I’ve recently been contacted by a company who is reviewing their RN understanding of delegation and direction especially when working with unregulated staff. I thought I would discuss this topic today because it is something, Registered Nurses need to be mindful of and our responsibilities around this. I wonder how many of us have been on to the NZNC to review what our responsibilities are around delegation and direction?
The NZ Nursing Council describes delegation and direction as follows:
- Delegation is the transfer of responsibility for the performance of an activity from one person to another with the former retaining accountability for the outcome.
- Direction is the active process of guiding, monitoring and evaluating the nursing activities performed by another.
While it might be easy to delegate a responsibility, how do you really know the level of knowledge of the person you are delegating to? We are all good at assuming that a person knows, BUT how do we know? Have you monitored or evaluated the person to ensure they have the knowledge and skill to do the job because ultimately you are responsible for the care being delivered? This 3 min video explains it really well
The problem I see is with the amount of paperwork and the physical workload that is now the responsibility of the Registered Nurse. It can become very easy to delegate a job assuming the person knows what to do but lacking the time to monitor and evaluate the caregiver/support worker.
I can see how easily this can happen as I constantly see on the ‘Facebook platform New Zealand Please Hear Our Voice’, the stress that nurses are under with their workload. Many people work long hours, do not take breaks and get burnt out, so how are you going to give direction to the person you are delegating the task too? It can be tricky.
Even if a person has a Level 2, 3 or 4 qualification, can you be assured they are competent at carrying out the delegated task? Unfortunately, you can’t. So how are you going to ensure the person has the specific training?
One way to get them to do targeted training for the task or tasks they are going to do, online. For instance, if you are dealing with someone in the community who has a tracheostomy, get them to show proof of understanding tracheostomies online. The same goes for any ostomy, including PEG feeding. I know for instance, that on Care Training Online, I have a training module that comprehensively covers these topics. It’s not an NZQA Unit Standard, it’s practical training and understanding of the topic.
So, targeted training is one thing but how are you going to monitor and evaluate their competence so that you are assured they know what they are doing. So here lies the problem. Unfortunately, there’s no other way but to actively assess them doing the job because ultimately, you, the Registered Nurse, is responsible for the care they are delivering.
It’s a very tricky situation but the one thing you must do at all costs, is protect not only your good name but your Practicing Certificate as well. You must not compromise yourself in any way. While I cannot tell you how to do this, as each organisation is different, I can tell you that you have to be proactive and find a suitable way for you to delegate and direct safely so you can be confident the person delegated is delivering safe care.