Delegation
Karilyn Bufka
Learning Objectives
1.
2.
3.
4.
5.
Be able to define delegation.
Know who is accountable for delegated tasks.
List the Five Rights of Delegation.
Understand why delegation is important.
Understand who makes the rules and regulations
regarding delegation.
6. Understand the concerns about delegation.
7. Integrate nursing theory and theories from other
disciplines with delegation.
What is Delegation?
• Delegation is “the process for a nurse to direct another
person to perform nursing tasks and activities.” (ANA &
NCSBN, n.d.)
Who is responsible?
Tasks are delegated,
but nurses retain accountability!
Who determines delegation
rules and regulations?
• Each state has different regulations for delegating tasks
• In Michigan:
• Occupational Regulation Sections
of the Michigan Public Health Code
• Michigan Board of Nursing’s
Administration Rules (MNA, 2010).
• Who is responsible for knowing the rules and regulations?
Why is delegation important?
• Increasing number of
consumers requiring
healthcare
• Increasingly complex
therapy for
consumers
• Higher nurse to
patient ratios
• Cost containment for
institutions
Five Rights of Delegation
1.
2.
3.
4.
Right task
Right circumstances
Right person
Right directions and
communication
5. Right supervision and
evaluation
(NCSBN, 1997)
Preparation for Delegation
1. Assess and plan
2. Communicate
3. Surveillance and supervision
4. Evaluation and Feedback
(ANA & NCSBN, n.d.)
What do studies show?
• Bittner, N. P., & Gravlin, G. (2009)
• Qualitative, descriptive study
• Nurses were given a survey regarding delegation, UAPs
(unlicensed assistive personnel), and the following:
•
•
•
•
•
•
•
Tasks Delegated
Knowledge Expectations of UAPs
Relationships with UAPs
Role Uncertainty
Communication Barriers
Omitted Care
System Support
• Conclusions: Chief nursing officers and nurse leaders were given
information on why delegation often fails, which can be used to
improve outcomes in the institution
What do studies show?
• Hasson, F., Hugh, M. P., & Keeney, S. (2013). Delegating
and supervising unregistered professionals: The student
nurse experience
• Two phases, one qualitative, the other quantitative
• A face-to-face interview and a questionnaire
• Findings:
• 78% of students thought their education was inadequate to properly
perform delegation
• Students often stated they performed tasks a UAP could perform due
to resistance from UAP and negative perceptions from staff
• Students felt their lack of education resulted in underuse of UAP,
ineffective delegation, and inhibited them from learning the
professional nursing role
• Conclusions: Newly licensed nurses may not be properly prepared
to delegate tasks to UAP, an important factor for administrators
and leaders to be aware of
What do studies show?
• Saccomano, S. J., & Pinto-Zipp, G. (2011). Registered
nurse leadership style and confidence in delegation.
• A quantitative study
• Nurses in a “magnet status” hospital were given a survey
• Findings:
• Leadership style did not have any correlation with confidence in
delegating tasks to UAP
• RNs with a least a BSN and less clinical experience exhibited higher
confidence in delegating tasks than those with an ADN and the same
amount of clinical experience
• Clinical experience increased confidence in those with an ADN
• Conclusion: Education leaders need to identify a strategy to
improve confidence in delegating tasks to UAPs and work with
institutions to help create programs for new graduates
What are the concerns?
• Newly licensed nurses have not learned the skills to
delegate.
• Education programs lack effective teaching in delegation
and supervision of UAPs.
• Skills needed to delegate effectively have not been
developed.
• Many nurses don’t want to
delegate due to accountability
issues and concerns.
Root Cause Analysis
Fear of Delegation
Insufficient delegation skills
Management
unaware/unsupportive
Accountability
Lack of training
in education
programs
Malpractice
Lawsuits
Staffing
shortages
Improper,
Inefficient, or
Lack of
Delegation
Increased
acuity
Increased nurse
to patient ratios
Increased
patient demands
Decreased
Revenue
Increased number of
healthcare consumers
Implications and Consequences
• Nursing Implications
• Patient Implications
• Hospital Implications
How does nursing theory relate
to delegation?
• Virginia Henderson’s philosophy based on 14 basic needs
of the patient.
• Needs include:
•
•
•
•
Eat and drink adequately
Eliminate body wastes
Move and maintain a desirable position
Avoid dangers in the environment and
avoid injuring others
• Henderson believed that if the patient is
not able to perform the needs on their
own, nurses are to assist them.
(Chitty & Black, 2011)
How do other disciplines
theories apply to delegation?
• Social Development Theory
• “The process of organizing human energies and activities at higher
levels to achieve greater results.” (Jacobs & Cleveland, 1999).
• Two aspects:
• Learning
• Application
• Society develops due to pressures from human contact and
pressures from the environment
• Outcome: Developments that improve efficiency and effectiveness
of human activities
• How does this apply to delegation?
Recommendations for Quality &
Safety Improvements
• QSEN (Quality and Safety Education for Nurses)
• Competency Areas:
•
•
•
•
•
•
Patient Centered Care
Teamwork & Collaboration
Evidence Based Practice
Quality Improvement
Safety
Informatics
(QSEN Institute, 2011)
• How can they help with delegation?
Recommendations for Quality &
Safety Improvements, cont.
American Nurses
Association Standards
of Professional
Performance
• Ethics
• Education
• Quality of Practice
• Communication
Case Study
Amy is a graduate RN working in a critical care
unit. There were two call ins for her shift, leaving
two nurses to care for seven critically ill patients.
A UAP has floated from a med/surg floor to help
care for patients. Amy has worked with this UAP
once before, but does not know the extent of his
ability in the critical care unit. How can Amy
decide what tasks she can delegate and which
she cannot?
Case Study
• Questions Amy must consider:
• Do state rules and regulations support delegation?
• Does my facility allow me to delegate this task?
• Have I properly assessed my patient to see what their
needs are?
• Have I assessed the UAPs abilities?
• Am I able to adequately supervise the UAP?
• Would another reasonable, prudent nurse delegate this
task in this situation?
• Have I communicated clearly with the UAP and
allowed them to ask questions?
(Anderson, Twibell, & Siela, 2006)
How can I improve my
delegation skills?
• Michigan Nurses Association – Continuing Education
Course
• http://www.minurses.org/files/files/Nursing%20Practice/SS_RNAcc
ountabilityforDelegation.pdf
• American Nurse Today – Delegating without doubts
• http://www.americannursetoday.com/assets/0/434/436/440/5120/5
122/5160/5162/be29a174-c47e-4ddb-a904-30a627589e56.pdf
Discussion Questions
1. Do you feel you received enough experience/teaching on
delegation in your education experience prior to
becoming a RN?
2. Do you delegate in your current practice? If so, do you
think management has done enough to properly educate
staff on delegation?
3. What are some of the reasons you think nurses are
uneasy about delegating tasks?
4. Knowing that you retain accountability for tasks, how do
you determine who to delegate to?
5. How do you think the increasing number of healthcare
consumers will affect nurses and delegation?
References
American Nurses Association (2010). Nursing: Scope and standards of practice
(2nded.). Silver Spring, Maryland: Author.
American Nurses Association & National Council of State Boards of Nursing
(n.d.). Joint statement on delegation. Retrieved from
https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf
Anderson, P. S., Twibell, R. S., & Siela, D. (2006). Delegating without doubts.
American Nurse Today, November 2006, 54-56. Retrieved from
http://www.americannursetoday.com/assets/0/434/436/440/5120/5122/5160/5
162/be29a174-c47e-4ddb-a904-30a627589e56.pdf
Bittner, N. P. & Gravlin, G. (2009). Critical thinking, delegation, and missed care in
nursing practice. The Journal of Nursing Administration, 39(3), 142-146.
Chitty, K. K. & Black, B. P. (2011). Professional Nursing: Concepts and
challenges (6th edition). Maryland Heights, MO: Saunders Elsevier.
References, cont.
Hasson, F., McKenna, H. P., & Keeney, S. (2013). Delegating and supervising
unregistered professionals: The student nurse experience. Nurse Education
Today, 33, 229.-235.
Jacobs, G. & Cleveland, H. (1999). Social Development Theory. Retrieved from
http://www.icpd.org/development_theory/SocialDevTheory.htm
Michigan Nurses Association (2010). RN accountability for delegation decisions.
Retrieved from
http://www.minurses.org/files/files/Nursing%20Practice/SS_RNAccountabilityfo
rDelegation.pdf
National Council of State Boards of Nursing. (1997). The five rights of delegation.
Retrieved from https://www.ncsbn.org/fiverights.pdf
Reference, cont.
QSEN Institute (2011). Delegation: A collaborative, patient-centered approach.
Retrieved from http://qsen.org/delegation-a-collaborative-patient-centeredapproach/
Saccomano, S. J. & Pinto-Zipp, G. (2011). Registered nurse leadership style and
confidence in delegation. Journal of Nursing Management, 19, 522-533. doi:
10.1111/j.1365-2834.2010.01189.x