DELEGATION ISSUES IN NURSING 1

Delegation Issues in Nursing

Janelle Blake

Mount San Jacinto College

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Delegation Issues in Nursing

The concept of delegation in nursing started in the 1800’s with contributions from the

widely known nursing theorist, Florence Nightingale, who states, “To look to all these things

yourself does not mean to do them yourself…But you can not insure that it is done when not

done by yourself?” (Kelly, 2004). Nursing delegation has evolved over the years and has

become increasingly important in a variety of settings across the continuum of health care. The

registered nurse (RN) may delegate components of their daily agenda of tasks to other unlicensed

assistive personnel (UAP) to assist in low-risk nursing care tasks, ensuring the utmost safety to

the patient. In order to protect the safety and the welfare of the patient, the RN must possess the

ability to comprehend the importance of utilizing what have been referred to as the five “rights”

of delegation. The National Council of State Boards of Nursing (NCSBN) has published these

delegation rights as: “the right task, under the right circumstances, to the right person, with the

right direction and communication, and the right supervision and evaluation” (Berman, Snyder,

& Frandsen, 2016). Within the platform of today’s ever evolving system of health care, it is

essential for the registered nurse to possess and implement outstanding delegation skills

grounded within their own sense of clinical judgment. To successfully accomplish this the nurse

must possess several key professional traits: competency in regards to critical thinking

capabilities, an exceptionally skilled level of communication, and the ability to work in collusion

with colleagues in order to provide effective patient care.

Nurses Need Critical Thinking Capabilities in Regards to Delegation

Today’s healthcare work environment, it requires the professional registered nurse to

have intellectual critical thinking skills to effectively delegate to others for the adequacy of

nursing care. Intellectual skills are critical and are highly valued to effectively make appropriate
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clinical decisions. This intellectual process includes the nurse’s capability to utilize problem

solving and reasoning throughout the nursing practice. Delegation tasks and activities that are

performed by the nurses involves a well-developed cognitive process in order to think critically

in each phase of the nursing process when considering a task within the parameters of the

delegatee’s scope of practice. As the leader of a nursing care team, effective delegation skills are

critical because the registered nurse is accountable for the outcomes. Therefore, it is important to

eliminate illogical and irrelevant thought processes when reasoning about client care. To help

guide the RN with assistance in the decision-making process, Tanner’s theoretical component

called “The Situated Clinical Decision-Making Framework,” is utilized to help foster the

development of one’s knowledge. One of the primary benefits of this framework is it “socializes

healthcare professionals to an understanding of the nature of decision-making in nursing; and

assists with the development of their knowledge, skill, and confidence as nurses” (Gillespie &

Paterson, 2009). This framework tool assists the nurse to recognize the collaboration of each

phase on the decision-making process made in the clinical setting while developing the

knowledge to ensure that one’s decisions will be accurate and safe during practice. Overall, it is

the nurse’s obligation to have the working knowledge of the standards of delegation of nursing;

and to demonstrate the continued self-development and maintenance in one’s competency in

order to provide safe, quality care.

The Importance of Communication in Nursing Delegation

Another critical aspect in the delegation process includes the ability to communicate

precisely when working with others while still meeting patient needs. The quality of a nurse’s

communication is an important factor in nursing care on a day-to-day basis. When delegating,

each individual’s role needs to be defined and made clear as a foundation for the principle of
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patient protection. The nurse individualizes the communication to the assistive personnel and

addresses any unique client requirements and characteristics. In addition, the delegator should

assess the unlicensed assistive personnel’s understanding of the expectations while specifying

each task and the skill required to perform the task. The RN must consider the barriers as well as

the benefits to delegating a specific task while utilizing one’s best professional judgment to

determine the decision. According to the National Council of State Boards of Nursing (2005), it

is important for the nurse to provide concise communication to the nursing assistive personnel

with expectations of: “how the task is to be accomplished, priorities for accomplishing tasks,

while acknowledging the need for flexibility should client conditions or needs change, and

expected observations and specific client outcomes and that would require prompt reporting.”

The health care provider must acknowledge that communication is a two-way process in the

clinical setting and are held accountable for competency. Thus, this allows for the opportunity for

interaction during the completion of the delegated task. In the scope of nursing, it requires the

nurse to be mindful in one’s communication style with correct, complete, and concise

information to achieve the results needed to meet patient care goals.

Nurses Must Demonstrate Exemplary Professional Unity in Order to Properly

Delegate Tasks

A fundamental aspect of nursing is the ability to have interpersonal skills to

collaboratively work and interact with others is key to a successful delegation. Interpersonal

skills are necessary for all daily nursing activities such as therapeutic communication,

comforting, and counseling. The occurrence of poorly developed partnerships across the licensed

and unlicensed staff members act as a barrier with delegation issues. At times, the nurse may not

want to delegate care to other unlicensed personnel until the delegator has acknowledged that the
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delegatee is competence with performing a fundamental skill on the job efficiently. The

registered nurse is accountable to the public for providing safe and effective care for patients and

is responsible for all actions of others in the context of delegation. Therefore, it may be common

for nurses to feel reserved when it comes to delegating nursing care tasks especially knowing

that they are legally responsible for the consequences if mistakes are present. Trustworthiness is

a key component in the world of nursing and must be developed throughout the workplace for

effective delegation to occur. When delegating components of care, the RN can assign reasonable

takes that are within the health care personnel’s scope of practice such as bathing, feeding, and

ambulation. To build a trustworthy foundation, the nurse can educate and teach the UAP how

they want the skill to be properly done then delegate the task with confidence. The nurse needs

the ability to work effectively with others as a member of the health care team. With consistent

education and training from the RN, it will help prepare the assistive personnel to perform the

activities and skills appropriately and reduce the risk for errors. Professional research provided

by Potter, Deshield, and Kuhrik (2010) found that participates described delegation as central

theme of conflict and that successful delegation is characterized by effective communication,

teamwork, and initiative. To fulfill this commitment of unity in the clinical setting, nurses should

embrace their delegation skills when managing the delivery of care.

It is essential for the registered nurse to build uniformity when working with multiple

healthcare experts because teamwork provides high-quality care. In healthcare, the relationship

between the nurse and other health care professionals is paramount. Teamwork depends on each

team member being able to anticipate the needs of others while adjusting to each other's actions.

Some fundamental features of teamwork include the collaboration between health care

employees as well as the enhanced communication that works towards a common goal. Health
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Services Research states that “teams make fewer mistakes than do individuals, especially when

each team member knows his or her responsibilities, as well as those of other team members”

(Baker et al., 2009). When an entire team of health workers comes together, it will help prevent

errors from occurring and help nurses reach their goal of providing optimal healthcare. In

addition, working as a team allows for the coordination of the patient’s well-being. If each

individual can effectively function as a unit in the healthcare industry, this will allow for the

measurable goal to be accomplished.

Summary

The principles of delegation in the field of nursing requires one’s understanding of the

concepts of the states nurse practice act. Challenges in the healthcare workplace make demands

on the RNs to have the proper knowledge to effectively delegate to others. In the delegation

process, the registered nurse’s clinical judgment, interpersonal relationships, and communication

are key factors that are necessary for effective delegation. These factors are essential in the

healthcare setting and allow the individual for continuous professional development. One

primary goal of the National Council of State Boards of Nursing (NCSBN) is the development of

the national guidelines to help standardize the nursing delegation process. The nurse must know

the expertise of the staff to whom care is delegated to and their decision-making should be

influenced by the mandates of the “five” rights of delegation. Effective delegation skills are

constantly being developed when the RN strategizes the delegation task to the nursing assistive

personnel. The registered nurse retains accountability for the outcome of the care and they must

be skilled in delegation. The nurse is known to be the advocate of the patient and the purpose of

delegation is to ensure that the quality care and patient safety is achieved. Throughout a nurse’s

career, one will have plenty of opportunities to expand with their practice delegation skills but
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will need acquire an expert level of competency. As learned by the NCSBN, it is essential for the

nurses today to take on the role as a team leader and understand the purpose and principles of the

delegation process in the field of nursing.

References
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References

Baker, David P, Day, Rachel, & Salas, Eduardo. (2006). Teamwork as an essential component

of high-reliability organizations. Blackwell Science Inc, 41(2): 1576–1598.

Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb's fundamentals of nursing:

Concepts, process, and practice (10th ed.). Boston: Pearson.

Gillespie, M., & Paterson, B. (2009) Helping novice nurses make effective clinical decisions:

The situated clinical decision-making framework. (2009). Nursing Education

Perspectives (National League for Nursing), 30(3), 164-170.

Joint statement on delegation: American nurses association and the national council of state

boards of nursing (2005). Retrieved November 23, 2016, from

https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

Kelly, P. (2004). Essentials of nursing leadership & management (2nd ed.). Clifton Park, NY:

Delmar Learning.

Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered nurses

and nursing assistive personnel. Journal Of Nursing Management, 18(2), 157-165.

doi:10.1111/j.1365-2834.2010.01062.x

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Last Name, F. M. (Year). Book Title. City Name: Publisher Name

DELEGATION ISSUES IN NURSING 9

References

Baker, David P, Day, Rachel, & Salas, Eduardo. (2006). Teamwork as an essential component

of high-reliability organizations. Blackwell Science Inc, 41(2): 1576–1598.

Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb's fundamentals of nursing:

Concepts, process, and practice (10th ed.). Boston: Pearson.

Gillespie, M., & Paterson, B. (2009) Helping novice nurses make effective clinical decisions:

The situated clinical decision-making framework. (2009). Nursing Education

Perspectives (National League for Nursing), 30(3), 164-170.

Joint statement on delegation: American nurses association and the national council of state

boards of nursing (2005). Retrieved November 23, 2016, from

https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

Kelly, P. (2004). Essentials of nursing leadership & management (2nd ed.). Clifton Park, NY:

Delmar Learning.

Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered nurses

and nursing assistive personnel. Journal Of Nursing Management, 18(2), 157-165.

doi:10.1111/j.1365-2834.2010.01062.x