Delegation and Related Concepts
Perhaps one of the most difficult responsibilities an RN has is that of effective delegation. RNs are required to understand what patients and families need and then engage the appropriate care givers in the plan of care in order to achieve desired patient outcomes while maximizing the available resources on the patient's behalf. Delegation is an important skill that influences clinical and financial outcomes; yet, an RN's delegation skills often are not evaluated in the same manner as other clinical skills, even though a number of nurses continue to need help in delegating appropriately.
The following scenario is a typical situation that RNs frequently describe when sharing their need for more staff:
Near the end of her shift, the RN finds that the LPN and nursing assistant have all their work completed and are sitting in the nursing station waiting for the next shift to arrive. The RN has been running all evening trying to juggle competing patient needs, such as administering blood and initiating IV antibiotics for patients assigned to the LPN and nursing assistant, in addition to answering a pharmacist's questions about a patient's lab results and performing requests made by team members from other services, all while trying to complete the care needed for her patients. The RN is struck by how overwhelmed she feels and questions the LPN and nursing assistant about why they did not help her. The LPN and nursing assistant respond that had the RN asked them to help, they would have, adding, "but we can't read your mind." The RN responded, "I didn't have time ask. Couldn't you see I was busy?"
There is no doubt that this RN needed help. The RN's challenge, however, was not related to a lack of available personnel. Rather the situation developed because the RN performed work that others could have completed. Almost all RNs can benefit from strengthening their delegation skills so as to maximize the available resources.