The RN verifies comprehension with the nursing assistive personnel and that the assistant accepts the delegation and the responsibility that accompanies it;
7) Communication must be a two-way process. Nursing assistive personnel should have the opportunity to ask questions and/or for clarification of expectations.
8) the RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is: (a) the right task; (b) Under the right circumstances; - to the right person; (d) With the right directions and communication; and (e) Under the right supervision and evaluation.
9) Chief of Nursing Officers are accountable for establishing systems to assess, monitor, verify and communicate ongoing competence requirements in areas related to delegation;
10) There is both individual accountability and organizational accountability for delegation. Organizational accountability for delegation relates to providing sufficient resources, including: (a) Sufficient staffing with an appropriate staff mix; (b) Documenting competencies for all staff providing direct patient care and for ensuring that the RN has access to competence information for the staff to whom the RN is delegating care - Organizational policies on delegation are developed with the active participation of all nurses, and acknowledge that delegation is a professional right and responsibility. ((American Nurses Association, 2005)
X. Basic Elements Required to Form Basis of Delegation by Nurse
It is related that the American Nursing Association has outlined some basic elements for the nurse that are necessarily required in formulation of the basis of delegation which includes; (1) an emphasis on the professional nursing practice; (2) defining delegation on the basis of the nurse practice act and rules/regulations; (3) reviewing specific sections of the law and regulations regarding the delegation; (4) emphasizing the tasks and functions that are not able of delegation or that cannot be delegated on a routine; (5) a focus on the judgment of the RN relating to task analysis and the choice to delegate or refrain from delegating; (6) making a determination of the degree of supervision that is required when delegating; (7) Identifying guidelines for reduction of risk related to delegation; and (8) developing mechanisms for feedback that ensure that tasks delegated are completed and that data is received regularly by which to evaluate outcomes of delegation. (American Nurses Association, 2005) the ANA relates that skills in delegation are developed over time and there is a need for those who employ nurses to understand that a "newly licensed nurse is a novice who is still acquiring foundational knowledge and skills." (American Nurses Association, 2005)
XI. Credentialing in Health Care
Credentialing of health professionals is stated in the work of Holmes (2008) entitled: "From Education to Regulation: Dynamic Challenges for the Health Workforce" to ask the question of "Across the continuum of levels and kinds of training, what is the appropriate mix of health professionals and workers needed in the U.S. health system? Depending on how the question is answered, the influence of the various forms of credentialing will be seen in practice acts, educational curricula, and third-party reimbursement policy. Related to this fundamental question are a host of others concerning the effect of credentialing on quality of care, salaries and wages of health personnel, educational preparation, and rigidity or flexibility within the health system." (Holmes, 2008)
Holmes (2008) states that the MA is "...largely unregulated but make up an increasingly significant part of primary care. They perform a variety of both administrative and clinical functions with the nature of those duties determined by the amount and type of training and any regulations specified by the state. The administrative duties may include activities such as patient-scheduling and insurance-billing; the clinical responsibilities may involve conducting basic lab tests, administering EKGs and x-rays, giving shots, and drawing blood." (Holmes, 2008) Holmes additionally states that a trend that is occurring presently in the United States is "the development of a bimodal workforce." (Holmes, 2008) Specifically this "bifurcation" is witnessed in "...greater numbers of individuals trained at lower levels, along with substantial increases in those who are prepared at higher educational levels. Concurrently, there is a decline, in a relative sense, of individuals prepared at the baccalaureate degree-level. While those prepared at the bachelor's level to enter the health workforce are also increasing in overall numbers, their growth is overshadowed by the large surge in individuals both above and below them on the educational continuum." (Holmes, 2008) Holmes states that graduates, health professions and related clinical services education statistics as shown in the following table.
Source: Holmes (2008)
XII. Summary & Conclusion
It is the position of this writer that problems are likely to arise in relation to the lack of standardization that presently exists. Therefore, this writer proposes that national accreditation standards come under consideration for the entire U.S. nursing profession. In relation to the first questions addressed in this study, it is clear that the entire U.S. nursing professional organizations are well aware of the challenges that exist and that an ongoing dialogue appears to be ensuring that these challenges will be collectively addressed.
Discussion Paper: Doctor of Nursing Practice (2005) American Academy of Nurse Practitioners. Online available at http://www.aanp.org/NR/rdonlyres/9DC9390F-145D-4768-995C-1C1FD12AC77C/0/DiscussionPaperDoctor_of_NursingPrac.pdf
Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply (2005) White Paper July 2006. American Association of Colleges of Nursing. Online available at http://www.aacn.nche.edu/publications/whitepapers/facultyshortages.htm
Hallmarks of the Professional Nursing Practice Environment (2002) AACN White Paper January 2002. American Association of Colleges of Nursing. Online available at http://www.aacn.nche.edu/publications/positions/hallmarks.htm
Holmes, Denise E. (2008) From Education to Regulation: Dynamic Challenges for the Health Workforce. Association of Academic Health Centers. Online available at http://www.aahcdc.org/policy/reports/From_Education_to_Regulation.pdf
Joint Statement on Delegation: American Nurses Association (ANA) and the National Council of State…