Delegation

This year, a WSNF mini grant for commu­nity-based health projects was awarded to Jordan Hardman, BSN, RN, the principal inves­ti­gator for a research study, origi­nally titled The Devel­op­ment of An Instru­ment for Assessing Patient Stability and Predictability by Nurse Delega­tors,” which inves­ti­gated the utility of an inves­ti­gator-devel­oped instru­ment that assessed clinical stability and predictability within nurse delegation. 

Nurse delega­tion, unlike general delega­tion, is a specific process within nursing under the Washington Admin­is­tra­tive Codes. It is focused on assigning care tasks to be performed by long-term care workers (i.e. nursing assis­tants and home care aides) within certain settings, under the manage­ment of a regis­tered nurse, called a nurse delegator. Delegated tasks can include, but are not limited to, oral, topical, nebulizer, G‑tube and rectal medica­tion admin­is­tra­tion; insulin admin­is­tra­tion; tracheal suctioning; in and out catheter­i­za­tion; tube feedings; oxygen admin­is­tra­tion, and certain dressing changes (Parada, 2017). In order for nurse delega­tion to occur, the patient/​client must be deemed stable and predictable” by the nurse delegator. 

It was deter­mined from prior quali­ta­tive research by Hardman, under the guidance of his research mentor from the Univer­sity of Washington School of Nursing, Barbara Cochrane PhD, RN, FAAN, FGSA, that the legal defin­i­tion of stable and predictable condi­tion” could be improved upon. This project attempted to add clarity to that defin­i­tion through the creation and evalu­a­tion of a standard­ized assess­ment instrument. 

To develop the instru­ment, Jordan Hardman BSN, RN and Nona Hunter BSN, RN, under the guidance of their honors program mentor, Dr. Cochrane, explored the legal defin­i­tions and peer-reviewed liter­a­ture found around the United States of stable and predictable condi­tion” pertaining to nurse delega­tion, to expand upon the Washington state legal defin­i­tion. Because few results could be found that differed from the current state defin­i­tion, the researchers decided to develop an instru­ment for clinical stability and predictability, building on evidence-based compre­hen­sive assess­ments that are utilized in similar settings where nurse delega­tion occurs. 

As part of the next stage of research and as the instru­ment was being devel­oped, it was presented to content experts, DSHS Nurse Delega­tion Program Managers and Heather M. Young, PhD, RN, FAAN, a nursing researcher whose early studies helped develop the nurse delega­tion program and regula­tions in Washington state. Their feedback indicated a need to have the instru­ment be more task-specific, and a new instru­ment was devel­oped to assess clinical stability and predictability for insulin admin­is­tra­tion. This new instru­ment was provided online to nurse delega­tors for review along with a survey for feedback on clinical utility and relevance. Results demon­strated that approx­i­mately 44 percent of partic­i­pants agreed or strongly agreed that the instru­ment could be helpful in making stable and predictable decisions within insulin admin­is­tra­tion, with sugges­tions on instru­ment improve­ments (e.g., stream­lining, targeting to early-career delega­tors) that would increase its likeli­hood of being incor­po­rated into clinical practice. Based on this research, a future study, using an online survey linked to specific clinical scenarios, is being devel­oped to inves­ti­gate assess­ment decision patterns for delegated insulin administration. 

Jordan Hardman, BSN, RN, and Nona Hunter, BSN, RN, are both recent gradu­ates of Univer­sity of Washington School of Nursing, where they conducted research on nurse delega­tion. Their mentor, Barbara Cochrane PhD, RN, FAAN, is a professor and the Family and Child Nursing interim chair at the Univer­sity of Washington School of Nursing.