Developing Delegation Skills
Published: 01 April 2020
Published: 01 April 2020
With the current global shortage of qualified nurses, there is often a need to delegate tasks to practitioners who may have less knowledge and experience than is ideal. So how can this be done safely and what are the benefits of delegation?
There is no doubt that with an overstretched workforce, delegation skills are needed. At its worst delegation can be used as a form of abdication, but at its best delegation can provide enormous benefits resulting from the optimum use of human resources (Wheeler 2001).
Gillen and Graffin (2010) suggest that several definitions of delegation can be found within the nursing literature, but they all share the same emphasis - that even though the work is done by a junior member of staff, the accountability and responsibility remain with the delegator who needs to be sure that the work is assigned appropriately.
As the Royal College of Nursing (2020) clearly states, nurses must be accountable for their decisions to delegate tasks and duties to other people. For the delegating nurse, this means:
Delegation should also only take place when it is in the best interests of the person receiving the care, and when a holistic assessment of need has been undertaken by the nurse who delegates. Employers also have a responsibility to ensure that the practitioners to whom nurses delegate tasks have the appropriate education, training and skills to carry out those tasks.
However, the nurse who delegates the task retains the responsibility to judge the appropriateness of the delegation by:
(Royal College of Nursing 2020)
Matching the right person with the right expertise for the right job is a complex professional skill requiring sophisticated clinical judgment and the willingness to have final accountability for patient care (Weydt 2010). Yet, done well, delegation can significantly improve patient care outcomes.
Barrow and Sharma (2019) note the need for the three key components of responsibility, authority and accountability to be in place if delegation is going to be successful. They describe the ‘five rights of delegation’ as:
Others in the wider team must also be informed of the delegation, whilst the delegator should provide ongoing evaluation so that any difficulties can be eliminated (Eveleigh 2018).
In theory, the delegation of roles and responsibilities should be a win-win situation, creating manageable workloads while also providing patients with the care they need.
For delegation to be safe and successful, the tasks allocated must be appropriate for the skill level of the delegate. In addition to having the necessary skills and experience to work safely, they must also be able to show that they have clearly understood the task. Furthermore, they must be adequately supervised and supported to ensure a high standard of care.
As Eveleigh (2018) notes, if these elements are in place the practitioner is not accountable for the decisions and actions of the person performing the delegated task. The person delegated then becomes accountable because:
Eveleigh (2018) also offers the following checklist to help practitioners decide if it is safe to delegate:
The three key elements in the act of delegation include the delegator, the delegate and finally, the situational context.
As Gillen and Graffin (2010) make clear, any of these elements, or a combination of any of them, can become a barrier to the delegation process, though most can be overcome with effective education and training. For example:
Barriers relating to delegators include:
Barriers that may arise from the perspective of the delegated practitioner include:
Barriers that may arise as a result of the situational context include:
Delegation and critical thinking skills naturally go hand-in-hand. They both require nurses to process large amounts of information and think through complex and often emergent clinical situations whilst making critical decisions about patient care, including delegation.
To gain a better understanding of this process, Bittner and Gravlin (2009) conducted a study to investigate how nurses use critical thinking to delegate care. They found that before delegating, nurses reported considering the patient’s condition, competency and experience, and the workload of the junior member of staff. They also expected the delegating nurse to report significant findings and have higher-level knowledge, including assessment and prioritising skills.
Yet, whilst all of these qualities are important, the real key to successful delegation was the relationship between the delegating nurse and the person assigned the task. In other words, successful delegation was ultimately about good communication and nursing leadership. Even so, Bittner and Gravlin (2009) reported that there were frequent instances of missed or omitted routine care that had been delegated.
Like anything else, delegation skills have to be practised to be perfected otherwise standards of care can suffer and valuable resources mismanaged. As Weydt (2010) notes, resources will surely continue to shrink and care demands will surely continue to rise, increasing the risks of inappropriate delegation.
Knowing when, how and to whom you can delegate requires a deep understanding of the task in hand, as well as confidence in the process of delegation. All of this has to be balanced with the skills, experience and existing workloads of the people available.
Achieving the right balance is crucial, because delegating too much may result in a loss of control, while failing to delegate or not delegating enough can lead to missed or inadequate care and a demotivated or uncooperative team (Wheeler 2001). Yet, when delegation is done well, everybody wins, and nothing could be more important in these times of overstretched resources.