Learning the art of delegation
Delegation is essential in nursing, and doing it effectively will mean that every member of your team will see the benefits
Delegation is essential in nursing, and doing it effectively will mean that every member of your team will see the benefits.
Delegation, as a core function in nursing, is not new, but its importance and relevance to the profession have increased enormously in recent years. This is due to the many challenges nurses encounter at work, including new technology, financial constraints, greater emphasis on teamwork, staff shortages and creating and sustaining a learning culture.
One of the ways nurses manage these challenges is through delegation. But effective delegation is not a simple process and many students and newly qualified nurses find it challenging. There are several important issues to consider before delegation can begin, including:
- Understanding what delegation means.
- Being aware of the scope of professional nursing practice documents, such as the Nursing and Midwifery Council’s (NMC) code of professional conduct and the Scope of the Nursing and Midwifery Practice Framework published by the Nursing and Midwifery Board of Ireland (NMBI).
- Understanding accountability and responsibility in the context of delegation.
- Understanding the delegation process.
- Understanding the advantages of, and barriers to, delegation.
- Having knowledge and awareness of leadership, and its importance in supporting delegation.
- Working with a multicultural workforce.
- Understanding the concepts of trust and job satisfaction.
It is impossible to discuss all these issues here, and suggestions for further reading are given below.
Delegation is an activity where a nurse, the delegator, transfers responsibility or authority for undertaking a specific nursing task to another person, the delegate (National Council of State Boards for Nursing 2015, NMBI 2016), and is therefore a way of ‘planning or controlling activities through others’ (Lipe and Beasley 2004).
There are several important principles which are inherent in this definition.
First, nurses can only delegate tasks which fall within their normal scope of practice so, although they may delegate responsibility, they remain accountable for the safe and satisfactory undertaking of the task. Second, delegates must be deemed competent to undertake the specified nursing task. Third, proper planning must be embedded in the process of delegation to ensure safety and accountability.
Lipe and Beasley (2004) suggest delegation can be properly achieved only if it is approached
in a structured and planned way. They use the nursing process as the platform on which to build this structure:
- Assess patient’s needs and consider both the delegate’s skills and knowledge.
- Plan care based on desired patient outcomes.
- Delegate the specified task based on the patient’s condition and expected outcomes.
- Implementation includes communicating expectations to the delegate while providing support and supervision.
- Evaluation of the delegation process should be conducted after the task is completed.
Hansten (2014) illustrates this planned approach in a practical tool called the five rights of delegation.
- Right circumstances (clinical context).
- Right task (patient outcomes).
- Right person (delegate).
- Right direction (communication).
- Right supervision (support).
Benefits and barriers
Delegation is one of the most difficult functions of management, but when performed correctly it has several benefits, for the delegator, the delegate, and the ward or organisation. There are several barriers to delegation, including factors related to managers, employees and situations. For more information, refer to Curtis and Redmond’s book about delegation. Sometimes delegation fail for various reasons, including the inability of managers to let go of tasks, managers being unreceptive to delegates’ ideas or decisions after tasks have been delegated, and poor communication and feedback.
Effective delegation demands leadership and, although the relationship between the two is not well researched, nurses must know about both concepts to fulfil the requirements of their roles. Yoon et al (2016) support this view, and report that leaders who have good communication and interpersonal skills and who support staff autonomy and empowerment, demonstrate greater confidence in delegating. However, Saccomano and Pinto-Zipp (2011) found no relationship between supportive leadership styles, education level or clinical experience and confidence in delegating.
One explanation for these findings is that education is important for confident delegating only when combined with clinical experience. After all, even though there was no significant relationship between leadership style and confidence, the data demonstrated that education and clinical experience were important for delegating patient care.
Effective leadership results in better patient care (Na’eem et al 2015) and research, which supports this assertion demonstrates a positive relationship between leadership and variables such as safe care (Tregunno et al 2009), healthy work environments (Shirey 2009), job satisfaction (Heller et al 2004, Sellgren et al 2007, Kaernested and Bragadottir 2012) and low turnover rates (Kleinman 2004, Roche et al 2015).
So what type of leadership is best suited for dealing with the multifaceted issues in nursing? The answer, regrettably, cannot be explored here, but some authors (King’s Fund 2011, Na’eem et al 2015) suggest that leaders in nursing and across healthcare must move away from a ‘heroic, leader-centric view of leadership’ to a more distributed approach, which we support.
Benefits of delegation
For the delegator:
- More time for managers to perform their other duties.
- Greater productivity as several staff members are performing many different tasks at the same time.
For the delegate:
- More opportunities to increase knowledge and skills, which can improve confidence, job satisfaction and morale.
- Effective delegation can result in better understanding and appreciation of the nature of the work in a care setting.
- Developing and expanding skills and knowledge can lead to promotion and better career opportunities.
For the team, ward or organisation:
- All organisations are concerned with efficiency, and effective delegation requires managers to select the right person for the task, someone who has the knowledge and skills to perform the task, thereby making good use of available resources.
- Decision making is faster and more effective because several people are likely to be involved.
- Effective delegation enables several individuals to become proficient in various tasks, thereby improving effectiveness and efficiency.
You should consider the following when planning delegation:
- The NMC code and local guidelines at your workplace.
- Your ward or department’s strengths.
- Who is the right person? Get to know your staff.
- The ward or department’s workload. Establish who has capacity to take on additional work; remember that delegation is not dumping.
- How will delegated tasks provide experience for the delegates?
- How will delegated tasks result in safe and high-quality results for patients?
- Opportunities to build on the creative talents of staff.
- Delegation is a systematic process that takes time and planning; preparation is necessary for success.
- Give clear instructions; effective communication is essential.
- Provide effective and appropriate supervision to support delegates.
- Hansten R (2014) Guidelines for prioritization, delegation, and assignment decisions. In LaCharity L, Kumagai C, Bartz B (Eds) Prioritization, Delegation and Assignment. Third edition. Elsevier, St Louis MO.
- Heller B, Esposito-Herr M, Tom S (2004) Educating nurses for leadership roles. Journal of Continuing Education in Nursing. 35, 5, 203-210.
- Kaernested B, Bragadottir H (2012) Delegation of registered nurses revisited: attitudes towards delegation and preparedness to delegate effectively. Nordic Journal of Nursing Research and Clinical Studies. 32, 1, 10-15.
- King’s Fund (2011) The Future of Leadership and Management in the NHS: No More Heroes.
- Kleinman CS (2004) Leadership: a key strategy in staff nurse retention. Journal of Continuing Education in Nursing. 35, 3, 128-132.
- Lipe S, Beasley S (2004) Critical Thinking in Nursing: A Cognitive Skills Workbook. Lippincott, Williams and Williams, Philadelphia PA.
- Na’eem A, Faheem A, Hiba A et al (2015) An NHS Leadership Team for the Future. Reform Research Trust, London.
- National Council of State Boards for Nursing (2015) Joint Statement on Delegation. American Nurses Association and the National Council of State Boards of Nursing.
- Nursing and Midwifery Board of Ireland (2016) Scope of Nursing and Midwifery Practice Framework.
- Roche MA, Duffield C, Dimitrelis S et al (2015) Leadership Skills for Nursing Unit Managers to Decrease Intention to Leave. Dovepress. 5, 57-64.
- Saccomano S, Pinto-Zipp G (2011) Registered nurse leadership style and confidence in delegation. Journal of Nursing Management. 19, 4, 522-533.
- Sellgren S, Ekvall G, Tomson G (2007) Nursing staff turnover: does leadership matter? Leadership in Health Services. 20, 3, 169-183.
- Shirey M (2009) Authentic leadership, organisational culture and healthy work environments. Critical Care Nursing Quarterly. 32, 3, 189-198.
- Tregunno D, Hall M, Baker R et al (2009) On the ball: leadership for patient safety and learning in critical care. Journal of Nursing Administration. 39, 7-8, 334-339.
- Yoon J, Kim M, Shin J (2016) Confidence in delegation and leadership of registered nurses in long-term hospitals. Journal of Nursing Management. 24, 5, 676-685.
- Boden R (2011) Distributed leadership in organisations: a review of theory and research. International Journal of Management Reviews. 13, 3, 251-269.
- Curtis E, Redmond R (2009) Delegation: A Short Primer for the Practising Nurse. Blackhall Publishing, Dublin.
- Gillen P, Graffin S (2010) Nursing delegation in the United Kingdom. Online Journal of Issues in Nursing.
- Harris A (2008) Distributed leadership: according to the evidence. Journal of Educational Administration. 46, 2, 172-188.
- Royal College of Nursing (2016) Accountability and Delegation.
Elizabeth Curtis is assistant professor and Fintan Sheerin is a lecturer in the School of Nursing and Midwifery, Trinity College, Dublin