Helping new nurses with the fine art of delegation
After reading this article, you will be able to:
- List tasks you might delegate to an unlicensed assistive staff member
- Recognize potential obstacles to effective delegation
Editor’s note: Managers can share the information in this article with new nurses to help them with their delegation skills. The article is adapted from the new HCPro book Quick-E! Pro: Time Management: A Guide for Nurses. For more information, visit www.hcmarketplace.com.
Delegation is critical to time management and productivity. Each member of the team has a valuable contribution to make. Skilled nurses know how to delegate in a way that saves them time, values members of the team, and meets patients’ needs.
Examples of tasks you might delegate to an unlicensed assistive staff member include obtaining routine vital signs on stable patients, documenting food and oral intake, bathing patients, changing bed linens, feeding patients who can eat safely, ambulating steady, stable patients, or transporting stable patients.
Delegation is a five-step process, as outlined below. First, as the nurse, determine how, where, and when assistance can be provided. Next, select an appropriate person. A discussion occurs wherein authority to complete the task is given from one person to another. The task is carried out under supervision. Finally, the delegation process is evaluated and feedback is given.
1. Decision to delegate. The patient care team can be made up of RNs, LPNs, unlicensed assistive personnel, and members from other disciplines. RNs organize and supervise the patient’s plan of care. The decision to delegate occurs after a patient has been assessed by the RN. The patient’s needs and condition are taken into consideration.
The nurse prioritizes the patient’s needs, considers his or her condition, differentiates between nursing versus nonnursing tasks, and selects tasks to be delegated. The nurse then chooses the appropriate member of the team to assume the task. Nurses need to know the skill level of each team member to match the assignment appropriately (Curtis and Nicholl 2004).
Below are some questions to consider when matching a delegated task with skill level:
- Is the person licensed or unlicensed?
- Is the person in orientation or off orientation?
- How long has the person worked in the role?
- Has the person been checked off on this particular skill?
- Does the person feel confident that he or she can complete the task?
- Does the person need additional training or practice prior to completing the skill independently?
2. Communication. First, the nurse gives a clear, concise, detailed description of the request. Next, the nurse describes the objective, limits, and expectations (Currie 2008). Although the nurse retains the accountability for the patient’s care, he or she may delegate some of the work to other members of the team. The person who accepts the work must be clear on the level of autonomy he or she has to carry out the request. The next step is to establish the appropriate level of authority for the task (Huber 2006).
Next, the nurse should ask the delegate whether he or she has time to complete the assignment. Most assistive personnel work with more than one nurse at a time. You need to ensure that the request is reasonable, given the unit climate. If the person has time, ask whether there are any questions, concerns, or feedback.
3. Supervision. Once the task has been formally delegated, the delegate is accountable for his or her actions. The delegate carries out the task as assigned. The nurse offers direct supervision and feedback as needed, ensures that the task has been completed per policy, and makes him- or herself available in case an unexpected outcome occurs (Huber 2006).
4. Evaluation. The nurse should evaluate the delegation process after the task has been completed to ensure that the patient received the care needed and the team worked together effectively. Learning to delegate effectively takes time and practice. Reflecting on the process and identifying areas for improvement will help you develop this important skill.
Use the five rights of delegation (NCSBN 1997) to reflect on each step of the delegation process. Ask yourself the following questions:
- Right task. Should this task have been delegated to someone else?
- Right circumstances. Did I consider the patient’s needs when I decided to delegate the task? Was there a better way to have achieved the desired outcome?
- Right person. Did I follow organization policies when I delegated the task? How did I know that the person I chose to complete the task had the right skills and training?
- Right direction/communication. Were the directions clear, concise, and specific? Was a level of authority established? Was it communicated to the delegate? Did I ensure that the delegate was -given an opportunity to ask questions and give input? Did I ask whether the delegate had time in his or her schedule to perform the task?
- Right supervision. Did I allow the delegate to complete the task as assigned? Did I check to see that the task had been completed satisfactorily? Was it completed within the time frame agreed -upon? Was I available to assist if needed?
5. Feedback. The final step in the delegation process is to ask for and give feedback. First, ask for feedback from members of the team. Ask for specific examples of what went well and what could be done better next time. Share relevant information from your reflections. The goal is to strengthen the healthcare team so patients receive the best care possible.
The learning scenarios on p. 7 provide exercises to use with new nurses to examine how to delegate.
Curtis, E., and Nicholl, H. (2004). “Delegation: A key function of nursing.” Nursing Management 11(4): 26–31.
Currie, P. (2008). “Delegation considerations for nursing practice.” Critical Care Nurse 28(5): 86–87.
Huber, D.L. (2006). Leadership and Nursing Care Management. (3rd Ed.). Iowa City, IO: Saunders.
National Council of State Boards of Nursing (NCSBN) (1997). Delegation Decision-making Tree. Retrieved January 2, 2009, from www.ncsbn.org/delegationtree.pdf.
Editor’s note: The following case studies and scenarios can be used with new graduate nurses to examine how, when, and why to delegate tasks.
Learning activity #1
You have a four-patient assignment. It is 0900, and you have completed your initial assessments. You are working with a nursing assistant. The nursing assistant has 10 patients and is working with three nurses. You want to delegate some tasks to the nursing assistant. Select tasks that you might delegate. Explain your rationale.
- Mr. Black (70-year-old male, diagnosis: urinary tract infection). Mr. Black is alert but is experiencing some confusion. Vital signs are ordered every four hours. He is experiencing urinary frequency. He needs to be reminded to use the urinal rather than getting out of bed on his own to use the bathroom.
- Ms. Swanson (58-year-old female, diagnosis: admitted for a hysterectomy). Ms. Swanson had a hysterectomy two days ago. Her postoperative course has been uncomplicated. The surgeon wants Ms. Swanson to ambulate three times per day. Her vital signs are stable. She is alert, oriented, and cooperative.
- Mr. Johnson (25-year-old male, new admit, diagnosis: suspected Crohn’s disease). Mr. Johnson has been having abdominal pain and severe bouts of diarrhea for the past several months. He was admitted this morning. He is NPO to rest his bowels and to prepare for an upper gastrointestinal series. He has IV fluids running and prn pain medications.
- Mrs. Tolento (66-year-old female, diagnosis: congestive heart failure). Mrs. Tolento is a new transfer to your unit. She was admitted four days ago with -fluid overload. She has history of CHF and takes diuretics, digoxin, and an ACE inhibitor at home. She is alert and oriented. She is on 2L of O2 with oxygen saturation at 93%. Vital signs are ordered every four hours. She is on strict I&O. She has a Foley catheter.
Examples of delegated tasks with rationales
The two patients that the nursing assistant would work the closest with are Ms. Swanson and Mr. Black. They are the two most stable patients. Tasks for delegation: obtain vital signs, assist Mr. Black with elimination (offer urinal), and ambulate Ms. Swanson.
Learning activity #2
Develop a sequence of sentences to delegate a task to a nursing assistant.
Ms. Swanson is a 58-year-old female admitted two days ago for a hysterectomy. Her postoperative course has been uncomplicated. The surgeon wants Ms. Swanson to ambulate three times per day. You have assessed Ms. Swanson and have determined that an assistant could help with the ambulation. You approach the assistant on your team.
“I need your assistance to ambulate Ms. Swanson. She needs to ambulate once per shift. I am hoping she will do it before lunch. She is steady on her feet, uses a walker, and needs stand-by assistance. She should walk from her room to the nurses’ station and back to her room. She is ready to walk when you have time. If you do walk with her, please stay with her the entire time. If you notice she is having trouble walking (not steady, becomes dizzy, etc.), assist her back to bed or into a chair. Do you have any questions or concerns? Do you think you’ll have time in your schedule to do this before lunch?”
Remember that delegation is not complete until the delegatee accepts responsibility. After the interaction, ensure this has happened. You can say something such as, “I am just making sure that you plan to ambulate Ms. Swanson before lunch. Is that right?”
Source: Adapted from Quick-E! Pro Time Management: A Guide for Nurses, by Debbie Buchwach, BSN, RN-BC, published by HCPro, Inc.