The provision of health care services of the high quality can save lives of many people, if health care services are provided in time and by well-qualified health care professionals. However, it is not always possible to provide health care services in time by health care professionals. For instance, in case of emergency the problem of the lack of well-qualified specialists can arise. However, it does not mean that people do not need medical aid in such a situation. In stark contrast, in such a situation, the medical aid can be vitally important and the only solution of the problem of the lack of well-qualified specialists is the delegation. In fact, the delegation can be very effective, especially in regard of the delegation of the nursing care. In this respect, it is important to underline the fact that professional nurses spend a lot of time with patients and the quality of health care services they deliver to patients can be determinant for their recovery. On the other hand, nurses may need to delegate their functions to other specially trained people, including practical nurses, in order to provide patients with essential medical aid and nursing care. However, on analyzing the problem of delegation of the nursing care, it is necessary to remember about patients’ needs and their health, which should be always prior to health care professionals. Hence, it is necessary to clearly define the scope of delegation and take consideration the position of specialists concerning the delegation of nursing practices in order to assess adequately whether delegation can be effective or not and whether benefits of the delegation can outweigh its possible drawbacks.
Today, the delegation of the nursing care may be essential for the provision of effective health care services. In this respect, it is necessary to underline the fact that the delegation of nursing care is regulated by legislative norms and acts in order to minimize the risk of professional negligence and to ensure the high quality of health care services. At this point, it is possible to refer to the New York State Nurse Practice Act, which regulates nursing care, including the delegation of nursing care.
In fact, the New York State Nurse Practice Act lays emphasis on the fact that only licensed specialists can provide health care and nursing care services. Naturally, speaking about nursing care it is professional nurses who have the priority in the provision of nursing care services, but they can delegate their functions to other specialists, such as practice nurses. At the same time, in order to become and practice as a professional nurse, health care professionals should meet quite strict requirements defined by the New York State Nurse Practice Act. To put it more precisely, according to the New York State Nurse Practice Act, the delegation of nursing practice can take place, but the essential condition of the delegation is the delegation of nursing care to an individual who is trained and is professionally prepared to the provision of nursing care. In other words, an individual whom the nursing care is delegated to should have the respective qualification which meets the requirements of the existing legislation as well as requirements of the commissioner.
Furthermore, the delegation inevitably involves at least two parties. On the one hand, there are professional nurses who are performing nursing tasks and providing nursing care. In fact, it is professional nurses who constitute the core of the nursing care services providers. On the other hand, there are specialists whom nursing care is delegated to. As a rule, such specialists are practical nurses whose educational level and qualification are lower compared to professional nurses, but they still can provide essential nursing care to patients. In such a way, professional nurses delegate their functions, namely nursing care, to practical nurses. At the same time, it is important to underline that the delegation cannot occur spontaneously. In stark contrast, according to the New York State Nurse Practice Act, the delegation of nursing care is possible only when such a necessity is determined by objective factors, such as the physical inability of a professional nurse to perform her functions, the lack of professional nurses able to provide nursing care. Finally, one of the major conditions of the delegation is the ability and skills of an individual whom nursing care is delegated to since this individual should able to substitute a professional nurse without any risks to patients’ health. In actuality, the delegation is possible not only for practical nurses but for other specialists who were professionally trained and prepared to nursing care. However, it is nurses either professional or practical who normally provide nursing care in the state of New York.
Taking into consideration strict legislative regulations and requirements concerning the delegation, it is necessary to underline that professional nurses should be very careful in regard to delegating their tasks to practical nurses. In this respect, it is worth mentioning the adequate assessment of the situation when the delegation of nursing care takes place. What is meant here is the fact that professional nurses should not delegate their tasks if only they have no other alternative, i.e. if they cannot perform nursing tasks themselves. At this point, the quality of nursing care is of the utmost importance. For instance, a professional nurse can be unable to fulfill her functions physically, especially when she has worked too much. In such a situation, she can delegate her tasks for certain period of time to a practical nurse. However, before delegating the nursing care a professional nurse should ensure that the person, who is delegated with nursing tasks, is qualified enough to perform these tasks. In fact, professional nurses should remember about the priority of patients’ needs and avoid putting patients’ health under a threat through action or inaction. Furthermore, the delegated specialists, a practical nurse, needs to be responsible and get detailed instructions concerning nursing practice and treatment of the patient she is supposed to provide nursing care to. At the same time, it is important to take into consideration not only the professionals skills of a person whom nursing care is delegated to, but it is also necessary to take into consideration the current physical and psychological state of this person since a practical nurse cannot get such responsibility as nursing care if she is unprepared for the fulfillment of her professional tasks.
In addition, it is necessary to pay attention to factors that hinder delegation. In this respect, the qualification is probably the determinant factor that defines the effectiveness of the delegation. What is more, it is the qualification of both the professional and practical nurses that does matter since the former delegates nursing tasks while the latter should perform these tasks with no negative effects for the patients. This is why the professional nurse should be qualified to assess properly whether she can delegate nursing tasks and who she can delegate them, while the practical nurse should perform all the tasks she has to perform in accordance with the needs of the patient.
Consequently, the lack of professional education can be a factor that hinders delegation. In addition, the state of the patient can also be a significant factor which should be taken into consideration in the process of delegation. For instance, patients get used to the nursing personnel and often it is difficult to them to get used to a new nurse. This is why it is necessary to the psychological effect of the delegation on the patient can be an important factor that hinders the delegation. In other words, it is impossible to delegate nursing care to an individual whom the patient is not confident in or whose presence or who qualification makes the patient anxious, for instance.
At this point, it is important to distinguish the patient care assignments and delegation. The former implies that a health care professional performs nursing tasks in relation to the patient in accordance with the treatment and recommendations of a health care professional responsible for the treatment of the patient. In the case of delegation, a professional who performs nursing care simply continues the provision of regular nursing care tasks which has been assigned to the patient. In other words, it is only professionals that changes in case of delegation, but not their tasks, while the patient care assignment involve the provision of specific health care services to the patient conducted by either health care professional.
Finally, the position of professionals dealing with the delegation is very significant in understanding of the effectiveness of delegation. In this respect, it is possible to refer to the position of the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN). Actually, both the ANA and the NCSBN attempt to reinforce the delegation as an essential nursing skill and they support practicing nurses in using delegation safely and effectively (Kappel and Stauffer, 2008). In such a way, the ANA and the NCSBN support the development of delegation since, objectively, nurses need the delegation of nursing care. Otherwise, the question of the quality of health care services at large and nursing care services in particular arises. Representatives of the ANA and the NCSBN stand on the ground that without delegation nurses will be unable to provide patients with the high quality of services, especially in case of emergencies, such as natural disasters or terror attacks. At the same time, specialists representing both the ANA and the NCSBN warn about the importance of the strict regulation of the process of delegation and sharing responsibilities between all participants involved in the process of delegation (Kappel and Stauffer, 2008).
Thus, taking into account all above mentioned, it is possible to conclude that delegation can be a very effective tool to increase the quality of health care services. At any rate, delegation enlarges opportunities for nurses to provide nursing care to patients in time and on the high professional level. At the same time, it is necessary to be aware of the fact that delegation should meet the basic demands and regulations of the existing legislative norms, such as the New York State Nurse Practice Act. The legislative regulation of delegation ensures the high quality of nursing care and minimal risks to patients’ health.