title: Balancing freedom with risks: the experience of nursing task delegation in community-based residential care settings.
abstract: BACKGROUND
  In 1995, Washington State implemented law reforming the state's long-term care system, favoring provision of service in less restrictive, lower-cost settings.
  
  
  OBJECTIVE
  The purpose was to systematically evaluate one facet of the new law regarding the implementation of a policy authorizing delegation of designated nursing tasks by registered nurses in community-based residential care settings.
  
  
  METHODS
  This was a descriptive study driven by the inductive process of grounded theory. Qualitative data sources included interviews, public forums, document review, and open-ended survey questions to facility operators, nurses, nursing assistants, and inspectors.
  
  
  CONCLUSIONS
  The study identified an overarching social process, balancing freedom with risks involving tension at the intersections, which is evident from 3 main perspectives: consumer, professional, and the health care system.
  
  
  CONCLUSIONS
  The study has implications for regulatory consistency, nursing practice and education, collaboration between overlapping providers of skilled nursing services in residential settings, and subsequent health policy.
authors.affiliation: Nursing Program at the University of Washington, Bothell, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Sikma
authors.forename: H M
authors.initials: HM
authors.lastname: Young
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003363:Cost Control; D005610:Freedom; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D008134:Long-Term Care; D009731:Nursing Audit; D009745:Nursing, Supervisory / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011787:Quality of Health Care; D012112:Residential Facilities / Q000458:organization & administration*; D012449:Safety; D014861:Washington