Practical strategies for delegation and team building in a redesigned environment

Many hospitals, health systems, and agencies are undertaking work on redesign projects, many of whom contain the use of unlicensed assistive personnel (UAP). This is not a new concept in health care, but it does require strong delegation skills on the part of all parties to be successful. One must consider the delegatee's level of training and experience, state laws and regulations, and the presence of appropriate competency processes. The decision to delegate should be based on potential for harm to patients, complexity of nursing activity in question, need for problem solving and intervention, predictability of outcomes, and extent of patient interaction. There are numerous barriers to delegation, which must be addressed, including agency policies, experience and training of all staff, levels of confidence and trust, and unclear role expectations. The challenge for all is to learn to work together better as a team.