Developing Delegation Skills
One of the most complex nursing skills is that of delegation. This skill is what most of our international nurses’ struggle with after deployment. It requires sophisticated clinical judgment and final accountability for patient care. Effective delegation is based on one’s state nurse practice act and an understanding of the concepts of responsibility, authority, and accountability.
Registered Nurses (RNs) are brokers of patient care resources. RNs synthesize data collected by nurses and other healthcare professionals to coordinate the patient’s safe and individualized care to best address patient and family needs in a way that maximizes available resources. RNs decide what patient care interventions are necessary and how, when, and by whom these interventions need to be provided. These decisions are made in a clinical environment in which shrinking resources and increased demands for services heighten the need for nurses to delegate care based on professional guidelines and their state nurse practice acts.
Perhaps one of the most difficult responsibilities an RN has is that of effective delegation. RNs are required to understand what patients and families need and then engage the appropriate care givers in the plan of care in order to achieve desired patient outcomes while maximizing the available resources on the patient’s behalf. Delegation is an important skill that influences clinical and financial outcomes, yet, an RN’s delegation skills often are not evaluated in the same manner as other clinical skills, even though a number of nurses continue to need help in delegating appropriately.
The following scenario is a typical situation that RNs frequently describe when sharing their need for more staff:
Near the end of her shift, the RN finds that the LPN and nursing assistant have all their work completed and are sitting in the nursing station waiting for the next shift to arrive. The RN has been running all evening trying to juggle competing patient needs, such as administering blood and initiating IV antibiotics for patients assigned to the LPN and nursing assistant, in addition to answering a pharmacist’s questions about a patient’s lab results and performing requests made by team members from other services, all while trying to complete the care needed for her patients. The RN is struck by how overwhelmed she feels and questions the LPN and nursing assistant about why they did not help her. The LPN and nursing assistant respond that had the RN asked them to help, they would have, adding, “but we can’t read your mind.” The RN responded, “I didn’t have time ask. Couldn’t you see I was busy?”
In the scenario provided above, the RN was the person directing the work of others. However, the RN did not communicate with the LPN and nursing assistant about what needed to be done. In addition, the RN accepted the responsibility to perform additional activities requested by other departments rather than redirecting some of them. This behavior is not uncommon. A study of 170,000 healthcare workers found that RNs often performed inappropriate work or work that others could have done, thus contributing to a loss of the professional components of nursing.
Delegation skills can be strengthened when:
- RNs understand the nurse state practice act
- Nursing education and nursing service support RNs as they continually expand their knowledge about delegation
- Simulation exercises using scenarios found in daily practice are used to teach and demonstrate delegation competency
- Pairing and/or partnering is utilized and supported by the staff schedule and method of patient assignment
Delegation is viewed as competency that is based on a skill set and that requires ongoing development. Developing delegation skills is indeed a multifaceted activity. Developing delegation skills begins during pre-licensure nursing education. It is important that educators and organizations provide clinical experiences for nurses to see delegation as a skill set that must be practiced in order for it to be perfected. Developing practice environments that foster nurses’ learning of delegation skills reinforces the authority of all RNs to delegate to LPNs and nursing assistants. As new RNs enter professional practice, they need ongoing support and education to perfect this skill, which ConexusMedstaff provides for our nurses through the Clinical Nurse Educators.
Concepts of responsibility, accountability, and authority are integral to each RN’s understanding of professional nursing practice, which includes properly assuming authority for the decisions and outcomes associated with patient care, sharing the process of patient care with other responsible members of the nursing team, and holding all members of the nursing team accountable for their responsibilities. Delegation requires RNs to use critical thinking skills in order to match staff expertise with patient and family needs. Staff relationships also influence the delegation potential and the delegation process.
When RNs do not effectively delegate to others, quality of care can be lessened, and valuable resources can be mismanaged. Resources will surely continue to shrink, and care demands will surely continue to rise, thus increasing the risks of inappropriate delegation. Having clarity about what can be delegated helps to define quality professional practice not only for nurses but also for other team members, patients, and families.
Weydt, A., (2010). Developing Delegation Skills. OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 1.