DELEGATION

INTRODUCTION
Delegation has long been a function of registered nursing, although
the scope of delegation and the tasks being delegated have changed
dramatically the past three decades with the increased use of
unlicensed personnel in acute care settings. As a result, the
professional nurse (Registered Nurse[RN]) role has changed in many
acute care institutions from one of direct care provider to one
requiring the delegation of direct patient care to others. (Huston,
2017)
DEFINITIONS
Delegation is defined as the transfer of
responsibility for the performance of a
task from one person to another.
The transfer of responsibility for the
performance of an activity from individual
to another while retaining accountability
for the outcome. (American Nurses
Association)
Delegator is the person making the
delegation
Delegate is the person receiving the
delegation
Responsibility, accountability and authority are concept related to
delegation although responsibility and accountability are often used
synonymously, the two words represents different concepts that go
hand in hand. Responsibility denotes an obligation to accomplish a
task, whereas accountability is accepting ownership for the results or
lack thereof. Responsibility can be transferred, but accountability is
shared.

Authority is the right to act by transferring authority, the delegation is

empowering the delegate to accomplish the task.
Delegation is often confused with work assignment. Delegation
involves transfer of responsibility and authority. In assignment no
transfer of authority occured. Instead, assignments are bureaucratic
function that reflect job descriptions and patient or organizational
needs. Effective delegation benefits the delegator, the delegate, the
manager and the organization
 PRINCIPLES OF DELEGATION
There are four fundamental principles which serves as guides for effective delegation:

Assignment of duties in terms of expected results

Parity of authority and responsibility while assigning duties to subordinates there

should be equality of authority and responsibility

Clarifications of limits of authority: it is clear limit of authority that permits subordinates

to exercise initiative to develop their personal capacity through freedom of action and to
know their area of operation.

Unity of command: as employee should receive orders from one superior only.
 THE FIVE RIGHTS OF DELEGATION
Right Task

One that is delegable for a specific patient. Tasks that require nursing assessment or judgement

should not be delegated (Austin, 2008)

Right Circumstances

Appropriate patient setting, available resources, and other relevant factors considered.

Right Person

Right person is delegating the right task to the right person to be performed on the right person.

Right Direction/Communication

Clear, concise description of the task, including its objective, limits and expectations.

Right Supervision and Evaluation

Appropriate monitoring, evaluation, intervention, as needed, and feedback.

 DELEGATION PROCESS

Define the task

Decide on the delegate

Determine the task

Reach an agreement

Monitor performance and provide feedback

 COMMON DELEGATION ERRORS

Under delegating

Over delegating

Improperly delegating
UNDER DELEGATING
Under delegation It is a lack of trust in the subordinate due to the

following reasons:

The delegator fails to transfer full authority to the delegate.

The delegator fails to equip and direct the delegate

The delegator believes that he/she can do it perfect

The delegator believes that he /she can do it faster

The delegator believes that she/he needs the experience.

Refusal to allow mistakes

OVER DELEGATION
Over delegation occurs when the delegator loses control over a

situation by providing the delegate with too much authority or too

much responsibility. this places the delegator is a risky position,

increasing the potential liability. The reasons for over delegations:

Managers who are poor managers of time.

Others over delegate because they feel insecure in their ability to

perform a task
IMPROPERLY DELEGATING
Delegating at the wrong time

Delegating to the wrong persons

Delegating for wrong reason

Delegating the task and responsibility that are

beyond capability

Delegating decision making without providing

adequate information
STRATEGIES FOR EFFECTIVE DELEGATING
Plan ahead

Identify necessary skill and levels

Select most capable person

Communicate goal clearly

Empower the delegate

Set deadlines and monitor progress

Model the role: provide guidance

Evaluate performance

Reward accomplishment
DELEGATION AS A FUNCTION OF PROFESSIONAL NURSING
Registered Nurse's at all levels are increasingly being expected to make

assignments for and supervise the work of different levels at employees.

To increase the likelihood that the increased delegation required in

today's restructured health-care organizations should does not result in

an unsafe work environment, organizations should have

A. Clearly defined structure where registered nurse's are recognized as

leaders of the healthcare team

B. Job descriptions that clearly define the role and responsibilities at all

workers
DELEGATION AS A FUNCTION OF PROFESSIONAL NURSING
C. Education programs that help personnel learn the roles and

responsibilities of coworkers.

D. Training programs that foster the development of leadership and

delegation skills

Nursing schools and health care organizations need to do a better job of

preparing professional Registered Nurses for the delgator roles.

Educating them about NPA (Nursing Practice Act) governing the scope of

practice.
DELEGATION AS A FUNCTION OF PROFESSIONAL NURSING

Healthcare organizations need to assure that new nurses are supported

in their early efforts to delegate and that these skills are not learned by

trial and error. Instead leaders must create workplace culture where

teamwork, mutual respect and open communication are valued and

where nurse's believe they can delegate without fearing they will be

perceived as lazy or incompetent.

 DELEGATING TO UNLICENCED ASSISTIVE PERSONEL

Delegation Regardless of the duty or task to be delegated there must

be a professional registered nurse present to assess the task and

delegate to competent unlicensed assistant personnel (UAP).The word

“competent” is very important because if the UAP is not competent for

the task; it will be irresponsible to delegate no matter how simple the

task is or how much support for delegation to UAP by the organization.

Organizations with standard protocol about duties that must be

delegated.
COMMON TASK GENERALLY CONSIDERED APPROPRIATE
FOR DELEGATION TO NURSING ASSISTIVE PERSONNEL
Noninvasive and non-sterile treatment

Collecting, report, and documenting data but not limited to vital signs,

height, weight, intake and output, and cappillary blod and urine test.

Ambulation, positioning, turing

Transportation of a client within the facility

personal hygiene and elimination

Feeding, cutting up of food, placing of meal trays

Socialization activities

Activities of daily living

 DELEGATING TO UNLICENCED ASSISTIVE PERSONEL
No task may be delegated to a UAP that requires substantial

knowledge or technical skill. For example:

Pre-procedure assessment

Post-procedure evaluation

Invasive lines

Sterile technique or procedure

Nursing process

Patient triage
In the late 1990s, the NCSBN (National

Council of State Boards of Nursing)

established a decision tree for delegation,

which includes a step by step analysis

nurses can use to decide whether a task

should be delegated.
 DELEGATING TO INTERDISCIPLINARY TEAMS

Interdisciplinary team members are generally highly trained, self-

directed professionals, the team must have a leader to coordinate team

members efforts and to facilitate communication between members.

The nurse leader/manager is often called upon as the individual to

coordinate such a team. In coordinating the efforts of the inter

disciplinary team or in delegating to members of the team, the leader/

manager must be sure to recognize the unique expertise of each team

members and to delegate accordingly.

 DELEGATING TO A TRANSCULTURAL WORK TEAM
Poole, Davidhizar, and Giger 1995 suggest that six cultural phenomena

must be considered when delegating to staff from a culturally diverse

background:

Communication-Especially the dialect, volume, use of touch and eye contact

Space-Interpersonal space differs between cultures

Social organization-Importance of a group unit to providing social support

Time-Some cultures tend to be past, present or future oriented

Environmental control-Cultures often have either internal or external locus of control

Biological variations-Susceptibility to disease and physiological differences

 SUBORDINATE RESISTANCE TO DELEGATION
Some subordinates resist delegation simply because they believe

they are incapable of completing the task

Another cause of resistance to delegation is an inherent

resistance to authority. In this case the delegator must be calm

but assertive about his expectation & provide work guidelines

Explicit work guidelines, if necessary to maintain an appropriate

authority power gap. It is an ongoing leadership challenge to

instill a team spirit between delegator and their subordinates.

 BARRIERS TO DELEGATION

The belief that "i can do it better myself"

Lack of confidence and trust in workers

Low self confidence, insecurity

Vague job description

Inadequate training

Lack of adequate recruitment and selection

Time involved in explaining the task

CONTINUE
Subordinate resistance to delegation Failure of the delegator to

see the subordinates perspectives

Workload assigned are highly challenging both physically and

mentally

Belief of employees that they are incapable of completing the

delegated task.

Inherent resistance to authority

Due to over delegation

 ADVANTAGES OF DELEGATION
Successful delegation results in Makes work easier.

Develops employees. improves efficiency, increases employee

effectiveness.

Morale improves in a sense of pride belonging develops as well

as greater awareness of responsibility.

Ensures that the right people do the right jobs

As delegation increases efficiency, the quality of care improves.

As quality improves, patient satisfaction increases.

 DISADVANTAGES OF DELEGATION

If the manager is wrong in selecting the delegate, the work may

not be done, or it may be done less well.

The leader may tend to pass all of his/her work to his

subordinate and stay idle without some work to do.

Performance may drop in a short time.

A leader may delegate decisions to persons with insufficient

experience.
REASONS FOR NURSES WHY ATTEMPTED DELEGATION FAILS TO
PRODUCE DESIRED RESULTS

Nurses fails to recognize and incorporate the principles of

effective delegation

Nurses do not recognize that habits ingrained from old practice

patterns prevent improvement in delegation skills.

Nurses are unwilling or unable to view delegation from the

perspective of the delegate.

 REFERENCES

https://www.mass.gov/info-details/five-rights-of-delegation

Patronis Jones, R. A. (2007) Nursing Leadership and Management.

Theories, Processes and Practice International Edition

Bessie L. Marqius and Carol J. Huston (2005) Leadership Roles And

Management Functions In Nursing: Theory & Application 5th edition

Marquis, Bessie L., and Carol J. Huston. (2017) Leadership Roles and

Management Functions in Nursing: Theory and Application.

THANK YOU