One can imagine a great list of essential qualities for a good healthcare leader. Academic researchers write big volumes of considerations about the necessary skill set. In this paper, the scope will be reduced to the topic of delegation. It by no means implies that delegation alone may solve all the issues of proper leadership. It should work in alliance with other skills, such as conflict resolution, change management, problem-solving, time management, and many others. Nevertheless, the main focus here will be on all the facets of delegation. The major thesis is that the courage to delegate coupled with precautions may be very effective for nursing staff.
Definitions of the Delegation
To begin with, there are different definitions of “delegation.” Weiss et al. (2015) provide two main varieties of definitions: “the reassigning of responsibility for the performance of a job from one person to another” or “the transferring of authority” (p. 104). In fact, a nurse’s delegated task can be given to a person with no nursing qualification. Delegations should not be confused with assignments, as delegation means giving one’s own tasks to a person who is not required to do so. At the same time, as Weiss et al. (2015) point out, “assignments relate to situations where an RN directs another individual to do something that the person is already authorized to do” (p. 104). Therefore, nurses are responsible for delegating tasks to others, so they must be fully aware of the risks and implications of this decision (Weiss et al, 2015). Such a distinction between assignment and delegation highly clarifies what the discussed concept means in healthcare discourse.
Considering the phenomenon of delegation in detail, scientists distinguish between “direct” and “indirect” delegation. Direct delegation means a verbal or written reassignment of duty by a nurse. Indirect delegation is “an approved listing of activities or tasks that have been established in policies and procedures of the health care institution or facility” (Weiss et al., 2015, p. 105). In other words, the latter means the documents distributed by healthcare facilities among medical staff.
Historical Background of Delegation
Attitudes toward delegation have changed throughout the course of history. To not make the unnecessary in-depth historical look on delegation, there is a sense to start from the 1990s. During this decade, the healthcare system in the US faced new challenges: the increased population, increased demand for shorter hospital stays, and a shortage of professional nurses (Weiss et al., 2015). To solve the problem, medical organizations started to hire nursing assistive personnel that are usually uncertified and do not have licensure (Weiss et al., 2015). At first glance, modestly paid assistive personnel eased nurses’ workload, allowing them to delegate some tasks. However, some scholars and associations indicated that some nurses might disregard the complexity of some duties and give work to people who do not have enough skills (Weiss et al., 2015). It dramatically changed the perception of delegation among non-nurse stakeholders.
The opposing side was against delegation as a phenomenon in nursing practice. The main stakeholder here was the Institute of Medicine, which in 2001 emphasized that registered nurses should provide all medical services because it ensures safety and preserves quality (Weiss et al., 2015). The problem was that keeping the great staff of nurses was economically destructive because of the shortage of nurses at the beginning of the 21st century. Therefore, the compromise was found in creating approved lists of medical activities that cannot be delegated by any means (Weiss et al., 2015). Such a measure changed the status quo and made some proponents of non-delegation to change their minds. Thus, in modern times, delegation with some restrictions is an indispensable part of contemporary staffing practices, which require a great amount of delegation from nurses.
Major Concepts of Delegation
The first set of concepts related to delegation is forming some form of the policy cycle. To secure the quality of service, nurses should conduct preliminary research and find someone from nursing assistive personnel with skills for the required task (assessment) (Weiss et al., 2015). Then nurses should prepare at least a draft of some plan to guide the assistant during the process. After the preparation for delegation, nurses give a task to assistive personnel, starting the implementation process. Lastly, after the task is completed, nurses must conduct the evaluation process. This cyclicality in the delegation process helps to avoid repeating mistakes and minimize unpredictable situations.
Other important concepts are concerned with defining criteria for choosing appropriate cases and assistive personnel. There are many ways of doing that: the qualities of efficiency, fairness, appropriateness, compatibility and others may influence the decision-making. The specialist in nursing leadership should be acquainted with all of the delegation criteria because micro-analysis of details is key for effective delegation practice.
Delegation’s Function in Nursing Practice
In order to discuss the role of delegation in everyday medical practice, it is a good strategy to discuss the relationship between different roles in healthcare. First, it is instructive to focus on the delegation function for bedside nurses. As already noted, the increased demand for healthcare shifted the discourse from delegation avoidance to delegation under necessity. The major influence this change had on bedside nurses: as Chua et al. (2019) point out, “registered nurses today have reduced involvement in bedside nursing care” (p. 7). Registered nurses started to focus on complex patient care coordinating basic care among “second-level” regulated nurses (Chua et al., 2019). From these facts, it is clear that nurses acquired more administrative duties in recent times, while patient care became more delegated to nursing assistive personnel.
Another role in healthcare that is inextricably linked with delegation is the chief nursing officer (CNO). Their role is multifaceted: CNO is responsible for managing finances, administering policies, and overall execution of connections between patients and nurses. These professionals are located in the middle between patients and nurses, so they need a balance between advocacy for patients (achieving quality in outcomes) and advocacy for nurses (accountability in the leading profession) (Ingwell-Spolan, 2018). CNO may delegate some assessment functions to outside people who will imitate the peer-reviewing process. However, because of the high responsibility of being the leader of the nursing staff, there should be some courage to delegate some duties.
Finally, the third figure in the healthcare system that can be mentioned is public health nurses. The main difference between them and hospital nurses is that they work in communities, offering services that may improve the entire population’s health, not only particular patients in a hospital. Weiss et al. (2015) admit that public health nurses have limited opportunities to delegate their workload. The reason is that they should constantly give qualitative judgment based on nursing knowledge during consultations. Their patients do not spend much time at the medical facility, so everyday routine is absent in these contact with people. Thus, it can be said that among public health nurses, the functioning of delegation is not really widespread.
Usefulness of Delegation in Personal Practice
Delegation in everyday nursing practice may be a useful tool for establishing a comfortable work schedule. It may make the work more efficient by giving some basic care to nursing assistive personnel and prioritizing tasks where professional nursing judgment is integral. In my practice, I can delegate tasks, such as assisting with hygiene, feeding meals, supervising some patients, and filling some secondary documentation. Without delegation, the workload would be so heavy that it would be impossible to perform specific nursing tasks with full concentration. Nevertheless, it is necessary to develop in this area. The most important skill in delegation is professionalism in using criteria for delegation. In nursing practice, it is important to understand what task needs to be delegated. Also, it is necessary to understand how assistants are ready to complete the necessary assignments. Since the detrimental consequences of delegation are the responsibility of nurses, it is necessary to improve assessment skills. As such, there are many academic articles and handbooks that discuss delegation criteria that are important to read and analyze.
SWOT Analysis (Influence of Delegation on Further Career Development)
|Strengths ||Weaknesses |
|Opportunities ||Threats |
Table 1. SWOT Analysis, compiled by the author
Three Essential Qualities of Nurse Leadership
The final part of the paper will be devoted to my subjective opinion about the major qualities an effective nurse leader should have. It will exclude the ability to delegate because it was extensively reviewed throughout the paper. The first quality worth mentioning is the dedication to excellence. Nurse leaders need to be an example to all medical staff, so everyday development and commitment to new knowledge will create an image for inspiration. During my practice, the academic accomplishments of college professors always inspired me to learn. The fact that your supervisor has publications in high-ranked journals and his research is valuable for the academic community was valuable for me. The same energy should come from nursing leaders in medical settings.
Another important quality is the attentive attitude towards the emotional conditions of subordinates. Emotional intelligence manifests itself in close attention to trainees, prevention of emotional exhaustion, and so on. Abraham & Scaria (2017) pay special attention to examples when leaders want to promote change in established practices. Changing the routine often causes a feeling of anxiety and uncertainty, so emotional support from the leader is the most important driver for the success of reforms.
The third important quality for nurse leaders is critical thinking. This quality is not limited only to the ability of critical thinking by the leaders themselves but also skills to find talented minds in the team. Weiss et al. (2015) indicate that “if you are a critical thinker and support other critical thinkers, you can contribute to an open-minded work environment” (p. 188). Indeed, the brainstorming sessions contribute to an exchange of ideas and subsequent critical evaluation of solutions. It may contribute to the increase in the quality of patient care among nurses. In my personal experience, critical thinking and attention to peers’ ideas were also effective during studies, especially for case studies and other practical homework.
This essay covered two specific topics concerning nurse leadership. First of all, critical attention was given to the practice of delegation. It was argued that under strict rules and clear procedures, delegation practice might increase patient care efficiency. It is achieved by giving secondary duties to nursing assistive personnel and focusing on more complex tasks requiring professional judgment. After that, three examples were laid out to explain how the delegation process differs among different kinds of nurses. Finally, SWOT analysis (Table 1) helped me to understand the influence of my delegation skills on career development.
The second part showed three qualities that are important for a nurse leader. A leader’s dedication to excellence inspires subordinates to become better in their expertise. Emotional intelligence helps to build comfortable mental conditions in a team. Critical thinking helps avoid unnecessary mistakes and determine the path toward smooth change to better practices. Nevertheless, many other qualities always play a big role in establishing effective leadership.
Abraham, J., & Scaria, J. (2017). Emotional intelligence: The context for successful nursing leadership: A literature review. Nurse Care, 2(6), 160-164.
Chua, W. L., Legido-Quigley, H., Ng, P. Y., McKenna, L., Hassan, N. B., & Liaw, S. Y. (2019). Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study. International Journal of Nursing Studies, 95, 56-64.
Ingwell-Spolan, C. (2018). Chief nursing officers’ views on meeting the needs of the professional nurse: How this can affect patient outcomes. Healthcare, 6(2), 1-10.
Weiss, S. A., Tappen, R. M., & Grimley, K. (2015). Essentials of nursing leadership & management (6th edition). FA Davis.