To meet the current demand for safe, affordable, and quality health care in our hospitals, health care providers must make an effort to improve health care by ensuring appropriate delegation of duties and responsibilities (Nagelkerk, 2006). Delegation in health care involves the practice of transferring responsibility for the performance of a particular task from one nurse to another while retaining responsibility and accountability for the outcome (Kelly, 2008). For instance, in the labour and delivery unit, a midwife may delegate the assistant nurse with duties to monitor the patient progress but the midwife retains the professional accountability to the overall care (Kelly, 2008).
During emergency cases in the labor room, the nurse in charge must delegate duties to ensure everything goes on smoothly. There are principles and basic steps that a registered nurse has to follow when delegating duties. RN must ensure that the nurse assistant available is competent enough to handle the particular task (Nagelkerk, 2006). Secondly, the RN must not delegate complex duties to the assistant nurse but can only assign simple duties such as patient care. In the labor ward, the nursing assistant can keep on checking the patient and keep reporting patient’s progress to the registered nurse (Nagelkerk, 2006). Thirdly, the RNs have to ensure that they are in a position to supervise the tasks they delegate while also ensure that the assistance nurse is competent and experienced to handle the assigned duty. Additionally, the RNs must ensure that during the process of delegating task, there is no violation of Nursing Practice Act that can be achieved through working together with the state nursing board (Kelly and Marthaler, 2010).
In most cases, the State Nurse Practice Act has the responsibility of determining parameters for delegating duties for nurses although most countries authorize RNs to delegate duties (American Nurses Association, 2011). The state requires that, all decisions concerning delegation of duties must be based on the fundamental principles including “protection of the health, safety, and welfare of the public” (American Nurses Association, 2011). The RNs must delegate duties to nurses who are under supervision and who are competent enough to promote quality health care (Kelly, 2008). The states acts also require that, RNs can only delegate duties based on the need and condition of the patient (Kelly and Marthaler, 2010). According to the state regulations, RNs must take full accountability for particular nursing practices and they should consider issues of quality service delivery before delegating duties.
In the labor and deliver unit the midwife is always in charge. As such, delegation of duties by a midwife is determined by numerous factors and the midwife has to clarify some issues before deciding whether it is necessary and appropriate to delegate any duty (Nagelkerk, 2006). For instance if the midwife has an emergence, it is appropriate that she should delegate duties to others. Secondly, where there are people who are experienced and competent to handle the task the midwife can delegate the duty but retain the overall responsibility. Thirdly, the midwife has to consider a task that is not complex for the assistant nurse to handle, while in a situation where the patient needs immediate care or constantly need to be observed, the midwife can assign someone this duty to ensure that the patient gets quality care. However, the midwife should be in a position to offer support and supervise the assistant nurse.
The decision to delegate duties by RNs can result in safe and effective health care, however, RNs must be very careful when making the decision to delegate duties and choosing the appropriate personnel who must be delegated a particular task (American Psychological Association, 2010). As such, RNs must determine suitable nursing practice by using nursing skills, personal judgment based on professional skills, and must consider all legal requirements when delegating a task (Kelly and Marthaler, 2010). Nagelkerk, (2006) argues that a RN must also make a decision to delegate duties putting into consideration issues such as “State Nurse Practice Act and professional standards.” To make the appropriate decision, RNs are advised to seek further guidance from their supervisors when considering delegating duties (American Nurses Association, 2011).
Today, delegation of duties have become complex and one of the challenges nurses face when delegating duties is the complexity of getting an assistance nurse with competent skills. Nagelkerk (2006) says that although delegating duties may be beneficial, RNs may not get the right person to delegate duties due to lack of enough skills in a particular area. Another challenge is that the hospital management often does not have a clear guideline and lack enough understanding of the parameters that are followed in the nursing arena, and particularly in the hospital setting (Nagelkerk, 2006).
Delegation can have both pros and cons. The advantage is that, delegating tasks gives the hospital an opportunity to benefit from skills of people who are experienced on a particular task. When skilled assistant nurses are given a task, they work hard to portray professionalism in their area of specialization bringing new perspectives in the nursing practice (Nagelkerk, 2006). For this reason, the midwife or RN is able to save time and handle other complex issues. Once a task has been delegated, the midwife is able to give more attention to other patients with complex conditions, which require special assessment. In addition to this, the delegation of duties to assistant nurses help in building trust among employees (Kelly and Marthaler, 2010). The midwife is able to trust assistance nurses, which in turn helps to develop respect in the work environment.
On the other hand, the delegation of tasks may be disadvantageous in that, the delegation of duties can result to poor service delivery (Kelly, 2008). For instance if the subordinates have other duties in their schedule or do not have the required skills, they can do substandard work. Another disadvantage is that, in case of poor communication conflicts may arise between the RN and the subordinates. Lack of effective communication can result to incomplete tasks and consequently poor quality health care, which is very risk to the patient (Kelly, 2008). Finally, the delegation of tasks can cause lack of commitment to a particular task from both the assistant and the RN (Kelly and Marthaler, 2010). For instance, a midwife who has been monitoring a patient is more passionate and committed to the progress of the patient than any other person who has delegated that duty at the last stages.
In summary, delegation is a process that can promote better health care especially if practised correctly and can also help to reduce cases where RNs are overburdened with many tasks giving them an opportunity to attend to complex duties (Kelly, 2008). To promote quality health care, delegation should be done appropriately considering all legal issues.
American Nurses Association. (2011). Joint statement on delegation. Web.
American Psychological Association. (2010). Publication manual of the American Psychological Association. (6th ed.). Washington, D.C: Author.
Kelly, P. (2008). Nursing leadership & management. (2nd ed.). Clifton Park, NY: Thomson-Delmar.
Kelly, P., & Marthaler, T. (2010). Nursing delegation, setting priorities, and making patient care assignments. Stamford: Cengage Learning.
Nagelkerk, J. (2006). Leadership and nursing care management. Houston: Elsevier.