Delegation and Ethics in Nursing

This paper discusses delegation and supervision requirements that must be met by a student on clinical placement. It also describes the ethical and legal dilemma outlined and discusses the codes, standards and laws that it contravenes.

Running head: DELEGATION AND ETHICS IN NURSING 1
DELEGATION AND ETHICS IN NURSING
Name of Student
Institution Affiliation

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DELEGATION AND ETHICS IN NURSING
Introduction
Delegation is a very common practice in clinical nursing. Delegation in nursing can be
defined as the process of a nurse directing another nurse or healthcare staff to perform
nursing tasks and activities on their behalf (Savage, 2017). There are at least two parties in
delegation. They include the delegator and the delegatee. The delegator is described as the
person who assigns a portion of his or her work to another person. There are essential
components in delegation that needs to be seriously considered when carrying out delegation.
These components include; responsibility, authority and accountability (Zaccagnini &
Pechacek, 2019). This paper therefore discusses delegation and supervision requirements that
must be met by a student on clinical placement. The paper begins with an outline and
discussion of scope of practice for a re-entry nurse at the beginning of their placement. This
paper seeks to identify and justify the nursing care roles that needs to be undertaken in the
first week of clinical placement. The next section of the report uses the Nursing and
Midwifery Board of Australia decision-making framework to discuss negotiation of nursing
care tasks with the registered nurse who is acting as a supervisor. Additionally, the report
discusses the scope of practice at the end of the clinical placement. It also provides a
justification on nursing tasks to be performed at the end of the clinical placement. The second
section of the paper describes the ethical and legal dilemma outlined and discusses the codes,
standards and laws that it contravenes.
At the beginning of clinical placement for a student nurse, the scope of practice is very
different from that of a registered nurse. The reason for this is that the student nurse is not
experienced enough and they need to learn under the supervision of a registered nurse in
order for them to perform the full tasks of a registered nurse (Day et al.2014). In order for a
student nurse to become competent, they have to learn through the tasks delegated to them by

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their buddy nurse. The buddy nurse must supervise the student nurse and they bear great
responsibility when delegating to the student.therefore, it is critical to understand the scope
within which a student nurse beginning their clinical placement can operate. The scope of a
student nurse beginning their placement stipulates that a student nurse may undertake the full
range of tasks and activities undertaken by a registered nurse but must be under supervision
of the registered nurse (Ironside, McNelis & Ebright, 2014). The decision on the specific
tasks to be undertaken is guided by the nature of the activities of the program being studies as
well professional role to be undertaken by the nurse once they are registered. The scope of
practice of a student nurse beginning clinical practice is also governed by the policies and
procedures of the healthcare policy where the student is attached (Freeling & Parker, 2015).
Additionally, the supervisor must be confident that the student has the competence to perform
a specific activity.
During the first week of clinical practice, the student is expected to perform simple and
basic nursing care tasks. It is vital for student nurses to be directly supervised when
performing these tasks to ensure that their skills are adapted to the pediatric setting. This also
ensures that students gets immediate feedback from the supervisor. The following are the
nursing care activities appropriate for students in the first week of placement:
 The student should be able to engage in a conversation that is centered around the appropriate
age, family and sensitive to the culture of the patient. This is critical first lesson in practice
because, communication is important in extracting important information from the patient
concerning their care. The student should be able to ask the patient questions depending on
their age because, people in different age groups experience different health complications.
The student also needs to understand how family and culture can impact on the health of an
individual.
 Within the first week, a student nurse should be able to admit patients to inpatient unit and

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carry out basic assessment of the patient. Assessment and admission of the patient may
involve activities such as; checking of allergy bands, assessing the medical history of the
patient and their family history, checking for vital signs in a patient, measuring the weight
and height of the patient and external collection of specimen of urine and faeces (Sinclair,
Papps & Marshall, 2016). The student should also be capable of assessing pain in a patient.
 Care and management of small wounds
 Should be able to check the condition of machines and equipment
Delegation is very important in nursing. Delegation has become very common in the
modern healthcare environment. One of the main roles of delegation is that it helps in
reducing workload for registered nurses (Lineberry, Whitney & Noland,2018). In Australia,
there has been a severe shortage of registered nurses. The shortage has been caused by a
variety of factors such as increase in aged population. The aging population of Australia
means that more people are in need of nursing care. There has been increase in incidences of
chronic disease and hence further increasing the demand for nursing. Despite many nurses
qualifying and being registered in Australia every year, the supply has not been able to
sustain the demand and hence the need to delegate.
According to the NMBA decision making framework, the primary motivation for any
healthcare based decision is to improve the health outcomes of the patients. It is critical
therefore to ensure that any decision made between the nursing student and the supervisor
should aim at improving the health of patients. When negotiating delegation of duties, it is
critical to consider that nurses are accountable for making a professional judgement in
situations when an activity is beyond their scope of practice. Another important consideration
when negotiating delegation of care is that the registered nurse is responsible for making
decisions about who is the most appropriate person to perform a particular nursing role.
The scope of practice for a nurse at the end of clinical practice is wider than that of nurse

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beginning clinical practice. A student nurse at the end of clinical practice can perform more
complex tasks that are almost similar to those of a registered nurse without direct supervision.
By the end of clinical practice, a student nurse should be able to perform the following
nursing cares;
Handing over allocated patients and handling documentation in electronic medical record. At
the final stages of clinical placement, a student nurse should be able to communicate the
condition of the patient to other healthcare staff involved in the care of the patient.
A student nurse should be able to administer medication under direct supervision through
means such as oral medication, subcutaneous as well as IV medication.
The student nurse can also perform nursing tasks such as assisting registered nurses in
administration of blood processes as well as assessing patients during infusion. The nurse can
alter and evaluate oxygen therapy in patients. The student nurse can also perform additional
functions such as applying skeletal traction, management of complex wounds as well as
assisting in caring for patients with complex social needs.
When negotiating with the supervisor nurse on the tasks to be allocated to me,we will
consider the confidence that I have in myself as well as the amount of practice on the
particular task. When administering medication to the patients, I need to ensure that am sure
of the medicine am offering patients and that it will contribute to better patient outcome.
Another consideration when negotiating tasks is whether the supervisor will be available to
offer supervision. In cases where the nurse is not available to offer supervision, I will opt for
tasks that am more familiar with and which are simple to accomplish. The task being
allocated also must be within the current scope of nursing practice and the standards of
practice should be able to support the nurse in accomplishing their work. When negotiating
on tasks with the supervisor, I need to ensure that any inherent risks that are associated with

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performance of the task are assessed and mitigating measures have been undertaken before
beginning the task.
Delegation helps in improving patient outcomes. This is because delegation makes
proper use of the skill mix in a healthcare facility. Therefore, nurses can be allocated roles
that they are able to perform best and once ensure that the patient gets high quality care (Cerit
& Dinç, 2013). Delegation also improves patient outcomes by ensuring improving nurse to
patient ratio in an hospital. This means that the delegatee is able to focus on the few patients
allocated to them and hence offer them best possible care.
Delegating also helps hospitals and other healthcare centers to reduce their expenses.
Staffing is one of the biggest expenses for hospitals. Some health facilities may therefore use
delegation as a tool for reducing their expenses on registered nurses who earn significant
salaries and hence reducing financial burden of the hospital (Wheeler,2013).
Delegation is classified into several categories. They include;
General or specific delegation. General delegation occurs when a person is given
authority to perform general functions of management while specific delegation is where a
person is given authority to perform a specific narrow role(Huber,2013).
Formal or informal delegation: formal delegation is recognized within the structures of an
organization while informal delegation occurs due to circumstances and its not stipulated in
the structures of the organization (Russell, 2017).
Lateral delegation is happens when a person is allocated authority to perform a task by a
person above them in the organizational structure. The person may need assistance from their
collegue and hence they may need to contact the colleagues directly to ask for assistance.
The following are the roles of the delegator and delegatee
 The delegator must assess the nursing care needs of the patient and prepare a nursing care
plan which should be handed over to the delegatee (Birks, Davis,Smithson & Cant,2016).

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 The delegater must ensure that the wishes, welfare and interests of the patient are considered
when carrying out the assessment and developing the care plan.
 The delegator must make sure that they have full confidence in the competence and skills of
the delagatee to perform the task allocated to them.
 The delegator nurse is accountable for tasks and activities allocated to the delegatee and
hence should take an informed and responsible approach when delegating.
Roles of delegatee
 The delegatee must act in accordance to the policies and standards of the health facility as
well as according to the guidelines of Nursing and Midwifery Board of Australia (National
Council of State Boards of Nursing,2016).
 By accepting any delegated activity, it means that the nurse is making a commitment to
personally perform the task. Therefore, the delegatee cannot further delegate the task to
another person.
 The delegatee nurse has to safeguard the safety of the patient and offer them utmost care
while under their care.
 The delegatee should ensure that they are capable of performing the activity assigned to them
before accepting the authority to perform the task.
Supervision in this case involves monitoring, guiding and giving directions to people to
perform specific tasks assigned to them.in regard to nursing care delegation; there are two
recognized levels of supervision (Yoon, Kim & Shin, 2016). One of the levels of supervision
is direct supervision. Direct supervision is provided when the registered nurse is present at all
times so as to observe, direct, assess as well as work with the person under supervision (Allan
et al.2016). Student nurses mainly apply it at the initial stages of clinical practice. Indirect
supervision is the other level of supervision in nursing. Indirect supervision is where a nurse
and the person being supervised are working in the same area/ward. The nurse is accessible to

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the student but does not constantly observe what the person being supervised is doing
(Westrick, 2013). A nurse working under indirect supervision is constantly required to
discuss and share their plans before beginning tasks and to report after accomplishing the
tasks.
Identification of ethical dilemma
Ethical values are very essential in healthcare. Ethical values are rules that are
recognized globally and they provide a background for identifying actions and motives that
are accepted in a society. Nurses have a set of ethical and legal standards that govern their
conduct while undertaking their nursing duties. More often than not, nurses find themselves
in ethical dilemma. According to (Mueller & Vogelsmeier, 2013), an ethical dilemma is a
situation in which a person has to decide between two options which are not ethically right.
In this case study a student nurse is found taking selfies with patients. This is against the code
of conduct and the standards set by the NMBA. The ethical and legal dilemma for the student
taking ‘selfies’ is creating a gap between therapeutic and cordial relationship with patients
while at the same time maintaining professional relationship with the patient. The student is
torn between having fun with the patients by taking ‘selfies’ with them and maintaining
professional relationship with the patients (Shoorideh, Nabizadeh, Khazaei & Alavimajd,
2014). Some of the patients may have been very willing and happy to take selfies with the
nurse but the nurse should not have taken the selfies because it contravenes the code of
conduct which governs them.
By taking selfies, the student contravenes the professional code which states that nurses
should practice in a safe and competent way. Nurses are accountable at a personal level for
providing nursing care which is safe and competent. Nurses are also expected not to
undertake activities that are not within their scope or which may interfere with the safety of
the patient under their care. When a nurse is taking selfies with patients, they may get

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distracted and neglect some patients who may need their assistance (Levett-Jones et al. 2015).
Additionally, the patients may get hurt trying to take selfies or they may interfere with the
machines and equipment connected to their body and hence compromising the safety of the
patient.
The student also went against the ethical code of conduct requiring nurses to promote
and preserve trust developed as a result of the relationship developed in the process of
offering care. Nurses are expected to safeguard the dignity of people under their care by
being kind to them and understanding that they are vulnerable and
powerless(Josephsen,2013). Under this code, nurses are also expected to ensure that they
maintain professional boundaries between themselves and the patients they are looking after.
Additionally nurses are expected to play roles outside their profession. They may act as
family or friends to people under their care but they should be aware that these relationships
can compromise healthcare outcomes. The student nurse therefore failed to draw a clear line
between professionalism and the additional non-professional roles they play as carers.
In order to ensure that myself and other nurses do not act in contravention of the ethics
and legal code, I will organize a training section whereby all the student nurses will be
trained on ethical and legal standards governing nursing practice (Kumaran & Carney, 2014).
Nurses will be frequently reminded of these standards in order to ensure that they are upheld
at all time. Additinally, tough disciplinary measures will be taken against nurses found going
against the code of practice. This will greatly help in reducing or eliminating such cases in
future.
Conclusion
Delegating is very critical in modern healthcare. Delegation is defined as the practice of
a registered nurse allocating another nurse tasks and functions to perform on their behalf. The
essential components of delegation include; responsibility, authority and accountability. In

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order for student nurses to familiarize themselves with the working environment and qualify
to become registered nurses, they need to perform certain roles of a nurse. The student nurse
can only perform the roles under the supervision of experienced registered nurse. This paper
begins by discussing the scope of practice for student nurses beginning clinical practice as
well as those ending their clinical practice. The report also discusses various tasks and
activities performed by student nurses and provides a justification. The paper also describes
the importance of delegation in nursing and also discusses the various types of delegation in
nursing. The roles and responsibility of the delagator include ensuring that the delegatee is
competent enough to perform the task assigned to them as well as assessing the nursing needs
of the patient and preparing a care plan for the patient. The levels of supervision in nursing in
healthcare include direct supervision and indirect supervision.the student nurse found taking
selfies with patients contravenes the code requiring nurses to promote and preserve the trust
developed with the patients in the process of providing care.

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