The key to planning, developing, and managing a full-scope assistant workforce – unveiling perceptions around confidence of delegated models of care

Miss Alita Rushton1, Dr Adrienne Young1, Professor Heather Keller2, Associate Professor Judy Bauer3, Dr Jack Bell1,3

1Metro North HHS, Brisbane, Australia, 2University of Waterloo and Schlegel Research Institute, Waterloo, Canada, 3The University of Queensland, Brisbane, Australia

Background: Delegated models of care are integral to delivering values-based healthcare. Opportunities for exploring these models exist within the assistant workforce for both systematised and individualised patient care. Delegation opportunities have been highlighted as a key component in a current state-wide Systematised Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE). This project aimed to explore the confidence of dietitians and dietetic assistants with respect to delegation of malnutrition care activities.

Method: A quantitative survey with face validity from experts in field was administered across 11 hospitals in Queensland. Likert scales were collapsed into low confidence, neutral, or high confidence. Data is being collected from December 2018 to March 2019.

Results: Preliminary data at time of abstract writing (dietitians n=50; dietetic assistants n=21) reveals very high confidence in dietitian delegation of one or more malnutrition activities to assistants (100%). However, confidence levels for specific activities varied within and across professionals, assistants and sites. Both dietitians and assistants had high levels of confidence in some activities: malnutrition monitoring and evaluation (76% dietitians, 81% assistants); malnutrition education (76% dietitians, 71% assistants). Levels of confidence decreased for other activities including discharge planning and clinical handover (high confidence 62% dietitians, 43% assistants); providing malnutrition professional development (50% dietitians, 43% assistants). The u-shaped curve observed for many activities displayed polarisation of the workforce to either high level of confidence or low level of confidence. None of the nine activities had predominately neutral responses. Assistant perceptions regarding working to full scope demonstrated 47.6% agreement, 4.8% ambivalent, and 47.6% disagreement. Most dietitians perceived assistants were not working to full scope (70%).

Discussion: Highlighting areas of difference and synergy for confidence in delegation, both between and within local professional and assistant workforces, is a ‘must do’ key step to locally tailor, implement and sustain delegated models of care.

Acknowledgements: Queensland Hospitals and staff participating in SIMPLE Phase II and the SIMPLE II Knowledge Translation Team. SIMPLE Phase II has received funding from the Allied Health Professions Office of Queensland, and the MRFF Next Generation Clinical Researchers Program.


Alita Rushton is a Nutrition Assistant at The Prince Charles Hospital. Alita completed a bachelor’s degree in Health Science, Nutrition major from Queensland University of Technology and is currently undertaking a Master of Philosophy at The University of Queensland. Alita is focussed towards improving patient malnutrition care through evolving opportunities for Dietitian’s assistant roles and delegated models of care.

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