LEARNING KEY SKILLS IN NURSING MANAGEMENT
Ineffective Delegation Ineffective delegation results in missed or omitted routine care, such as feeding, turning, am- bulating, and toileting (Bittner & Gravlin, 2009; Gravlin & Bittner, 2010). Poor communica- tion and interpersonal relationship between nurses and unlicensed assistive personnel (UAP) has been found to result in ineffective delegation (Standing & Anthony, 2008).
The RN/UAP unit is a microsystem in health care and when that unit is dysfunctional or functioning at less than optimal performance, the quality of care suffers. One reason for prob- lems with delegation is the assignment of a single UAP to more than one RN. The UAP’s work- load may be more than one person can handle but each nurse may be unaware of the assistant’s overload.
Another reason for ineffective delegation is that nurses define delegation differently (Stand- ing & Anthony, 2008). Some nurses define delegation as explicit instructions to carry out a spe- cific task. Others think that delegation is both specific and implicit in expected tasks, such as ambulating or toileting.
Potential barriers to effective delegation include organizational factors or the delegator’s or delegate’s beliefs or inexperience.
Organizational Culture The culture within the organization may restrict delegation. Hierarchies, management styles, and norms may all preclude delegation. Rigid chains of command and autocratic leadership styles do not facilitate delegation and rarely provide good role models. The norm is to do the work oneself because others are not capable or skilled. An atmosphere of distrust prevails as well as a poor tolerance for mistakes. A norm of crisis management or poorly defined job descriptions or chains of command also impede successful delegation.
Lack of Resources Another difficulty frequently encountered is a lack of resources. For example, there may be no one to whom you can delegate. Consider the sole registered nurse in a skilled nursing facility. If practice acts define a task as one that only a registered nurse can perform, there is no one else to whom that nurse can delegate that task.