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 processes 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 www.Hansten.com, www.RROHC.com, tweets (@Rhansten) and www.Hansten.com/blog.
–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.