Discussion Question: Below are some common delegation issues with examples. Give your own examples of over-delegation, under-delegation, and refusal to accept a legitimate delegation, and explain what

Expert Solution Preview

Introduction:

Delegation is an important aspect of healthcare practice in which healthcare professionals assign tasks or responsibilities to other healthcare professionals or non-professionals. Effective delegation enhances workflow, productivity, and patient care. However, delegation can be complex and may involve various challenges such as over-delegation, under-delegation, and refusal to accept a legitimate delegation. As a medical professor, it is crucial to train medical college students on effective delegation practices and strategies.

Response to Discussion Question:

Over-delegation: Over-delegation involves assigning too many tasks or responsibilities to someone beyond their competence or capacity. For example, a physician asks a medical student to pass medications and sign off orders while they attend to other duties. In this scenario, the medical student may not have the necessary training, knowledge, or experience to perform the assigned tasks. Moreover, signing off orders is a significant responsibility that requires a thorough understanding of patient conditions and medications.

If I were in such a situation, I would first assess the medical student’s competence and knowledge in medication administration and orders signing. If they lack adequate proficiency, I would decline their request and suggest alternative solutions such as hiring an additional nursing staff for assistance. Alternatively, I would educate the medical student on effective delegation practices and the risks associated with over-delegation.

Under-delegation: Under-delegation involves failing to assign tasks or responsibilities to subordinates or assistants appropriately. For instance, a nurse insists on performing all patient care tasks, such as bathing and feeding, without involving the nursing assistant or other team members. This scenario may result in burnout, decreased productivity, and poor patient outcomes.

To address this issue, I would educate the nurse on delegation practices and the roles of the nursing assistant in patient care. I would also encourage teamwork and collaboration among the nursing staff to enhance efficiency and effectiveness in patient care. Furthermore, I would monitor the nurse’s workload and provide adequate support to ensure they do not experience burnout or exhaustion.

Refusal to accept a legitimate delegation: Refusal to accept a legitimate delegation involves rejecting an assigned task due to various reasons such as lack of knowledge or excess workload. For example, a nursing assistant refuses to assist in cleaning a patient’s wound, claiming they do not have enough training or knowledge in wound care.

To deal with such a situation, I would first evaluate the nursing assistant’s competency level and knowledge in wound care. If they have insufficient proficiency, I would provide training and education on wound care. However, if they refuse to take up the task due to an excessive workload, I would reevaluate the delegation’s fairness and appropriateness, and redistribute the tasks accordingly to allow for an equitable workload distribution.

Response to Assignment Questions:

State Board of Nursing: According to the New York State Board of Nursing, unlicensed assistive personnel (UAP) refers to nursing assistants, orderlies, attendants, and other non-licensed personnel who perform designated patient care tasks under the supervision of a registered nurse (RN) or licensed practical nurse (LPN). The Board outlines the RN’s responsibility in delegation, including assessing the patient, task, and UAP competence, providing clear instructions, providing feedback and support, and ensuring accountability and documentation.

ICU environment: The ICU environment differs significantly from a general medical-surgical unit in UAP’s assigned responsibilities. In ICU, UAPs’ role is limited due to the high acuity of patient conditions and the need for specialized care. UAPs in ICU may provide basic patient care such as bathing, monitoring vital signs, and assisting in mobility. However, UAPs may not carry out specific tasks such as administering medications, inserting invasive lines, or performing critical procedures, which are exclusively under the RN’s domain.

Conclusion:

Effective delegation is crucial in healthcare practice to enhance productivity, efficiency, and patient outcomes. Understanding the challenges associated with delegation, such as over-delegation, under-delegation, and refusal to accept a legitimate delegation, is pivotal in promoting effective delegation practices. The RN’s responsibility in delegation, as outlined by the State Board of Nursing, is essential in ensuring accountability and promoting patient safety. In the ICU environment, UAPs’ role is limited due to the high acuity of patient conditions and the need for specialized care.