Author Identifiers

Carol Crevacore https://orcid.org/0000-0003-4008-1418

Date of Award

2021

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

First Advisor

Christine Duffield

Second Advisor

Elisabeth Jacob

Third Advisor

Linda Coventry

Abstract

Background:

Delegation is an essential skill that allows the Registered Nurse (RN) to allocate aspects of patient care to other team members including the unregulated Assistant in Nursing (AIN). Concerns have been raised about the activities delegated to AINs in the acute care environment.

Aim:

The aim of this research was to explore the practice of delegation between the RN and the AIN in the acute care environment. This delegation practice was examined through the lens of both the RN and the AIN.

Methodology:

This study used a mixed method explanatory sequential design. The participants were RNs and AINs working in an acute public hospital in Western Australia. The surveys completed by the RNs (n = 100) included their attitude to delegation, the risk management process undertaken prior to delegation and the tasks that they delegated to the AIN. The surveys completed by the AINs (n = 79) included their experience with RNs during delegation and the activities they complete while working in the clinical environment. The survey data were analysed using descriptive statistics. The findings from these data informed the questions for the semi structured interviews which formed the second phase of this research. Interviews with RNs (n = 12) and AINs (n = 11) were conducted, transcribed verbatim and analysed using Braun and Clarke’s thematic analysis. Results from both phases were triangulated to provide a richer understanding of the phenomena.

Results:

Five factors were identified that influence the RN’s decision-making surrounding delegation: 1) personality characteristics of the RN; 2) the multifaceted act of delegation, 3) understanding of the AIN scope of practice; 4) clinical decision-making, and 5) undergraduate nursing students working as AINs.Two factors were identified that influence an AIN’s decision to accept a delegation; wanting to be thought of as a valuable team member and, the quality of the handover.

Conclusion:

Shortages in skilled nursing staff, financial constraints, and increasing patient acuity within healthcare have resulted in the increased use of the AIN. Nursing staff need to work effectively with these staff to ensure safe, efficient care delivery. Therefore, it is essential that RNs have the skills, knowledge and experience to delegate effectively to the unregulated workforce.

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