According to the National Council of State Boards of Nursing, the RN scope of practice is defined as “Assessment, nursing diagnosis, setting goals, planning care strategies, implementing care, delegating care to qualified others, supervising, evaluating, teaching, managing care, maintaining patient safety and collaborating with other health care members”. Due to concerns about the nursing workforce scarcity and the constant cost growth within the healthcare industry, it is vital that we comprehend how to handle the “delegation” portion of the role of nursing in order to execute accountabilities outlined in the RN Scope of Practice. Delegation is one of the most important aspects of the nurses’ role, but patient safety, cultural background, competency, right task, patents’ needs, and many other factors should be considered before a job is assigned to assisting personnel.
A nurse should not only be able to delegate, but also to assess if the delegated job was completed correctly. By delegating, cost of service in hospitals can be reduced significantly due to the specific care provided by personnel with lower pay grade. Another factor that should be considered while delegating according to Giger & Davidhizar (Giger & Davidhizar, 2002) are the six types of cultural phenomena. This model evaluates differences between individuals in cultural groups by inquiring about six cultural dimensions: communication, time, space, social organization, environmental control, and biological variations. In order to deliver safe, culturally competent care, a common understanding of the patient’s cultural needs must be accomplished through communication. Verbal and non-verbal communication account for a great portion of the cultural differences between nurses and patients. Nurses have to understand the concept of time when it comes to delegation because some cultures are focused on the past and approach things like their predecessors, which may lead to unwillingness to accept new technologies or treatments. Individuals from these groups may decline preventive measures or miss appointments (Giger ; Davidhizar, 2004).
Individuals from these groups must be approached with questions like: “Is the past, present, or future most important to me?” and “How does my outlook of time mirrors in my own health choices?” Nurses have to be conscious of their patients’ comfort level associated to body distance during a conversation, closeness to family members, awareness of space, eye contact, and personal and cultural touch practices (Giger & Davidhizar, 2004). Regarding social organization, RN’s need to factor in geography, socioeconomic status, religious association, gender and sexual orientation, as well as age and lifecycle status. Environmental control is another dimension of the transcultural assessment model. Environmental control could be explained by the patient’s ability to map activities that handle their environment as well as their understanding of personal control over factors in the environment. Examples are folk medicine and health beliefs.
Biological variations include race, body organization, hereditary variations, dietary preferences, and psychological characteristics. Nursing examples incorporate diseases connected to specific ethnic groups, as well as rural versus urban health. It is critical that nurses understand their personal values, culture, and biases, as well as those of their profession through familiarity and reflection of cultural assessment tools.
As a nurse in Bridgeport Hospital Emergency Department, I delegate to ED techs, unit support, and other RN’s on a daily basis. Most of the time everything goes by the book, but sometimes the delegated task is not completed or there is a problem, which needs to be addressed. I remember the time when due to lack of female technicians on the night shift, I delegated the personal hygiene care of a female patient to a male technician. Unfortunately, the patient felt that she did not want to be helped by the tech and requested a help from a female technician. I felt obligated to resolve the situation with understanding and respect to my patient’s request.
As mentioned above due to lack of female technicians, I delegated the task to another female RN which currently was available to help. Sometimes it is not about the religious background of the patient or the current situation the patient is in, but no matter what, the patient is the core of the holistic centered care and care should be provided with respect to patient’s wishes. Later when the patient was discharged to home she personally came and thanked me for validating and not ignoring her wishes. She explained to me that she has been mistreated by a male family member in her childhood and never felt comfortable being helped by male technicians with her personal hygiene. I learned that in situations where patient’s requests are difficult or even impossible to attend to they still have to be addressed with respect and understanding. Delegation is a complicated process, with many factors affecting a successful outcome. When done correctly, the delegation practice could be beneficial to patients, nurses and hospitals in many ways such as patient satisfaction, cost of services, safety, and quality of care.
Understanding the delegation practice is a must for every provider including doctors, nurses, and technicians.
