifts to examine their conveyance and delegation abilities. This will be measured through an overall weekly evaluation ranking on whether they are misunderstanding or missing the communication skills or they are improving in their delegation duties assigned to them.

Forms for recording purposes during the pilot change process

The feedback forms can be deployed for recording purposes, which will be made with the assistance of the clinical coordinator. They will have sections for recording reactions and follow-ups to make the change process effective.

Resources available to staff during the change pilot

During the change pilot, the available resources include the RN, who opinionated adopting the change process, and the healthcare setting intranet. In addition, other notable resources include the charge nurse, the clinical coordinator, and the nurse tutors, who are responsible for ensuring improved delegation abilities.

Meetings of certain stakeholders throughout the trial

Throughout the three-month project trial, there will be bi-weekly meetings between the clinical coordinator, the RN, and the PCT. In that process, the clinical coordinator will be responsible for giving negative and positive reactions to the nursing workforce concerning the conveyance and delegation outcomes.

Evaluation

Reporting the outcomes of the trial

The most appropriate method to report the trial results is by manifesting the available consumer assessment of healthcare providers and systems (HCAPS) improved patient scores. This is because the healthcare victims can pinpoint the attitude of the nursing staff within the specified timeline.

The next steps for the use of the change process information

The initial procedure would be collecting the available information from the trial change process. After that, such a database will be presented to the healthcare nursing council meetings for implementation throughout the healthcare setting.

References

Aburumman, N.Z., & Sadig, M.S. (2020). The legal delegation of medical responsibility: A comparative framework. Journal of Legal, Ethical and Regulatory Issues, 23(4), 1–9.

Motacki, Burke, K., & Motacki, K. (2017). Nursing delegation and management of patient care (2^nd Ed.). Elsevier.

National Council of State Boards of Nursing. (2016). National guidelines for nursing regulation.Journal of Nursing Regulation, 7 (1), 5-14. Web.

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