Delegation decision-making by registered nurses who provide direct care for patients with spinal cord impairment
Parsons, L.C.
Sci Nursing a Publication of the American Association of Spinal Cord Injury Nurses 21(1): 20-28
2004
ISSN/ISBN: 0888-8299 PMID: 15176346 Document Number: 572297
Delegation and coordination of patient care are critical skills for registered nurses (RN). Most educational programs and clinical experiences in nursing school have not prepared nurses to function in a delegation decision-making capacity. Nurses caring for individuals with spinal cord impairment (SCI) are especially challenged to provide partial or total assistance to meet the requisite care needs of this patient population. Hospital length of stay has decreased for individuals with SCI. RNs employed in long-term care (LTC) facilities have found admissions of patients with SCI occur more frequently with the onset of managed care and the increased longevity of Americans. Capitated markets within managed care require a nursing care delivery model that safely and judiciously uses nursing personnel to their fullest potential. Conger's (1993) Delegation Decision-Making Model (DDMM) utilizes all levels of personnel to their maximum potential while staying within the confines of individuals state nurse practice acts. The ability of RNs to direct the health care team is crucial to affect positive patient outcomes. The purpose of this descriptive comparative study was to ascertain baseline information on nurse delegation decision-making knowledge, job satisfaction, and level of comfort with this skill for RNs practicing in hospital and LTC settings. After reading a case study on a patient with SCI, RNs in the hospital and LTC facilities used Conger's (1993) DDMM. Scores for delegation decision-making were determined using the Nursing Assessment Decision Grid. Delegation knowledge scores were the same for RNs practicing in the hospital and LTC settings. Of interest was that RNs practicing in LTC settings cited learning delegation skills "on the job" 50% of the time compared to hospital nurses who reported learning these skills on the job 19% of the time. Additional research in the area of nurse delegation with this patient population needs to be investigated to support the findings of this study.