Empowerment can be seen as the riskier option in a health care setting. Liability concerns, among hospital staff, often contribute to an environment reluctant to empower employees. However, as McConnell confirms, proper delegation should facilitate, rather than prohibit, empowerment. The latter function of management is necessary to increase morale and productivity (Cherry and Jacob, 2005). However, as this study will show, the balance between delegation and empowerment can be hard to strike concerning the critical task of administering medication.
Case Study Overview
The California legal environment allows UAP to administer medication to patients, within certain limitations. California medical assistants do not need to be licensed to perform procedures that are considered to be within their “scope of practice” (The Medical Board of California, 2010). This leeway presents California RNs with many considerations to make when delegating this critical task to a subordinate. While the ability of California UAP to assist in the administration of medications may be unique, the circumstances giving rise to this need are not. The use of UAPs to perform increasingly complex tasks has become a necessity in many hospitals. Often an UAP is legally limited to performing supporting task that require little skill and carry even less risk. However, a trend of delegating more responsibilities to UAP is evident in many states. Across the country, un-licensed personnel are trained in skilled and involved procedures, including venipunctures and catheter insertions (Cherry and Jacob, 2005). The proper delegation of these tasks is important to manage the large volume of patients in hospitals and to deliver efficient care.
However, Cherry and Jacobs document the risks associated with the improper delegation of tasks. Unlicensed personnel are more likely to deliver improper care and make errors than RNs. As delegation becomes increasingly important in hospital settings, it is important to consider the method RNs should use in directing non-licensed staff to perform these duties. While autonomy in decision-making is important to morale, improperly distributed medications can adversely affect the safety of patients. This case makes it evident that the use of California UAPs to administer medication brings attention to the proper balance between empowerment and delegation.
Considerations and Constraints
A California RN delegating the administration of medications to patients has three factors that must be carefully weighed: organizational restraints, legal restraints, and ethical restraints. The first consideration, organizational restraints, refers to the hospital policies by which RNs are bound. When deciding whether the administration of medication to a patient should be delegated, the RN should ensure that his or her hospital policies provide him or her with the capacity to make this decision. If the answer is yes, the task can be delegated.
Second, legal restraints must be taken into considerations. While California state law allows RNs to delegate the administration of medications, there are restrictions placed on the level of empowerment that can be given in this situation. For example, law prohibits the extent to which an UAP can take control over this function of his or her job. They will not be able to complete autonomously this task. Specifically, California law requires the RN to measure medications before they are administered to a patient (The Medical Board of California, 2010). However, a degree of empowerment is still possible within the current legal framework. The law provides a wide range of duties that can be undertaken by an UAP. After the dosage is confirmed, they can administer injections or distribute medications to be inhaled or ingested. RNs may delegate any function that falls within the acceptable legal range.
Finally, ethical considerations are to be considered before determining if delegation is appropriate. Ultimately, the RN is responsible for ensuring the safety of the patient. This implies that they must provide additional oversight, even if it is not required by law or hospital regulations. Part of their duty as a delegator is to ensure that the medication is administered properly and at the right dosage. They must also use their judgment to ensure that staff members administering the medication are competent in this task. When in doubt, RNs have an ethical obligation to either provide direct supervision or perform the task herself.
Additionally, the issue of medication distribution needs to be addressed by multiple levels of management within the organization. It is recommended that UAP assisting with medication be given continual training to ensure that they can perform this function effectively (Dickens, G. & Stubbs, J. & Raw, C., 2008). The responsibility of directing resources toward the appropriate training falls on the department coordinator, rather than the supervising RNs. However, without training in place, the RNs should limit the use of delegation to an even greater extent, until the competency of the UAP is demonstrated.
Recommendations and Conclusions
As this case shows, empowerment must be limited within a medical environment to ensure the safety of patients. RNs must use the stricter approach of delegation to make sure that there are no errors carried out among UAP. Strict criteria must be put in place to determine whether UAP can administer medications to patients with lower degrees of supervision. However, an UAP can legally administer medication without supervision, once the dosage is verified and their competence is confirmed. Within this framework, RNs can empower subordinates to deliver medications – through injection, oral ingestion or other means – without direct supervision. Still, while the routine administration of medications can be time consuming for overworked nurses, they can never eliminate their active involvement in the process of distributing medication to patients.
References
Cherry, B., & Jacob, S. (2005). Contemporary nursing: Issues, trends, & management. St. Louis, MO: Elsevier Inc.
Dickens, G. & Stubbs, J. & Raw, C. (2008). Delegation of medication administration: An exploratory study. Nursing Standard, 22(22), 35-40.
McConnell, C.R. (2007). The effective healthcare supervisor (6th ed.). Sudbury, MA: Jones and Bartlett Publishers.
The Medical Board of California. (2010). Medical assistants – frequently asked questions. Retrieves online from, http://www.medbd.ca.gov/allied/medical_assistants_questions.html#3
