Factors impacting delegation decision making by registered nurses to assistants in nursing in the acute care setting: A mixed method study

Background
Healthcare organisations have been redesigning care delivery models in an attempt to extend, expand and supplement the registered nurse workforce by including more unregulated healthcare workers, such as the assistant-in-nursing. As the number of assistants-in-nursing grows it is essential that nurses have the requisite skills and knowledge to effectively delegate and supervise this growing workforce.

Objective
The aim of this research was to explore the factors that impact the nurse's decision to delegate to assistant-in-nursing in the acute care environment.

Design
This study used a mixed-method explanatory sequential design. The participants were RNs in an acute public hospital in Western Australia. The surveys completed by the registered nurses (n = 100) included their attitude to delegation, the risk management process undertaken prior to delegation and the tasks that they delegated to the assistants-in-nursing. 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 registered nurses (n = 12) 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
Overall, approximately half have a ‘somewhat negative attitude’ (n = 45, 45%); and the other half have a ‘somewhat positive attitude’ (n = 48, 48%) towards delegation. Concerningly, many nurses do not complete a risk assessment prior to delegating to the assistant-in-nursing. This study identified a range of factors that impact nurses' decision to delegate to the assistant-in-nursing including their level of experience, level of education pertaining to delegation, the assistant-in-nursing skills, knowledge and attributes, and the individual nurses' personality traits.

Conclusions
As demand and financial constraints on healthcare systems increase, governments and health care providers are needing to reconsider how to deliver effective, cost efficient healthcare in the acute care environment. As models of care evolve to include more unregulated workers it is essential that safe, effective delegation practices occur between registered nurses and the assistant-in-nursing.