Because the depth of expertise varies within roles, including the RN role, delegation is more difficult when the assistant is not known by the RN. Pairing and partnering increase delegation because trust is developed, relationships are fostered, and growth is supported. In partnering, there is increased commitment to one another and confidence that complex situations can be managed. The partnership enables RNs to perfect their delegation skills more fully.
Some staff members have shared with me that having limited nursing assistants or LPNs available with whom they can partner poses a challenge to implementing this partnering scenario. Creativity is needed to make this scenario work using existing resources. For example, in situations with predominately RN staff, more experienced RNs could mentor new RNs using pairing or partnering, thus enhancing care and helping the new RNs to grow professionally.
Work Complexity Assessment consultants have demonstrated that the amount of work delegated can be expanded when direct care givers work together consistently. Delegation potentials are significantly higher when caregivers are paired or partnered, with the partnered scenario generally having the highest delegation potential. In analyzing the findings from delegation potential studies, RNs frequently cite trust with their co-workers as a key factor when delegating. They state that delegation requires an understanding of one another's knowledge and skills. Direct care givers who work together consistently have been found to experience the following gains in the work setting: (a) more knowledge about each other's competence and continued growth in competence; (b) increased commitment to each other and ability to deal with more complex situations; and (c) increased efficiency in getting the work done through natural synergy (Weydt, 2009, p. 11). The Table compares the description, outcomes, and challenges of the unit-based, pairing, and partnering assignment patterns.
Developing Delegation Skills
Delegation is a multifaceted skill set that begins with understanding one's state nurse practice act which outlines nursing's legal responsibility, authority, and accountability for patient care. RNs are encouraged to conduct ongoing reviews of their state practice act with special attention given to delegation. The review often prompts discussion about organizational policies and procedures as well as clarifying roles, such as that of the LPN or technical support staff. The role clarification becomes increasingly important as new positions develop to address the variety of complex patient care needs. Understanding the role expectations as well as knowing the expertise of the staff to whom care is delegated influences what the RN delegates.