The purpose of delegation is not to assign tasks to others that you do not want to do yourself. When you delegate to others effectively, the result is you have more time to perform the tasks that only a professional nurse is permitted to do.
In delegating, the nurse must consider both the ability of the person to whom the task is delegated and the fairness of the task to the individual and the team (Whitehead, Weiss, & Tappen, 2010). In other words, both the task aspects of delegation (Is this a complex task? Is it a professional responsibil- ity? Can this person do it safely?) and the inter- personal aspects (Does the person have time to do this? Is the work evenly distributed?) must be considered.
The ANA (2005) has specified tasks that RNs may not delegate because they are specific to the discipline of professional nursing. These activities
include initial nursing and follow-up assessments if nursing judgment is indicated (Zimmerman &
Schultz, 2013):
■ Decisions and judgments about client outcomes
■ Determination and approval of a client plan of care
■ Interventions that require professional nursing knowledge, decisions, or skills
■ Decisions and judgments necessary for the evaluation of client care
Task-Related Concerns
The primary task-related concern in delegating work is whether the person assigned to do the task has the ability to complete it. Team priorities and efficiency are also important considerations.
Abilities
To make appropriate assignments, the nurse needs to know the knowledge and skill level, legal defini- tions, role expectations, and job description for each member of the team. It is equally important to be aware of the different skill levels of caregivers within each discipline because ability differs with each level of education. Additionally, individuals within each level of skill possess their own strengths and weaknesses. Prior assessment of the strengths of each member of the team will assist in providing safe and efficient care to clients. Figure 7.2 outlines the skills of various health-care personnel.
People should not be assigned a task that they do not have the skills or knowledge to perform, regardless of their professional level. People are
LPN Skills
Vital signs
Some IV medication (depending on state Nurse Practice Act and institution) Physical care
Interprofessional Personnel Patient Care Needs
PT OT Nutrition Speech
NAP
Feeding Hygiene Physical care
RN Skills
Assessment IV medications Blood administration Planning care Physician orders Teaching
Figure 7.2 Diagram of delegation decision-making grid.
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often reluctant to admit they cannot do something.
Instead of seeking help or saying they are not com- fortable with a task, they may avoid doing it, delay starting it, do only part of it, or even bluff their way through it, a risky choice in health care.
Regardless of the length of time individuals have been in a position, employees need orientation when assigned a new task. Those who seek assis- tance and advice are showing concern for the team and the welfare of their clients. Requests for assis- tance or additional explanations should not be ignored, and the person should be praised, not criti- cized, for seeking guidance (Whitehead, Weiss, &
Tappen, 2010).
Priorities
The work of a busy unit rarely ends up going as expected. Dealing with sick people, their families, physicians, and other team members all at the same time is a difficult task. Setting priorities for the day should be based on client needs, team needs, and organizational and community demands. The values of each may be very different, even opposed.
These differences should be discussed with team members so that decisions can be made based on team priorities.
One way to determine patient priorities is to base decisions on Maslow’s hierarchy of needs.
Maslow’s hierarchy is frequently used in nursing to provide a framework for prioritizing care to meet client needs. The basic physiological needs come first because they are necessary for survival. For example, oxygen and medication administration, IV fluids, and enteral feedings are included in this group.
Identifying priorities and deciding the needs to be met first help in organizing care and in deciding which other team members can meet client needs.
For example, nursing assistants can meet many hygiene needs, allowing licensed personnel to administer medications and enteral feedings in a timely manner.
Eff iciency
In an efficient work environment, all members of the team know their jobs and responsibilities and work together like gears in a well-built clock. They mesh together and keep perfect time.
The current health-care delivery environment demands efficient, cost-effective care. Delegat- ing appropriately can increase efficiency and save
money. Likewise, incorrect delegation can decrease efficiency and cost money. When delegating tasks to individuals who cannot perform the job, the RN must often go back to perform the task.
Although institutions often need to “float” staff to other units, maintaining continuity, if at all pos- sible, is important. Keeping the same staff members on the unit all the time, for example, allows them to develop familiarity with the physical setting and routines of the unit as well as the types of clients the unit services. Time is lost when staff mem- bers are reassigned frequently to different units.
Although physical layouts may be the same, client needs, unit routines, use of space, and availability of supplies are often different. Time spent to orient reassigned staff members takes time away from delivery of client care. However, when staff mem- bers are reassigned, it is important for them to indicate their skill level and comfort in the new setting. It is just as important for the staff mem- bers who are familiar with the setting to identify the strengths of the reassigned person and build on them.
Appropriateness
Appropriateness is another task-related concern.
Nothing can be more counterproductive than, for example, floating a coronary care nurse to labor and delivery. More time will be spent teaching the nec- essary skills than providing safe mother-baby care.
Assigning an educated, licensed staff member to perform non-nursing functions to protect safety is also poor use of personnel.
Relationship-Oriented Concerns
Relationship-oriented concerns include fairness, learning opportunities, health concerns, compati- bility, and staff preferences.
Fairness
Fairness requires the workload to be distributed evenly in terms of both the physical requirements and the emotional investment in providing health care. The nurse who is caring for a dying client may have less physical work to do than another team member, but in terms of emotional care to the client and family, he or she may be doing double the work of another staff member.
Fairness also means considering equally all requests for special consideration. The quickest way to alienate members of a team is to be unfair. It is
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important to discuss with team members any deci- sions that have been made that may appear unfair to any one of them. Allow the team members to participate in making decisions regarding assign- ments. Their participation will decrease resentment and increase cooperation. In some health-care institutions, team members make such decisions as a group.
Learning Opportunities
Including assignments that stimulate motivation, learning, and assisting team members to learn new tasks and take on new challenges is part of the role of the RN.
Health
Some aspects of caregiving jobs are more stressful than others. Rotating team members through the more difficult jobs may decrease stress and allow empathy to increase among the members. Special health needs, such as family emergencies or special physical problems of team members, also need to be addressed. If some team members have difficulty accepting the needs of others, the situation should be discussed with the team, bearing in mind the employee’s right to privacy when discussing sensi- tive issues.
Compatibility
No matter how hard you may strive to get your team to work together, it just may not happen.
Some people work together better than others.
Helping people develop better working relation- ships is part of team building. Creating opportuni- ties for people to share and learn from each other increases the overall effectiveness of the team.
As the leader, you may be forced to intervene in team member disputes. Many individuals find it difficult to work with others they do not like per- sonally. It sometimes becomes necessary to explain that liking another person is a plus but not a neces- sity in the work setting and that personal problems have no place in the work environment. For example:
Laura had been a labor and delivery room supervi- sor in a large metropolitan hospital for 5 years before she moved to another city. Because a position similar to the one she left was not available, she became a staff nurse at a small local hospital. The hospital had just opened its new birthing center. The first day on
the job went well. The other staff members seemed cordial. As the weeks went by, however, Laura began to have problems getting other staff to help her. No one would offer to relieve her for meals or a break. She noticed that certain groups of staff members always went to lunch together but that she was never invited to join them. She attempted to speak to some of the more approachable coworkers, but she did not get much information. Disturbed by the situation, Laura went to the nurse manager.
The nurse manager listened quietly while Laura related her experiences. She then asked Laura to think about the last staff meeting. Laura realized that she had alienated the staff during the meeting because she had said repeatedly that in “her hospital”
things were done in a particular way. Laura also realized that, instead of asking for help, she was in the habit of demanding it. Laura and the nurse manager discussed the difficulties of her changing positions, moving to a new place, and trying to develop both professional and social ties. Together, they came up with several solutions to Laura’s problem.
Staff Preferences
Considering the preferences of individual team members is important but should not supersede other criteria for delegating responsibly. Allowing team members to always select what they want to do may cause the less assertive members’ needs to be unmet.
It is important to explain the rationale for deci- sions made regarding delegation so that all team members may understand the needs of the unit or organization. Box 7-4 outlines basic rights for
Professionals in the workplace are entitled to:
• Respect from other members of the interprofessional health-care team
• A work assignment that matches skills and education and does not exceed that of other members with the same education and skills set
• Wages commensurate with the job
• Autonomy in setting work priorities
• Ability to speak out for self and others
• A healthy work environment
• Accountability for his/her own behaviors
• Act in the best interest of the client
• Be human
Adapted from ANA Resolutions: Workplace Abuse (2006).
box 7-4
Basic Entitlements of Nurses in the Workplace
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professional health-care team members. Although written originally for women, the concepts are ap- plicable to all professional health-care providers.