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Delegation
Changes in government reimbursement policies and public
expectations of transparency in the healthcare system have given rise to
changes in the model of nursing care (Anthony, 2010). To achieve cost
effective healthcare outcomes, healthcare providers now relay heavily upon
unlicensed assistive personnel (UAP) to assist registered nurses (RNs) in
providing care to patients (Anthony, 2010). Accordingly, health care
outcomes often depend on the communication between RNs and UAPs. In
the article, Mindful Communication, the author explains that successful
communication between a RN and UAP is dependent on five key aspects of
the communication process:

1.

Information Decay: Irrelevance of information as a result of

2.

changes in a patients condition or the passage of time.

Information Saliency: The clarity of information in the context of

3.

what others know about the patient.

Mindfulness: Keen situational awareness of the present and an
active process of continually updating and evaluating

4.

information.
Stacking: Being mindful and able to make sense of situations

5.

about the flow of work as situations change.

Trust: The willingness of the RN and UAP to rely on one anther
with the expectation that the other will act appropriately, which
fosters frequent and dynamic communication in a reciprocal

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relationship. This allows more information to be shared and less
to be lost (Anthony, 2010).

At first glace, many of the concepts discussed by Anthony and Vidal appears
to be nothing more than common sense. However, these often taken for
granted principles are vital to successful communication in the healthcare
setting.
For example, most people would agree that clear communication is
important. However, as pointed out by Anthony and Vidal, even clear
communication can fail to produce desired health care outcomes if it is not
transmitted in a timely manner (i.e., while the information is salient). In the
healthcare setting, information changes rapidly and loses value as tie
passes. Thus, when information is not communicated between a RN and UAP
in a timely way, important opportunities to address problems or improve
healthcare outcomes may be missed (Anthony, 2010).
Similarly, even if a RN communicates a directive to a UAP in a clear
manner, UAPs may not appreciate the significance of a directive or may
misconstrue the basis for the request. UAPs do not have the same
knowledge base as RNs and may have difficulty in identifying meaningful
information. Thus, if a RN delegates a task to a UAP without explaining the
rationale (salience) for the delegated task, the UAP may not identify the
desired outcome or relay important information to the RN (Anthony, 2010).

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The Hawaii Nurse Practice Delegation Policy (HNPDP) provides
guidance to Hawaii RNs in delegating tasks and responsibilities to UAPs.
Under the HNPDP, tasks delegated by the RN to the UAP should not exercise
judgment or intervention (except in an emergency situations) and nurses
must use the NCSBN delegation decision-making process contained in the
NCSBN documents approved by the Board (Hawaii Administrative Rules 1689-100). In addition, the Hawaii Administrative Rules and NCSBN documents
provide that the RN must ensure that the UAP is competent to perform
delegated tasks and hold the RN responsible for healthcare outcomes
resulting from the actions of UAPs (Saccomano, 2013).
This means that the RN can delegate the task of obtaining a blood glucose
level to a UAP because it does not require the utilization of the nursing
judgment but, the RN is responsible for making sure the UAP knows how to
correctly execute the procedure and is ultimately responsible for the results.
Being responsible for the actions of UAPs is frightening; however, RNs
can effectively utilize UAPs by following the rules regarding delegable and
non-delegable tasks and applying Anthony and Vidals suggestions for
effective delegation. In addition, although the financial reality of todays
healthcare model requires the use of UAPs, this does not have to translate
into negative healthcare outcomes.

Works Cited
Anthony, M. V. (2010). Mindful Communication: A Novel Approach to Improving
Delegation and Increasing Patient Safety. OJIN: The Online Journal of Issues in
Nursing , 15, No. 2.
Hawaii Administrative Rules 16-89-100. (n.d.). Honolulu, Hawaii, USA.
Saccomano, S. J. (2013, February 25). Advance Healthcare Network for Nurses.
Retrieved January 19, 2015, from Art & Science of Delegation in Nursing:
www.nursing.advanceweb.com/Features/Articles/Art-Science-of-Delegation-inNursing.aspx
Saunders, V. (2001, October). Notes taken from: Valisa Saunders, APRN, MS, NP.
Honolulu, Hawaii, USA.