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Sikma and YoungBalancing Freedom with Risks: The Experience of Nursing Task Delegation in Community-Based Residential Care Settings

nurse delegation increased dramatically over the course of thestudy. As this practice becomes more widespread, ongoingevaluation of the outcomes of interest will be important,particularly the determination of whether nurse delegation hasindeed met the goals of the Washington State legislature toimprove access and quality of care in more cost-effective ways.

The study process illustrated policy implementation and eval-uation in action in a highly politicized environment. It elucidatedmultiple perspectives and experiences with a changing nursingpractice policy. It provides a basis for us to continue to ask criticalquestions such as what parts of our care systems and communitiesare changing, how we can best use professional nursing judgmentand supervision to meet community needs, how we can accom-plish the appropriate array of long-term care services forconsumers, what is the best mix of professional and nonprofes-sional caregivers at the community level, and finally, in an imper-fect world, what are the optimal solutions to bring structure,purpose, quality, and choice to community-based long-term care.Can we, as professional nurses, espouse in statements such as ourSocial Policy Statement24 that we promote health yet supportpolicy decisions that create barriers to choice, barriers that keeppeople from living in a real home versus an institution? Such posi-tions would contradict our professional commitments to theconsumer if taken with the purpose of protecting the scope of thenursing practice. Instead of focusing on fears about the erosion ofthe nursing practice, let us look for creative ways to partner withconsumers to expand nursing’s scope of influence in the commu-nity, enhancing quality of life and care for the growing populationof people with long-term care needs in the home.

We thank Drs Sandra Eyres, Debbie Ward, Barbara Bowers, and Kristen

Swanson for their professional collaboration and Cheryl Allen, Gaye Jensen,

Shannon Fitzgerald, Patty Hayes, Lisa Hoffman, Colleen Erskine, Kathy

Woods, Blythe Strong, Gail Bond, Yvonne Shull, and Darci Mathison for

their participation on the study team. �

REFERENCES

1. Krainovich-Miller B, Sedhom LN, Bidwell-Cerone S, Campbell-Heider N, Malinski VM, Carter E. A review of nursing research onthe use of unlicensed assistive personnel (UAP). J New York StateNurs Assoc 1997;28:8-15.

2. Huston CL. Unlicensed assistive personnel: a solution to dwindlinghealth care resources or the precursor to the apocalypse of registerednursing? Nurs Outlook 1996;44:67-73.

3. Manuel P, Alster K. Unlicensed personnel: no cure for an ailinghealth care system. Nurs Health Care 1994;15:18-21.

4. Barter M, Furmidge ML. Unlicensed assistive personnel: issuesrelating to delegation and supervision. J Nurs Admin 1994;24:36-40.

5. Kane RA. Expanding the home care concept: blurring distinctionsamong home care, institutional care, and other long-term-careservices. Milbank Q 1995;73:161-86.

6. Just G, DeYoung S, VanDyk R. Assisted living: challenges fornursing practice. Geriatr Nurs 1995;16:165-8.

7. Brent NJ. Delegation and supervision of patient care. HomeHealthcare Nurse 1993;11:7-8.

8. Harris MD. Competent, supervised unlicensed personnel willcontribute to high-quality in-home health care. Home HealthcareNurse 1993;11:55-6.

9. MacEachen E, Munby H. Developmentally disabled adults incommunity living: the significance of personal control. QualitativeHealth Res 1996;6:71-89.

10. American Nurses Association. Registered professional nurses &unlicensed assistive personnel. 2nd ed. Washington, DC: AmericanNurses Publishing; 1996.

11. Parsons LC. Delegation skills and nurse job satisfaction. Nurs Econ1998;16:18-26.

12. Johnson SH. Teaching nursing delegation: analyzing nurse practiceacts. J Continuing Educ Nurs 1996;27:52-8.

13. Parkman CA. Delegation: Are you doing it right? Am J Nurs1996;96:43-8.

14. Huber DG, Blegen MA, McCloskey JC. Use of nursing assistants:staff nurse opinions. Nurs Manage 1994;25:64-8.

15. Jung FD. Teaching registered nurses how to supervise nursing assis-tants. J Nurs Admin 1991;21:32-6.

16. Kane RA, O’Connor CM, Baker MO. Delegation of nursing activ-ities: implications for patterns of long-term care. Washington, DC:American Association of Retired Persons; 1995.

17. Glaser B. Theoretical sensitivity. Mill Valley (CA): Sociology Press;1978.

18. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park (CA):Sage; 1985.

19. Strauss AL. Qualitative analysis for social scientists. Cambridge:Cambridge University Press; 1987.

20. Strauss A, Corbin J. Basics of qualitative research: grounded theoryprocedures and techniques. Newbury Park (CA): Sage; 1990.

21. Bowers BJ. Grounded theory. In: Sarter B, editor. Paths to knowl-edge: innovative research methods for nursing. New York: NationalLeague for Nursing; 1988. p. 34-59.

22. Sandelowski M. The problem of rigor in qualitative research. AdvNurs Sci 1986;8:27-37.

23. Kimchi J, Polivka B, Stevenson JS. Triangulation: operational defi-nitions. Nurs Res 1991;40:364-6.

24. American Nurses Association. Nursing’s social policy statement.Washington (DC): American Nurses Publishing; 1995.

201NURSING OUTLOOK JULY/AUGUST 2001

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Carole A. Anderson, PhD, RN, FAANCollege of NursingThe Ohio State University1585 Neil AvenueColumbus, OH 43210-1289

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