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chapter 9 | Delegation of Client Care 125 CikguOnline
staff nurse at a small local hospital. The hospital had box 9-4
just opened its new birthing center. The first day on
Basic Entitlements of Individuals in the
the job went well. The other staff members seemed Workplace
cordial. As the weeks went by, however, Laura began
Professionals in the workplace are entitled to:
to have problems getting other staff to help her. No
• Respect from others in the work setting
one would offer to relieve her for meals or a break. • A reasonable and equitable workload
She noticed that certain groups of staff members • Wages commensurate with the job
always went to lunch together but that she was never • Determine his or her own priorities
invited to join them. She attempted to speak to some • Ask for what he or she wants
• Refuse without guilt
of the more approachable coworkers, but she did not
• Make mistakes and be accountable for them
get much information. Disturbed by the situation, • Give and receive information as a professional nurse
Laura went to the nurse manager. The nurse man- • Act in the best interest of the client
ager listened quietly while Laura related her experi- • Be human
ences. She then asked Laura to think about the last Adapted from Chevernet, M. (1988). STAT: Special Techniques in Assertiveness
staff meeting. Laura realized that she had alienated Training for Women in Healthcare Professions, 2nd ed. St. Louis, Mo.: Mosby.
the staff during the meeting because she had said
repeatedly that in “her hospital” things were done in educated before the 1970s worked in settings with
a particular way. Laura also realized that, instead of LPNs and nursing assistants, where they routinely
asking for help, she was in the habit of demanding it. delegated tasks. However, client acuity was lower
Laura and the nurse manager discussed the difficul- and the care less complex. Older nurses have con-
ties of her changing positions, moving to a new place, siderable delegation experience and can be a
and trying to develop both professional and social resource for younger nurses.
ties. Together, they came up with several solutions to The added responsibility of delegation creates
Laura’s problem. some discomfort for nurses. Many believe they are
unprepared to assume this responsibility, especially
Staff Preferences in deciding the competency of another person. To
Considering the preferences of individual team decrease this discomfort, nurses need to participate
members is important but should not supersede in establishing guidelines for UAP within their
other criteria for delegating responsibly. Allowing institution. The ANA Position Statements on
team members to always select what they want to Unlicensed Assistive Personnel address this.
do may cause the less assertive members’ needs to Table 9-1 lists the direct and indirect client care
be unmet. activities that may be performed by UAP.
It is important to explain the rationale for deci-
sions made regarding delegation so that all team Licensure Issues
members may understand the needs of the unit or The current health-care environment requires
organization. Box 9-4 outlines basic rights for pro- nurses to delegate. Many nurses voice concerns
fessional health-care team members. Although about the personal risk regarding their licensure if
written originally for women, the concepts are they delegate inappropriately.The courts have usu-
applicable to all professional health-care providers. ally ruled that nurses are not liable for the negli-
gence of other individuals, provided that the nurse
Barriers to Delegation delegated appropriately. Delegation is within the
scope of nursing practice. The art and skill of dele-
Many nurses, particularly new ones, have difficulty gation are acquired with practice.
delegating. The reasons for this include experience
issues, licensure issues, and quality-of-care issues. Legal Issues and Delegation
State nurse practice acts establish the legal bound-
Experience Issues aries for nursing practice. Professional nursing
Many nurses received their education during the organizations define practice standards, and the
1980s, when primary care was the major delivery policies of the health-care institution create job
system.These nurses lacked the education and skill descriptions and establish policies that guide appro-
needed for delegation (Mahlmeister, 1999). Nurses priate delegation decisions for the organization.