title: Critical thinking, delegation, and missed care in nursing practice.
abstract: OBJECTIVE
  The aim of this study was to understand how nurses use critical thinking to delegate nursing care.
  
  
  BACKGROUND
  Nurses must synthesize large amounts of information and think through complex and often emergent clinical situations when making critical decisions about patient care, including delegation.
  
  
  METHODS
  A qualitative, descriptive study was used in this article.
  
  
  RESULTS
  Before delegating, nurses reported considering patient condition, competency, experience, and workload of unlicensed assistive personnel (UAP). Nurses expected UAP to report significant findings and have higher level knowledge, including assessment and prioritizing skills. Successful delegation was dependent on the relationship between the RN and the UAP, communication, system support, and nursing leadership. Nurses reported frequent instances of missed or omitted routine care.
  
  
  CONCLUSIONS
  Findings from this project provide insight into factors that influence delegation effectiveness. These can guide CNOs and frontline nurse leaders to focus on implementing strategies to mitigate the consequence of missed care. Ineffective delegation of basic nursing care can result in poor patient outcomes, potentially impacting quality measures, satisfaction, and reimbursement for the institution.
authors: School of Nursing and Health Professions, Regis College, 235 Wellesley Street, Weston, MA 02493, USA. nancy.bittner@regiscollege.edu
authors: Nancy Phoenix
authors: NP
authors: Bittner
authors: Gayle
authors: G
authors: Gravlin
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007857:Leadership; D009730:Nursing Assessment; D009736:Nursing Process; D005791:Patient Care; D013850:Thinking