Discussion: Health care systems

Improving Patient Care Outcomes Through Better Delegation-Communication Between Nurses and Assistive Personnel

Elissa A. Wagner, DNP, RN

In acute care settings, registered nurses need to delegate effectively to unlicensed assistive person- nel to provide safe care. This project explored the impact of improved delegation-communication between nurses and unlicensed assistive personnel on pressure injury rates, falls, patient satisfac- tion, and delegation practices. Findings revealed a tendency for nurses to delay the decision to delegate. However, nurses ability to explain performance appraisals, facilitate clearer communica- tion, and seek feedback improved. Patient outcomes revealed decreased falls and improved patient satisfaction. Key words: assistive personnel, communication, delegation, nursing delegation, unlicensed assistive personnel

OVER the last 2 decades as health caresystems have implemented processes to improve communication and team ef- fectiveness, much attention has been given to nurse-physician and nurse-patient com- munication strategies. This is evidenced by guidelines such as SBAR (situation, back- ground, assessment, recommendation) to im- prove communication as well as goal set- ting for patient-centered care. Professional or- ganizations such as the Institute for Health Care Improvement,1 The Joint Commission,2

Author Affiliation: University of Michigan School of Nursing, Ann Arbor, Michigan.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.jncqjournal.com).

The author declares no conflicts of interest.

Correspondence: Elissa A. Wagner, DNP, RN, Univer- sity of Michigan School of Nursing, 400 N. Ingalls, Room 2344, Ann Arbor, MI 48109 ([email protected]).

Accepted for publication: June 7, 2017

Published ahead of print: August 1, 2017

DOI: 10.1097/NCQ.0000000000000282

and the Agency for Healthcare Research and Quality3 have widely supported the use of SBAR to improve effectiveness of communica- tion. However, less attention has been given to the delegation effectiveness between regis- tered nurses (RNs) and unlicensed assistive personnel (UAP) in acute care settings. To meet expected outcomes, care delivery mod- els frequently include UAP in the provision of direct care and require nurses to be ac- countable for the care they deliver.4-8 With the addit

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