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Functions of Administration in Nursing

Coordination as a Function of Management in Nursing

Delegation as a Function of Management in Nursing

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Staffing Nursing Units

Total Quality Management in Health Care

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Quality assurance, obstetric auditing, records, reports, norms, policies, protocols, practice and standards for OBG unit

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World Health Reports from World Health Organization

Introduction

Delegation is getting the work done by others or as directing the performance of one or more people to accomplish organisational goals.

Definition

• "Delegation  is defined as the transfer of responsibility for the performance of a task from one person to another"

• "Transferring to a competent individual the authority to perform  a selected nursing task in a selected nursing situation . The nurse retains accountability for delegation"

5 Rights to delegation

National Council of State Board of Nursing in the US presented  5 rights to delegation from the perspectives of both nursing service administrator and staff nurse. Nursing service administrator is responsible for  job description, role delineation, development of organisational policies, procedures and standards an assurance of adequate human resources. Staff nurse is responsible for assessing client, delegating  appropriately, communicate clearly, providing monitoring and supervision.

1. Right task
2. Right circumstance
3. Right person
4. Right direction/communication
5. Right supervision/evaluation

Strategies for effective delegating

• Plan ahead
• Identify necessary skill and levels
• Select most capable person
• Communicate goal clearly
• Empower the delegate
• Set deadlines and monitor progress
• Model the role: provide guidance
• Evaluate performance
• Reward accomplishment

Common delegation errors

• Under delegating-frequently occurs from managers false assumption is that it may be interpreted as a lack of ability on his part to do the job correctly or completely. Another cause is manager’s desire to complete the whole job personally due to lack of trust in sub-ordinates.

• Over delegating- some managers over delegate burdening their subordinates. Others do so because they feel insecure in their ability to perform a task, and due to lack of organisation time. It can decrease the productivity.

• Improperly delegating- it includes delegating the things at wrong time, to the wrong person or for the wrong reason. Also delegating the yaks and responsibilities that are beyond the capability of the person to whom they are being delegated or that should be done by the manager.

Barriers to delegation

• The belief that “i can do it better myself”
• Lack of confidence and trust in workers
• Low self confidence, insecurity
• Vague job description
• Inadequate training
• Lack of adequate recruitment and selection
• Time involved in explaining the task
• Reluctance to take the risks involved in depending on others.
• Fear of loss of power

Delegation as a function of professional nursing

With  the restructuring of care delivery models registered nurse at all levels are expected to make assignments for and supervise the work of different levels of employees. Registered nurses should perform role of supervisor and delegator need preparation to assume these leadership tasks. Nursing schools and health care organisations have to prepare professionals for the delegator role. This includes basic principles of delegating to right person, at a right time and for the right reason, and an action that must be undertaken when work is delegated in an appropriate or unsafe manner.

Delegating to unlicensed assistive personnel’s (UAP)

Assuming the role of delegator and supervisor to UAP increases the scope of liability for the registered nurses. Although nurses are not directly liable for all acts of negligence on the part of those they supervise, they may be held liable if they were negligent in the supervision of those employees at the time when they committed negligent acts.

In delegating tasks to the employees the RN must be aware of job description, knowledge base and demonstrated skill of each person

Subordinate resistance to delegation

Common cause of this can be:

• Failure of the delegator to see the subordinates perspectives
• Workload assigned are highly challenging both physically and mentally
• Belief of employees that they are incapable of completing the delegated task.
• Inherent resistance to authority
• Due to over delegatio

Delegating to a transcultural work team-factors which may affect here include

• Communication
• Space
• Social organisation
• Time
• Environmental control
• Biological variations

Integrating leadership roles and management functions in delegation

Delegation provides a means for increasing productivities . It is also a managerial tool for subordinate accomplishment and enrichment. It also requires highly developed leadership skills such as sensitivity to subordinate capabilities and needs, and the ability to communicate clearly and directly , the willingness to support and encourage subordinates in carrying out delegated tasks and the vision to see how delegation might result in increased personal growth for subordinates.

Conclusion

For the effective administration of any organisation co-ordination and delegation are essential. Without these two functions it will be difficult to achieve the organisational goals . The right to delegate and the ability to provide formal reward for successful completion of delegated tasks reflect the legitimate authority inherent in the management role.

ANA Principles for Delegation

Research Inputs

Factors influencing outcomes after delegation to unlicensed assistive personnel.7

A national survey of licensed nurses in US that describes factors associated with patient outcomes when nursing activities are delegated to unlicensed assistive personnel (UAP) found that  licensed nurses' overall experience and UAP's experience in the current work setting were associated with more positive events. When the outcome of the delegated activity was determined by routine observation, more positive events occurred. However, when there was no direct supervision of the UAP, more negative events occurred. Recognition of the importance of the supervisory process has implications for educational opportunities that focus on strengthening licensed nurses' delegation competencies.

References

1. Ward MJ, Price SA .Issues in nursing administration. St.Louis: Mosby;1991.

2. Marquis B.L. ,Hutson C.J . Leadership roles and management functions in nursing– Theory and application. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.

3. Douglass L M. The effective nurse- leader and manager. 5th ed. Mosby: St. Louis; 1996.

4. Morrison M. Professional skills for leadership. Mosby: US; 1993.

5. Ellis J R, Hartley C L. Managing and Co-ordinating nursing care. 3rd ed. Lippincott: Philadelphia;1995.

6. Basvanthappa BT. Nursing administration. New Delhi: Jaypee brothers; 2000.

7. Anthony, Mary K., Theresa; Hertz, Judith .Factors Influencing Outcomes After Delegation to Unlicensed Assistive Personnel. JONA.  30(10):474-481, October 2000.