More Current Research about Delegation, Missed Care, and RROHC

Let’s look at some recent research regarding how nurses work together at the bedside:

Bea Kalisch has been researching missed care:  (Kalisch 2009)  In her study about nurses self-reporting care being missed,

  • 44% said they missed assessment
  • Basic care planning was missed by 71%
  • Basic care was missed by 73%
  • One of the most frequent missed was turning (82%)
  • The reasons were due to labor shortages (85%) materials (such as medications or supplies and equipment) (56%) and communication (38%)

NOW! One missed turn could result in a decub, which costs an average of $70,000 per ulcer and kills 60,000 patients nationally per year. Our RROHC planning, teamwork, and communication processes would solve this problem. Critical thinking problem solving would also help staff identify and repair the broken systems that don’t serve them well in terms of supply of equipment and personnel.

Bittner and Gravelin’s article published in the March JONA shows that missed care was due to critical thinking and delegation issues.  There were 7 categories:

  1. Unsure of tasks delegated
  2. knowledge expectations (i.e. RNs thought aides should be performing at a higher level than allowed, such as critical thinking without their assistance)
  3. Relationships
  4. Role uncertainty
  5. Communication barriers
  6. Systems support
  7. Omitted care.

Again, RROHC can help organizations overcome these issues.

Standing, Anthony and others from 2000 to 2009 have published research that shows that RNs are uncomfortable with delegation and leadership roles and that from novice through the seasoned nurse, and that the following issues impacted teamwork:

  • Trust,
  • collaboration,
  • willingness to assist each other,
  • appreciation of each other’s roles,
  • and recognition that all contribute individually to a shared problem

We know from Standing, Anthony, and Herz’s 2001 research that assistive personnel not following directions and/or following policy also was related to lack of routine observation and direct supervision.  Lack of direction and ongoing communication figured prominently.

We are so glad to be able to communicate with these nurse scientists and discuss how we can together improve care at the bedside!

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