A scoping review of registered nurses' delegating care and support to unlicenced care and support workers

Abstract

AimTo scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts.DesignScoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA‐ScR checklist.MethodsThe study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers.ResultsA total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers.ConclusionsThe scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature.Implications for the ProfessionDecisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re‐distribution of nurses' work.Relevance to clinical practiceDelegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.

Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study

“…The notion that registered nurses and nursing assistants are not fully conversant about the nursing assistant's scope of practice is not unique to this research with the literature reporting that registered nurses were unsure of the suitability of tasks for delegation (Gravlin & Bittner, 2010); and both registered nurses and nursing assistants lacked understanding of the assistant scope of practice (Kaernested & Bragadottir, 2012;Potter et al, 2010;Standing & Anthony, 2008;Spilsbury et al, 2011). As discussed in a recent review of delegation literature by Wilson et al (2023), the accountability and responsibility of delegation lies with the registered nurse including decisions surrounding who is the most appropriate person to complete a task at any given time. When nurses fail to delegate correctly, they are legally liable for their practice (Wilson et al, 2023) and it would appear that some registered nurses in this study may not be meeting their legal obligation.…”

“…As discussed in a recent review of delegation literature by Wilson et al (2023), the accountability and responsibility of delegation lies with the registered nurse including decisions surrounding who is the most appropriate person to complete a task at any given time. When nurses fail to delegate correctly, they are legally liable for their practice (Wilson et al, 2023) and it would appear that some registered nurses in this study may not be meeting their legal obligation.…”

Factors associated with continuing education needs in medication administration among school nurses

“…How to utilize the UAP model proposed by Wilson et al. (2023) to administer medication in schools according to the standard will be a key focus of the School Nurses Association.…”

“…However, different countries adhere to varying models of campus medication administration because of differences in finances, laws and systems (Baltag et al., 2015). These models may involve full medication administration by school nurses or medication delegation which encompasses three delegation modes: direct, indirect and a mixture of both (Wilson et al., 2023). In Taiwan, the School Health Act mandates a minimum of one licensed nurse per school, and two for schools with over 40 classes (Taiwan Ministry of Education, 2002).…”

“…According to Taiwan's government regulations, there are no explicit guidelines for unlicensed assistance personnel (UAP)(Lee, 2020). How to utilize the UAP model proposed byWilson et al (2023) to administer medication in schools according to the standard will be a key focus of the School Nurses Association.4.1 | LimitationsOur study represents the first attempt to examine the continuing education needs and predictive factors of school nurses in medication administration on school campuses in Taiwan, utilizing a national sample. The study has certain limitations that should be acknowledged.…”