Delegation and Supervision Outside the Hospital

Abstract

Nursing, San Francisco, CA. Rs the trend toward community-based health care accelerates, nurses are practicing in more diverse settings, from ambulatory care clinics and skilled nursing facilities to schools and patients' homes. Nurses who practice outside the acute care hospital now have more elements to consider when supervising unlicensed assistive personnel and other caregivers and deciding which tasks to delegate. Fortunately, the nursing process can provide a decisionmaking framework for delegating care. The hospital is a far more stable, controlled environment than are the homes of many patients. In most hospitals, assistive personnel have standardized job descriptions and some training in basic procedures. Registered nurses are now making delegation decisions relating to high-tech care provided in the home and community. We're increasingly being called upon to supervise family members, neighbors, and various community workers as well as other health care personnel. Leading these newly configured patient care teams is a major challenge. It adds to the confusion that many RNs feel when they change from hospital to community practices. The Pew Commission Report calls on all health professions to make fundamental changes in order to survive in the twenty-first century. For nurses to successfully navigate these changes, we'll need to understand the basic elements of delegation and supervision.