Answer one crucial question to avoid care lapses and value-based care penalties

FollowFollow on FacebookFollow on Google+Tweet about this on TwitterFollow on LinkedInFollow on TumblrPin on Pinterest

By Ruth Hansten, RN, BSN, MBA, PhD, FACHE

Pressure ulcers, pneumonia, readmissions, wound infections, patient deconditioning leading to additional care:  all of these healthcare acquired issues can be related to omitted basic care such as turning, repositioning, ambulation, hygienic care, hydration and nutrition.   Basic care tasks that would avoid these problems can be delivered by assistive personnel such as nursing aides or patient care technicians.  The value based care trend means that healthcare facilities are financially penalized for avoidable errors and rewarded for optimal results.

In my consulting, education, and coaching work with over 175 healthcare facilities over the last two decades, I have discovered that a basic question is at the foundation of whether or not appropriate care is being completed.  Often, it is unclear who is actually supervising the care delivered by assistive personnel.  Is it the charge RN? Is it the RN assigned care of that patient? The nurse manager?  Often patient care RNs aren’t aware that they are accountable for the total nursing care of their patients, whether they themselves, or the patient care technician, actually performed the task. 

A key question for patients, families, and nursing personnel to ask when reviewing nursing care questionprocesses for excellence is this: Who is supervising whether or not appropriate care has actually been completed?

Delegation, supervision, and assignment are complex nursing leadership skills that may require additional education and coaching.  The Hansten Learning Center includes courses with worksheets, slides, and videos including several related to delegation, supervision, and making assignments.   Other resources are available through Ruth Hansten’s Amazon Author Homepage or,, tweets (@Rhansten) and

–Ruth Hansten RN, MBA, PhD is the author of seven books and numerous articles. Her mission is to promote healing and wholeness, transforming organizations through relationship enhancement and skills development. With 40 years of experience in nursing, she brings both a practical and humorous approach to the essential work that nurses do. For the past 22 years her national consulting practice has worked with nursing care delivery models, critical thinking, delegation and leadership skills, coaching, and interdisciplinary team development. Dr. Hansten has developed a care delivery model and philosophy called Relationship and Results Oriented Healthcare ® (RROHC) and this model had resulted in improved patient outcomes, clinical indicators, employee engagement, provider satisfaction, and healthcare employee retention. This model is described in her book with colleague Kimberly McNally, The Relationship & Results Oriented Healthcare Planning and Implementation Manual (Hansten Healthcare PLLC 2008). Ruth’s doctoral research focused on critical thinking and clinical judgment and she incorporates her research into her teaching and consulting strategies. She has been a Fellow of the American College of Healthcare Executives. In 2008 the 4th edition of her Clinical Delegation Skills: A Handbook for Professional Practice book was published, the first edition of which was granted the AJN Book of the Year award. She has served as adjunct faculty for the University of Washington and Seattle University School of Nursing, and has lectured or consulted at 175 organizations. She has served as a Board of Directors trustee at a Pacific NW medical center and on the AHA (American Hospital Association) Regional Policy Board.

She is most proud of being voted “boss of the year” by the MWBA in Spokane, WA, and one of the “great head nurses” by the AJN in the 1980s, being selected as a Transformational Pioneer in Nursing in 2011 by NWONE, and being a mom and grandmother to 5 adults and six grandchildren, 5 kitties and grandcats. Ruth resides with her husband in Port Ludlow, Washington on beautiful Squamish Harbor.

Print Friendly, PDF & Email
This entry was posted in Assertiveness, Communication in Healthcare, Complexity in nursing, Diversity, Healthy Workplaces, Listening, Nurse Leadership, Patient Advocacy, Patient Safety and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

One Response to Answer one crucial question to avoid care lapses and value-based care penalties

  1. Beth Boynton, RN, MS says:

    I think this is a brilliant question to ask, Ruth and thank you for bringing it into the light. I would add that we need to ask it w/o blame or judgment in order to understand the full scope of potential answers and solutions. Not too long ago, I was in a situation as a Charge RN (1 RM [me], 2 aides and 24 patients with dementia) on one unit when a Med Tech came to me from an adjacent unit b/c a patient there was in trouble. She told me I was supervising her. I had no idea and was already maxed out. I got the supervisor to help solve the immediate crisis but was furious to put in that position. It challenged my assertiveness the next day in taking my concerns up the ladder. (more about that story here: ) Yet in addition to my own communication challenges/skills there are organizational components that involve scheduling, staffing, training, orientation, and leadership that will all contribute either positively or negatively to delegation-related outcomes. The beauty of your question is that all of these can be discovered!

What are your thoughts?