COVID19,  Financial Resources,  New Grad Nurse,  Nurse,  Nursing Profession,  Self-care,  stress in nursing,  Uncategorized

The Art of Delegation in Nursing

Nurse giving instructions about a delegated taskHave you learned the art of delegation in nursing? Or are you quickly burning out and constantly staying late to chart and complete tasks because you feel it’s faster and easier if you do it all yourself? Delegation is an art and a science. You need to understand how and when to do it, but sometimes it’s essential and you need to practice before it gets that desperate.

Admittedly, most nurses are overachievers and asking for help can be perceived as a weakness or even a failure. You might also feel like you’ve not met your goals, or lived up to your ideal of perfect if you ask someone to help you with a task or two.

The truth is, if you’re plate is too full, the patients are going to suffer, you’re much more likely to make an error, and you’re going to continue to be overworked and suffering from a work-life imbalance.

Delegating is not a simple task, and it never relives you from the ultimate responsibility and accountability for the patients you’ve been assigned.  Delegating takes planning and careful thought as to the appropriateness of it.

There are 4 things you will never delegate. These can be remembered with an anagram of TAPE:

1) Teaching

2) Assessment

3) Planning

4) Evaluation ( of the POC and outcomes)

If the task you’re considering delegating involves any of these, look for something else to delegate. If you have nothing you can delegate, ask for a co-worker to help you double-team a patient or two to get you back on track. Good time management skills offer you 4 options: Do it, Delegate it, Defer or Delay it,  or Delete it (also known as Dump it.) Don’t forget to return the favor as this helps to build rapport and team work.

There are many factors in nursing today that increase the need for delegation in order to provide the best quality care for patients. The impact of the nursing shortage which comes from many issues including the COVID pandemic and the aging population of nurses in combination with an increased complexity of patient needs and fiscal constraints imposed on the hospitals creates an environment where delegation is essential. If the art of delegation is successfully performed, patient outcomes should show improvement, and nurses should have an improved work-life balance.

In order to prepare for this, you need to stop feeling like you’re the only one who can do for your patents. You need to let go of your perfectionism’s and opt for progress. And you need to acknowledge that your worthiness as a nurse is not tied to your accomplishments. Perfection can be paralyzing and it promotes procrastination. These will will adversely affect you and your patient’s quality of care and outcomes.

Five Rights of Delegation

If delegation is done improperly, the outcomes can be devastating. However, with care and mindfulness, delegation can be effective in freeing up RNs for other tasks, the ability to be more focused on care and assessments, and a time saver for all. Most of all, patient outcomes will show improvement. Delegation does have some specific rules you need to abide by in order to provide the best for your patient.  There are five rights of delegation developed by the American Nurses Association to consider. These are:

  • Right Task
  • Right Circumstance
  • Right Person
  • Right Supervision
  • Right Direction and Communication

The Right Task

Patient care and safety always come first. In delegating a task, ensure that it will be done correctly and safely. The task must fall in the scope of practice of the person being assigned the task. It should never be something that person has never done before. Delegated tasks considered safe to delegate should be regular day-to-day tasks. Anything more complex or something that isn’t done often should be left to the nurses with the training and experience.

The Right Circumstance

Delegating tasks should only be done when the patient is stable. assess the patient before delegating any tasks. If the patient is experiencing a change in condition or is prone to having fluctuations, this places the patient in unnecessary danger, and a more appropriate delegation should be chosen. Ensure the right equipment is available, the delegatee has the appropriate supervision, and For example, if the patient is complaining of pain and discomfort which requires assessment and intervention by the RN before bathing, don’t delegate his bath. It may be possible to assess and treat the pain now and delay the bath. If at a later time the patient is stable, it would be safe to delegate the bathing, but after reassessment, a bed bath might be more appropriate than a shower today. Another example might be a CNA or unlicensed person has been educated in feeding bed bound patients, but if your patient has a high risk for aspiration, this might not be the best task to delegate.

The Right Person

Make sure the person you are delegating tasks to has demonstrated the ability to handle delegated tasks in general as well as the specifics of the task. The safety and well-being of the patient is the priority. Make sure you know the job description, scope of practice, and level of competency of the person you’re delegating a task to. It would be good practice to question the delegatee about their qualifications such as  if they have performed the task before, with or without supervision, and what issues they may have encountered and what they did about it, before asking them to take on a task.

The Right Supervision

Although you have delegated the task, the patient remains your responsibility. You only delegated the task, you didn’t reassign the patient. Be clear on that with yourself and the delegatee. Be available to assist or assess the patient should the need arise. Supervise the task, ensure that the outcome is good. Provide corrections or modification as well as feedback, both good and educational. Then check that they documented the care they gave and the outcomes. Assess the patient and ensure the task was completed as directed. Document this.

The Right Directions and Communication

Clear directions and communication are essential to successful delegation. Make sure your delegatee understands exactly what needs to be done, any specific modifications that are needed, and what your expectations are. Ask if they have any questions and have them repeat the instructions in their own words. Correct as needed.  You are still responsible for this patient and the outcomes. Be sure that you get report on the task and outcomes from the delegatee as soon as they complete the task.

Team Building Exercise

The delegation process can be a huge team building exercise and have many positive results for the staff as well as for the patients. Use these opportunities effectively to create positive growth experiences. Understand that others want and need to be helpful and useful. Help others achieve professional growth and meet their personal and professional goals. Accept that others can help you achieve your personal growth and goals as well and that perfectionism is not the ultimate goal.

kathy signature




Photo from Deposit Photos