Throughout your clinical rotations, you have hopefully witnessed the true teamwork that is essential in caring for each individual’s needs using Maslow’s hierarchy of needs. As the nurse, you will play a major role in coordinating the patient’s care and will be required to delegate assignments and responsibilities. Delegating requires you to carefully consider all your options and team members’ training and abilities. You are ultimately responsible for the care rendered to a patient and so proper decisions and thorough follow up are imperative.
To help you make decisions both on your NCLEX-RN exam and in real life situations use the “Five Rights” below.
1. Right Circumstance
You need to consider the level of care the patient requires, rules and regulations of the institution and state, and the training and abilities of the other staff members. Patients in the ICU require a high level of advanced care requiring a highly trained RN, where as a patient in a long term care center requires consistent care which can initially be planned by an RN, performed by an LPN on a daily basis and periodically reassessed by an RN. Chronic care facilities often have medical or nursing assistant who aid with basic daily needs. The nurse is always responsible for ensuring that the patient receives the appropriate level of care.
2. Right Task
The nurse must consider the patient’s current state, the preferred outcomes, and whether a competent individual is available to provide the care required. While as the nurse, you may believe that you are the best person to complete a treatment, you must prioritize and delegate some tasks, as you are only one person and you can not do everything alone in a timely and safe manner.
Consider the following:
- As the RN assigned to these patients, what tasks must I do?
- Which tasks can I safely delegate based on institutional policies and state regulations?
- Considering the available staff, how qualified are they to perform the required tasks?
- Who can I call if additional assistance is required?
Providing immediate post op care versus providing activities of daily living are tasks that clearly require a different level of training. Certain tasks, such as administration of chemotherapy, blood transfusions, and critical medications require an RN, where as many other tasks can be safely delegated. Dressing changes, positioning a patient, and measuring vital signs can be delegated.
3. Right Person
Learning to trust your team members starts with understanding their training and responsibilities.
A stable patient who requires the same care day after day can usually be assigned to another team member as long as that team member has been properly trained and the duties are within their scope of practice. A new or critical patient will require the RN to be assessing their immediate and future needs, and should considered a top priority for the RN. As you get to know your team members, the task of delegating becomes easier since you will have a better understanding of their abilities and a more trusting relationship. Each team member has strengths and weaknesses which, over time, you will learn and consider when delegating a task. As you gain confidence as a nurse, the task of delegating will become easier
4. Right Direction and Communication
Once a task has been assigned to another team member, the nurse must properly inform the individual of their responsibilities, which includes the assigned task and how and when it must be done. Some staff may need more guidance than others which is something you will learn overtime, but it is your responsibility to provide clear, concise, correct and complete instructions.
5. Right Supervision
Even after you have delegated care, you remain responsible for the total care of the patient, and therefore you must remain involved and aware. Try and remain positive when communicating with support staff. If a task has not been completed, first ask for their input and see if they require additional guidance. Always offer credit for work completed; everyone likes to be recognized for a job well done. If you see something not being done correctly, offer guidance and use the opportunity as a teaching moment. Staff feel more valued when you try and further their knowledge rather than scolding them for doing something incorrectly. Working together always benefits everyone and should remain as an essential goal.
While you are ultimately responsible, you will need to learn to trust others in providing care to your patients. As a team, you will succeed a great deal more for each patient.