Effective Delegation Skills in Midwifery

Delegation is a multilevel process requiring decision making and risk assessment. A midwife must consider relevant competence and supervision factors before assigning procedures of client care to another member of the health care team.

Allocation

• Delegation may be the transfer of authority to a person who is already competent to perform specific tasks in the care context. The midwife is responsible for making sure the person receiving the delegation accepts and understands their own accountability and that the activities are normally within that person's responsibilities and scope of practice. Context refers to the model of care, type of service and facility or practice setting.

Supervision

• Alternatively, delegation of authority to perform a task for which the person has competence but not the autonomous authority, requires supervision. Teaching, providing guidance, support and evaluation of outcomes while monitoring and directing performance are responsibilities of the delegator. The level of supervision must be agreed on by both the delegator and the person performing the tasks.

Client Rights

• The midwife must determine the level of skill and knowledge necessary to ensure the safety and comfort of the client prior to delegating care. This determination is based on a comprehensive health assessment and complexity of client needs. Delegation should be made in consultation with the client, her family and other members of the care team whenever possible.

Risk Assessment

• A comprehensive health assessment is done for the purpose of planning client care. Relevant data is collected from the client, significant others (when appropriate), other care providers, records, direct observation, examination, measurements and diagnostic tests, as well as from continuous monitoring and review to detect relevant changes. Interpretation of data requires midwifery knowledge and judgment.

When to Delegate

• The goal of delegation is to meet consumer needs and to provide access to services. This goal is met when appropriate personnel are available at the appropriate time to give the appropriate care, including procedures, education and support. The midwife is accountable for the comprehensive assessment, the decision to delegate and for monitoring outcomes.

Limits of Delegation

• Procedures delegated by a midwife cannot be delegated by that person to any other individual unless they have the autonomous authority to perform the procedure. Additionally, accountability to consumers, licensing authorities, policies and practice guidelines cannot be delegated.

Accepting Delegation

• Midwives may receive delegation and with it certain responsibilities: to negotiate in good faith the level of supervision needed, to notify in a timely manner if unable or unwilling to perform the task, to be aware of monitoring and reporting duties associated with the task, to seek support and build confidence, to perform the procedure safely and to participate in evaluation of results.

  Collaboration takes place in an atmosphere of mutual respect and depends on communication, consultation and shared decision-making to provide effective and efficient care. Competence is the combined abilities, perspectives, skills and knowledge that are the basis of team confidence and capability.