SKD - Assignment Essays

Using article attached

NR 103 TRANSITION TO THE NURSING PROFESSION

TRANSITIONS PAPER ASSIGNMENT GUIDELINES ADDENDUM

Purpose

The purpose of this assignment is to explore a critical concept in nursing through summarizing an approved article on the concept and reflecting on the information. The student will be able to demonstrate application of information literacy and ability to utilize resources (library, writing center, Smart Thinking, located within the Tutor Source tab under Course Home, APA resources, Turnitin, Essay Review Service, and others) through literature search and writing the paper.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO 2: Identify characteristics of professional behavior including emotional intelligence, communication, and conflict resolution.

CO 3: Demonstrate information literacy and the ability to utilize resources.

Due Dates

Please refer to the NR 103 Assignments and Due Dates document in the Map to Success located in the course files under the RUA tab.

Requirements and Guidelines

You must choose one of the articles from the “Approved Articles for the RUA” document located in the files. Your article choice must be submitted by the end of week 1 into the appropriate assignment drop box. The articles are based on the following nursing topics:

· Safety

· Delegation

· Prioritization

· Caring

After you select your article
from the approved list, you will complete a
one – two-page
summary of the article and reflection. The paper should be completed in APA 7th edition format and include the following:

· Page 1: A cover page (not included in the page number requirement)

· Pages 2-3:

· A one paragraph introduction.

· The summary of the article based on the rubric must include:

· A level one heading labeled “
Summary of Article”.

· One direct quote from your reference, appropriately cited as per APA within the text of the paper.

· One indirect quote (or paraphrased quote) appropriately cited as per APA within the text of the paper.

· A one paragraph conclusion. This should include a level one heading labeled “

Conclusion

”.

· The reflection should be in a separate paragraph with a level one heading labeled “

Reflection

”. This is the
ONLY portion of the paper that can be written in first person. This should also be the last paragraph of the RUA.

· Page 3 or 4: A reference page appropriately formatted using the APA 7th edition.

· Citations and references should be in APA format, using the 7th edition and the Chamberlain College of Nursing APA format guidelines.

TOTAL POINTS: 150 POINTS

Best Practices in Preparing the Paper

Utilize resources available to you to assist with preparing for and writing the paper (e.g., Smart Thinking which is located within the Tutor Source tab under Course Home; the writing center; Turnitin; APA manual; online resources; the Essay Review Service, and/or the librarian).

Helpful Hints (tips to gain all the points available):

1. Start early. The deadline is closer than you realize. Time moves fast in nursing school.

2. The purpose of this assignment is to explore a critical concept in nursing through summarizing an approved article on the concept and reflecting on the information. This assignment will also assess how well you can read, understand, and paraphrase one article.

3. There should be
ONLY ONE reference on your Reference page. Since you are only summarizing one article and providing your personal reflections, you do not need supporting documentation.

4.
The article must be chosen from the approved article list in the course files. No exceptions!

5. Use the APA template located in the files (in the RUA folder) to write your paper. It will keep you on track not only with APA format, but also with organizing your paper according to the rubric requirements.

6. Use the video in the Media Gallery to help you understand the rubric.

7. Visit faculty open office hours for help understanding the rubric.

8. Use Grammarly to be sure your grammar and sentence structure are professional.

9. Use the Essay Review Service to review your document for grammar and format.

10. Use of the Turnitin Draft Submission drop box is required PRIOR to submitting your paper for grading.

a. First submit your paper into the draft submission drop box; your similarity score must be 24% or less.

b. If it is above 24% you should revise your paper and resubmit it into the same box for a new score.

c. You can do this as many times as necessary to meet the requirement.

d. After you have achieved a Turnitin similarity score of 24% or less, you also need to submit the paper into the Week 5: RUA: Transitions Paper drop box.

11. The late policy will apply to this assignment.

The grading rubric will help you understand how your paper will be evaluated. Use it as a checklist to make sure that you have included all the important elements.

Grading Criteria for Transitions Paper Assignment

Category	Points	%	Description: See Rubric for Specific Details of Grading
Introduction Use of an article that is NOT on the approved list means a score of 0 in this category.		20	13%	· Clearly states the purpose or focus of the paper with conceptual key points to be discussed. · Engages the interest of the reader.
Body of Paper (the summary) Use of an article that is NOT on the approved list means a score of 0 in this category.		40	26%	· Complete, well-developed discussion of key points · Logical development of ideas with information clear and accurate, supported by examples from personal and/or professional experiences.
Conclusion Use of an article that is NOT on the approved list means a score of 0 in this category.	14%	· Summarizes ideas presented in the body of paper in a clear and concise manner. · Provides reader with a thought, idea, or key message.
Reflection Use of an article that is NOT on the approved list means a score of 0 in this category.	30	20%	· Student provides own perspectives on the topic; reflective and insightful.
Writing Style, APA Format, and References	27%	· Proper grammar and mechanics. · Correct spelling. · APA format: Margins, font style and size, spacing, citations, title page, and reference page. · One direct quote with in-text citation. · One indirect quote with in-text citation. · Reference from authorized list of potential articles from the files.
TOTAL	150 Points	100%	A quality assignment will meet or exceed all the above requirements.

Grading Rubric

Assignment Criteria

Outstanding or Highest Level of Performance

A (92 – 100%)

Very Good or High Level of Performance

B (84 – 91%)

Competent or Satisfactory Level of Performance

C (76 – 83%)

Poor, Failing or Unsatisfactory Level of Performance

F (0-75%)

Introduction

Use of an article that is NOT on the approved list means a score of 0 in this category.

· Introduction of paper is clearly presented

· Introduction clearly establishes the purpose of the paper and key points to be discussed

· The introduction immediately captures the reader’s interest.

19 – 20 points

· Introduction of the paper is clearly presented.

· Introduction presents the general purpose of the paper and points to be discussed.

· Introduction can gain general interest of the reader.

17 – 18 points

· Introduction of the paper is present.

· Introduction presents the general purpose of the paper, but key points are not clearly presented.

· Introduction can gain general interest of the reader.

16 points

· Introduction of the paper is not clearly presented, irrelevant to the topic, or is absent.

· Introduction does not present the purpose of the paper or key points to be discussed.

· Introduction does not capture the reader’s interest.

0 – 15 points

Body of Paper

Use of an article that is NOT on the approved list means a score of 0 in this category.

· Complete, well-developed discussion of key points strongly supports the purpose or main idea of the paper.

· There is logical development of ideas with clear and accurate information.

· Ideas and statements are supported by three or more examples from personal and/or professional experiences.

37 – 40 points

· Complete discussion of key points generally supports the purpose or main idea of the paper.

· There is logical development of ideas with clear and accurate information.

· Ideas and statements are supported by two examples from personal and/or professional experiences.

34 – 36 points

· General discussion of key points somewhat supports the purpose or main idea of the paper.

· There is some logical development of ideas, somewhat clear information; some information is inaccurate.

· Ideas and statements are supported by one example from personal and/or professional experience.

30 – 33 points

· There is vague or minimal discussion of key points, which does not support the purpose or main idea of the paper.

· There is poor development of ideas; information is unclear and/or inaccurate.

· Ideas or statements are not supported by examples from personal and/or professional experiences.

0 – 29 points

Conclusion

Use of an article that is NOT on the approved list means a score of 0 in this category.

· Conclusion of the paper is clearly and concisely presented.

· Conclusion clearly establishes key points discussed in the paper.

· The conclusion leaves a strong impression on the reader (important thought, idea, or key message).

19 – 20 points

· Conclusion of the paper is clearly and concisely presented.

· Conclusion generally states key points discussed in the paper.

· The conclusion leaves a general impression on the reader (important thought, idea, or key message).

17 – 18 points

· Conclusion of the paper is present.

· Conclusion vaguely states key points discussed in the paper.

· The conclusion leaves a vague impression on the reader (important thought, idea, or key message).

16 points

· Conclusion of the paper is not clearly presented.

· Conclusion does not present key points discussed in the paper.

· The conclusion does not leave an impression on the reader (important thought, idea, or key message).

0 – 15 points

Reflection

Use of an article that is NOT on the approved list means a score of 0 in this category.

· Student provides own perspectives on the topic: reflective, insightful, and original.

·
28 – 30 points

· Student provides own perspectives on the topic: reflective and insightful.

·
25 – 27 points

· Student generally provides own perspectives on the topic: somewhat reflective and insightful.

·
23 – 24 points

· Student does not provide own perspectives on the topic lacks reflection and insight.

·
0 – 22 points

Rubric continued next page for Writing Style, APA Requirements, and References.

Writing Style, APA Format (7th Edition), and References

Writing Style:

· Paper has correct use of Standard English grammar, paragraph, and sentence structure.

· There are no spelling or typographical errors.

· Paper is clearly organized around required components.

· Information flows in a logical sequence that is easy for the reader to follow.

APA Format and References

· There is correct and appropriate use of margins, spacing, font, and headers.

· Document setup includes title and reference pages in correct APA format

· At least one direct and indirect quote included.

· Citation of sources included in the body of the paper uses correct APA format for direct and indirect quotes.

· Sources are cited correctly on the Reference page. All elements of each reference are included in the correct order.

· All information taken from the source, even if summarized, must be cited and listed on the Reference page.

· All sources used are nursing journals published within the last five years.

37 – 40 points

Writing Style

· There are one to three minor errors in use of Standard English grammar, paragraph, and sentence structure.

· There are one to two spelling or typographical errors.

· Paper is organized and generally easy to read and follow.

APA Format and References

· There is incorrect format for any one of the following items: margins, spacing, font, and headers.

· Document setup includes title and reference pages, with one to two errors in APA format.

· At least one direct and indirect quote included.

· Citation of sources is included in the body of the paper for direct and indirect quotes, with one to two errors in APA format.

· Sources are cited on the Reference page. There are one to two errors in elements of each reference.

· All information taken from source, even if summarized, must be cited and listed on the Reference page.

· All sources used are nursing journals published within the last five years.

34 – 36 points

Writing Style

· There is one major or more than four minor errors in use of Standard English grammar, paragraph, and sentence structure.

· There are three to four spelling or typographical errors.

· Paper is organized and generally easy to read and follow.

APA Format and References

· Incorrect format is used for any two of the items: margins, spacing, font, and headers.

· Document setup includes title and reference pages, with three errors in APA format.

· Either one direct or one indirect quote included.

· Citation of sources is included in the body of the paper for direct and indirect quotes, with three errors in APA format.

· Sources are cited on the Reference page. There are three errors in elements of each reference.

· Some information taken from sources (even if summarized) is not cited and/or listed on the Reference page.

· Not all sources used are from nursing journals or are not published within the last five years.

31 – 33 points

Writing Style

· Language needs development.

· There are more than four spelling and/or grammar errors.

· Paper has poorly organized thoughts and concepts; it is difficult to follow logic.

APA Format and References

· Incorrect format is used for three or more of the items: Margins, spacing, font, and headers.

· Document setup includes title and Reference pages, with four or more errors in APA format.

· No quotes included.

· Citation of sources is included in the body of the paper for direct and indirect quotes, with four or more errors in APA format.

· Sources are cited on the Reference page. There are four or more errors in elements of each reference.

· Some information taken from sources (even if summarized) is not cited and/or listed on the Reference page.

· Not all sources used are from nursing journals and/or not published within the last five years.

0 – 30 points

NR 103 Transitions Paper Atlanta campus Revised Dec 2022 RL

ajn@wolterskluwer.com AJN ▼ December 2018 ▼ Vol. 118, No. 12 51

TRANSITION TO PRACTICE

Delegating as a New Nurse
How to master this complex but common practice early in
your career.

“Norma, it’s 4:30,” I call out to the nurs-
ing assistant assigned to monitor the vital
signs of my patients. “I’m going to take

Mr. Smith’s temperature.” Amidst the day’s whirl of
activity, I’d forgotten to review the previous temper-
ature readings but figured Norma would have told
me if anything was wrong. As I looked at the current
reading, my heart sped up. It was abnormal.

“He has a fever of 102°,” I said curtly. As I wrote
the number in the patient’s chart, I saw that Norma
had noted Mr. Smith had a low-grade temperature
at 8 am. “Why didn’t you tell me?” I demanded.

Norma, who was sitting hunched over a computer,
looked up and said loudly, “I just didn’t. Go tell the
manager if you want.”

Shocked, I thought of all the dangers this high tem-
perature potentially signaled for my patient—and what
my knowledge of it earlier in the day could have ac-
complished. Fuming as I prepared blood culture bottles
and spoke to a physician about an antibiotic order, I
realized I had delegated temperature taking to Norma,
not the interpretation of this value. The latter was not
her responsibility. As the patient’s nurse, it was mine.

THE STANDARDS OF DELEGATION
According to the American Nurses Association
(ANA), “Delegation generally involves assignment of
the performance of activities or tasks related to patient
care to unlicensed assistive personnel while retaining
accountability for the outcome.”1 The standards of
this complex but common task are based on nurses’
scope of practice within each state, as specified by
state boards of nursing and nursing practice acts; these
standards are also guided by theoretical documents,
such as the ANA’s Principles for Delegation and its
Code of Ethics for Nurses with Interpretive State-
ments.1, 2

In 2016, the National Council of State Boards of
Nursing (NCSBN) published an article, “National
Guidelines for Nursing Delegation,” that details the
responsibilities of employers and nurse leaders, li-
censed nurses, and delegatees in the delegation pro-
cess.3 These guidelines refer to the “Five Rights of
Delegation,” a list for nurses to consider before they
delegate, similar to the safety check nurses perform
before administering medication (see Five Rights of
Delegation).

Delegation requires much more than a checklist,
however. It requires an appreciation of nuance and in-
sight, both of which new graduates may lack. Delega-
tion often requires skills that aren’t taught in nursing
school and are difficult for preceptors to teach in the
clinical setting. Marjorie M. Whitman has succinctly
summarized the intricacies of delegation: “Nurses
must delegate the exact tasks to be done, verify that
the delegatee has been trained to do the tasks correctly,
and explain how and when to report the results of the
tasks.”4

PRACTICAL TIPS
The process of delegation is a daunting one, so much
so that the perceived potential for failure and confu-
sion may lead new nurses to avoid delegating any
tasks. The following are steps you can take to bypass
barriers to delegation, establish effective delegatory
relationships, and ease your transition to expert prac-
tice.

Stay within scope of practice. According to the
NCSBN, nurses may delegate tasks and aspects of
care, but they cannot delegate the nursing process
and judgment.3 Analyze your delegatory requests in
the same way you would analyze any task that has
been delegated to you. Just as you would not perform
a duty that falls within a physician’s scope of practice,

By Amanda Anderson, MPA, MSN, RN, CCRN

This column is designed to help new nurses in their first year at the bedside—a time of insecurity, growth,
and constant challenges—and to offer advice as they learn what it means to be a nurse. This article offers
strategies new nurses can use and specific steps they can take to help them succeed in delegating tasks
to LPNs/LVNs and unlicensed assistive personnel.

52 AJN ▼ December 2018 ▼ Vol. 118, No. 12 ajnonline.com

TRANSITION TO PRACTICE

an unlicensed staff member shouldn’t be asked to per-
form a duty within a nurse’s scope of practice.

Take the time to understand your state’s nurse
practice act and review the NCSBN’s Five Rights of

Delegation as well as your institution’s policies and
procedures. Practice acts are located on the NCSBN
website (www.ncsbn.org/npa.htm), as well as on the
website of each state’s board of nursing. Knowing
your scope of practice will help you to understand the
scope of others’ work. Currently, American nurses
can be licensed as RNs, advanced practice RNs, and
LPNs/LVNs, with each state’s board of nursing regu-
lating the scope of practice for each license. The edu-
cational path to an RN license is varied, with nurses
having completed a range of programs, from asso-
ciate’s degree to accelerated bachelor’s degree pro-
grams. Yet the basic elements of an RN’s scope of
practice do not fluctuate based on the type of educa-
tional program. By contrast, both educational levels
and scope of practice vary among unlicensed assistive
personnel (UAP) and LPNs/LVNs, whose practice
must be supervised and is regulated by state legisla-
tion and institutional policies and procedures.

Your employer will likely not ask you to review a
state practice act during orientation but should pro-
vide you with information about the institution’s pol-
icies and procedures, which should align with state
law. You may need to review this information when
delegating, and your employer will expect you to
know how to locate it in the hospital’s policy and
procedure manual.

Know the level of competency. Successful delega-
tion requires that you know the level of competency
of your UAP and LPN/LVN colleagues. For example,
if your hospital allows assistive personnel to perform
certain advanced functions, like endotracheal suction-
ing, make sure you know how to verify that a given
colleague has gained this competency and that it’s cur-
rent. You can do this by checking to see if departmen-
tal records of competency exist and by observing the
assistant performing the task, verifying that she or he
is competent.

Communicate expectations and parameters. One
of the most important aspects of delegation is commu-
nication. In instances of miscommunication and un-
clear communication, the delegation of duties can lead
to errors or missed care. According to the Five Rights
of Delegation, nurses should use two-way communi-
cation when delegating. Ask clarifying questions and
verify that the delegatee understands and accepts the
delegated task. Additionally, you are responsible for
making sure the delegatee knows that your nursing
judgment is never being delegated and that the dele-
gatee does not have the power to change or alter her
or his responsibilities without notifying you.3

This may seem like a complex concept to grasp as
a new nurse, so it may help to use an abbreviated
SBAR (Situation, Background, Assessment, Recom-
mendation) report to guide delegation to your UAP

Five Rights of Delegation

Right task
• The activity falls within the delegatee’s job description or is in-
cluded as part of the established written policies and procedures
of the nursing practice setting. The facility needs to ensure the
policies and procedures describe the expectations and limits of
the activity and provide any necessary competency training.

Right circumstance
• The health condition of the patient must be stable. if the patient’s
condition changes, the delegatee must communicate this to the
licensed nurse, and the licensed nurse must reassess the situa-
tion and the appropriateness of the delegation.

Right person
• The licensed nurse along with the employer and the delegatee
is responsible for ensuring that the delegatee possesses the ap-
propriate skills and knowledge to perform the activity.

Right directions and communication
• Each delegation situation should be specific to the patient, the
licensed nurse, and the delegatee.

• The licensed nurse is expected to communicate specific instruc-
tions for the delegated activity to the delegatee; the delegatee,
as part of two-way communication, should ask any clarifying
questions. This communication includes any data that need to
be collected, the method for collecting the data, the time frame
for reporting the results to the licensed nurse, and additional
information pertinent to the situation.

• The delegatee must understand the terms of the delegation and
must agree to accept the delegated activity.

• The licensed nurse should ensure that the delegatee understands
that she or he cannot make any decisions or modifications in car-
rying out the activity without first consulting the licensed nurse.

Right supervision and evaluation
• The licensed nurse is responsible for monitoring the delegated
activity, following up with the delegatee at the completion of the
activity, and evaluating patient outcomes. The delegatee is re-
sponsible for communicating patient information to the licensed
nurse during the delegation situation. The licensed nurse should
be ready and available to intervene as necessary.

• The licensed nurse should ensure appropriate documentation
of the activity is completed.

Reprinted with permission from the National Council of State Boards of Nursing. J Nurs Regul
2016;7(1):5-14.

http://www.ncsbn.org/npa.htm

ajn@wolterskluwer.com AJN ▼ December 2018 ▼ Vol. 118, No. 12 53

colleague.5 Communicating expectations using tools
that you know, while also following national guidelines
and those established by your institution, can provide
a structure and format for delegatory conversations
(see Table 1 for an example of how to do this based
on the opening scenario in this article).

Know who to delegate to. Most of the time, nurses
will delegate to UAP or LPNs. These staff play a vital
role in caring for patients, and it’s our duty as nurses
to be familiar with their legal scope of practice.1 New
nurses should also consider the value of turning
to other RNs for help, even if delegation to UAP is an
option. A good rule of thumb is to first ask yourself,
“If I don’t ask for help right now, will my patients be
safe?” You can then determine what would best serve
the situation: additional assistance or additional nurs-
ing assessment? For example, if one of your patients is
in intractable pain, another is having a reaction to a
new antibiotic, and another needs water and a toilet
break, don’t be afraid to ask a nursing colleague if she
can determine the cause of your first patient’s pain.
There is no substitute for a nursing assessment when

there is an increase in a patient’s pain. Asking your
colleague for assistance allows you to focus on man-
aging your other patient’s reaction to the antibiotic.
You can then ask assistive personnel to attend to the
patient who needs assistance with toileting. It’s impor-
tant to consider that the right person for the job, in
some circumstances, may be another nurse.1

Know when to delegate (not always, not never).
Just because unlicensed personnel are available to per-
form basic functions and care and to assist with activ-
ities of daily living doesn’t mean you should delegate
every one of these tasks. A nurse’s best assessment can
be the one she or he performs while providing a bed
bath, for instance. Similarly, wounds can be assessed
when assisting with incontinence care. In another ex-
ample, helping a patient to walk down the hall offers
dual benefits: it allows you to build your relationship
with the patient while also providing an opportunity
to conduct a fall risk assessment.

Florence Nightingale likened a good nurse to one
who could distinguish the call bell of her patient from
that of others.6 Responding to call lights, providing

SBAR Step RN Statement 5 Rights of Delegation Step

Situation “Norma, I’m concerned about
Mr. Smith’s temperature.”

Right task: This step confirms that the task you are
about to delegate falls within the job description
and scope of practice of the delegatee.

Background “He is being treated for pneumonia
and has had low-grade fevers since
his iv antibiotics were changed last
night to oral antibiotics.”

Right circumstance: This step confirms that the
situation is stable, and that the delegatee under-
stands that if a change occurs, you need to know
about it.

Assessment “He is stable now, but I am
concerned about him becoming
septic again.”

Right circumstance: This step confirms that the
situation is stable, and that the delegatee un-
derstands that if a change occurs, you need to
know about it.

Assessment “I know that part of your
responsibility on this unit is to take
patients’ temperature.”

Right person: This step confirms that the
delegatee is the right person for the task, based
on her or his job description, scope of practice,
competency, and the nature of the situation.

Recommendation “For the duration of our shift
together, please take Mr. Smith’s
temperature every 4 hours instead
of every 8 hours and report to me
any reading higher than 100°F.”

Right directions and communication: This step
confirms that you’ve clearly communicated your
directions, as well as the delegatory responsibility,
to the delegatee.

Recommendation “Can you confirm the plan for
Mr. Smith’s care today?”

Right supervision and evaluation: This step
confirms the delegatee’s understanding of, and
agreement with, your delegation and allows you
to evaluate how it was carried out.

Table 1. Delegating with SBAR

54 AJN ▼ December 2018 ▼ Vol. 118, No. 12 ajnonline.com

TRANSITION TO PRACTICE

water pitchers and meals, and assisting with trips to
the bathroom are duties too often automatically del-
egated to nursing assistants. RNs risk becoming re-
moved from the intimate physicality of our jobs and
miss out on the way these responsibilities sharpen
our assessment skills and help us to prevent emer-
gencies if we are always on the sidelines.

This is not to say nurses should never delegate.
There are instances in which nurses must bring their
expert knowledge, skills, and labor to tasks that non-
RN colleagues simply cannot perform. For example,
if pulmonary edema is worsening in one of your pa-
tients, it may be necessary to ask a nursing assistant to
help clean another patient, who is incontinent. Hearing
“Why don’t you change her?” from a nursing assistant
may prove challenging. But if it’s your practice to work
alongside your assistant, you will find that her or his
pushback will lessen when you firmly delegate.

Make a practice of using simple responses drawn
from established communication tools, such as the
Agency for Healthcare Research and Quality’s CUS
(Concerned, Uncomfortable, Safety) tool, which is
part of its TeamSTEPPS program.5 By using these
words intentionally, you highlight the facts and focus
on the importance of the delegated task: “I am con-
cerned about spending my time on this task right
now. I am uncomfortable with the way my other pa-
tient is breathing. I am concerned about her safety
and need to assess her further. Thank you for com-
pleting this work. As soon as I think the patient has
stabilized, I will assist you.” In doing so, you commu-
nicate that both your work and the work of your unli-
censed colleague is important to your patients’ safety.

Be open to learning and teaching opportunities.
The interaction described above promotes teaching
opportunities, in which the nurse helps the assistant to
gain valuable clinical knowledge. Nurses must also be
open to learning from such interactions. Although
some practices we see carried out by our unlicensed
colleagues may be incorrect or unsafe, others might
genuinely help our patient care. In care settings other
than the hospital, such as in the home, RNs may see
patients only weekly or during emergencies. Nursing

assistants often provide these patients with around-
the-clock assistance. It’s thus important to learn how
to interpret and appreciate their feedback, which can
inform your assessment and the care to these patients
you provide.

Troubleshoot pitfalls and barriers. As a new nurse,
many of your delegatory relationships may be with

colleagues who are older than you. They may have
different educational and cultural backgrounds, as
well as varying levels of experience. At times, you may
encounter communication barriers or resistance to
your delegation efforts. Keep in mind that although a
nursing assistant with 25 years of experience is an in-
valuable resource, you have expert knowledge of clini-
cal care and the ability to analyze clinical evidence.

Take advantage of cultural and in-service training
programs, which can provide you with a better un-
derstanding of the diverse health care workforce and
effective delegation strategies. Pausing to consider a
person’s background and cultural mores is never the
wrong step. In my experience, relationships are of-
ten born from the simple question, “So, where are
you from?” asked with genuine interest.

Also, weigh the complexity of the delegated task.
If it makes the delegatee uncomfortable, or if you don’t
fully understand whether a task should be delegated,
step back and ask for help from a colleague. More ex-
perienced nursing colleagues can serve as leaders in
these instances and should direct you to institutional
policy and best practice resources.

If resistance persists, don’t hesitate to ask for sup-
port from your nurse manager. Sometimes the most ef-
fective tactic is to convene a meeting with the assistant
and your supervisor as soon as possible. A third party
can serve as an important sounding board in a dele-
gatory relationship. In addition, your supervisor is
responsible for maintaining an ongoing understand-
ing of your relationship with your unlicensed colleague
and for helping you find ways to improve this rela-
tionship.

It is important to understand that working rela-
tionships and delegatory instructions are not intended
to achieve dominance or control. They are for the

It is important to understand that working relationships and

delegatory instructions are not intended to achieve dominance or

control. They are for the benefit of the patient.

benefit of the patient. If communication problems or
cultural or behavioral issues get in the way of patient
care, it’s important to immediately address this bar-
rier with your colleague or supervisor.

Show your appreciation. To enter into any delega-
tory relationship is to begin a conversation that should
start with a respectful request, continue with encour-
agement, and end with gratitude and praise. Leaving
praise out of a delegatory relationship—or any work-
ing relationship—will sour it quickly. Intentional and
effective praise calls out specific behaviors, giving
weight to the worth of your delegatee’s work. In the
opening scenario, for instance, I didn’t offer praise
to Norma for her assistance. Ideally, I would have
checked the temperature readings she’d recorded ear-
lier in the day and then said, “Norma, thank you so
much for keeping a close eye on Mr. Smith’s tempera-
ture today; because of you, we caught a change in his
temperature trend as early as possible and got this in-
formation to the physician right away.”

Expressing appreciation also establishes that you
are a leader in this delegatory relationship. As such,
you must engage in heathy practices to inspire engage-
ment and team building. By rolling up your sleeves,

getting your hands dirty, and giving your UAP col-
leagues credit for their contributions to the team,
you’ll show that you value their work and rely on
their unique assistance. ▼

Amanda Anderson works in nursing administration for the
Mount Sinai Health System in New York City. She is also on the
editorial board and a contributing editor of AJN. Contact author:
amandajandersonrn@gmail.com. The author has disclosed no
potential conflicts of interest, financial or otherwise.

REFERENCES
1. American Nurses Association. ANA’s principles for delegation:

by registered nurses to unlicensed assistive personnel (UAP). Sil-
ver Spring, MD; 2012. https://www.nursingworld.org/~4af4f2/
globalassets/docs/ana/ethics/principlesofdelegation .

2. American Nurses Association. Code of ethics for nurses with
interpretive statements. 2nd ed. Silver Spring, MD; 2015.

3. National Council of State Boards of Nursing. National guide-
lines for nursing delegation. J Nurs Regul 2016;7(1):5-14.

4. Whitman MM. Return and report: establishing accountabil-
ity in delegation. Am J Nurs 2005;105(3):97.

5. Agency for Healthcare Research and Quality. Module 2: Com-
municating change in a resident’s condition. Appendix. Exam-
ple of the SBAR and CUS tools. Rockville, MD; 2017. System
design resources; https://www.ahrq.gov/professionals/systems/
long-term-care/resources/facilities/ptsafety/ltcmod2ap.html.

6. Nightingale F. Notes on nursing for the labouring classes.
London: Harrison; 1861.

8-Y824E IV Fluids tip card 5×7 FINAL.indd 1 4/16/18 2:23 PM

8-Y821 LNC Card Nsg HH ad FINAL.indd 1 9/14/18 11:47 AM

mailto: amandajandersonrn@gmail.com

https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principlesofdelegation

https://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmod2ap.html

NR 103 Article Review (Place the title of your paper here)

Your Name (first and last without credentials)

School

Class

Name of Instructor

Assignment Due Date (month date, year)

Title of Your Paper in Upper and Lower Case (Centered, Bold)

The title of your paper should be identical to what you placed on the title page. Type

your introduction here and remove the instructions. Although the first paragraph after the paper

title is the introduction, no heading labeled “Introduction” is used. Refer to your assignment

instructions for the headings to be used for the body of the paper. There are additional resources

located in your courses and the Chamberlain Library.

Article Summary (Level 1 Heading; bold and centered)

Be sure that you have chosen an article from the approved list in the rubric. Begin to

type the body of your paper here. Use as many paragraphs as needed to cover the content

appropriately based on the assignment instructions.

Levels of headings will depend on the length and organization of your paper. Your paper

for NR 103 should only have level 1 headings. Longer papers may require more organizational

detail. See your APA Manual for additional instructions on formatting multiple levels of

headings.

Conclusion

Papers should end with a conclusion or summary. The assignment directions will specify

which is required. It should be concise and contain no new information. No matter how much

space remains on the page, the references always start on a separate page (insert a page break

after the conclusion so that the references will start on a new page). Also, the reflection is a

continuation of the paper and is not required to be on a separate page. Remember, you can

submit your paper to the Essay Review Service for feedback on grammar and/or format. This

needs to be done at least by Wednesday of the week it is due for you to receive their feedback

and make needed revisions prior to submitting for grading.

Reflection

The reflection should be in a separate paragraph with a heading labeled “Reflection”.

This is the ONLY portion of the paper that can be written in first person. It should be a

continuation of the paper and not specifically placed on a separate page. The total length of the

paper, including the introduction, the summary of the article, the conclusion, and the reflection

should be 1-2 pages. If you include the separate title page and reference page, it should not

exceed 4 pages.

Reference (centered, bold)

Type your reference here using hanging indent and double line spacing (under “Paragraph” on

the Home toolbar ribbon). See your APA Manual and the resources in the APA section of

Resources for reference formatting.

NOTE: ONLY ONE REFERENCE SHOULD BE HERE, THE REFERENCE FOR THE

ARTICLE YOU ARE SUMMARIZING!

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