Research exploring nursing 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.