Under delegation occurs when
● The delegator fails to transfer full authority to the delegate; ● The delegator takes back responsibility for aspects of the task; or ● The delegator fails to equip and direct the delegate.
As a result, the delegate is unable to complete the task, and the delegator must resume re- sponsibility for its completion.
Sharon, RN, is a school nurse with three separate buildings under her direction. UAPs, called health clerks, operate in the school health office when Sharon is at another build- ing. Joye, a first-year health clerk, has had minimal medication administration instruction and experience. During the first week of school, Joye tries to “speed up” the medication administration process and sets out all of the noon medications in individual, unlabeled cups for the students. The cups are rearranged by students trying to find their meds and Joye cannot identify what meds belong to which students. Sharon is called back to the school to administer the correct medications, students are late to class, and Joye is frus- trated that she couldn’t handle the task.
It may be that the RN fears liability or lacks confidence or experience in delegating and decides to do all the tasks rather than delegate to an assistant (Mitty et al., 2010). Conversely, the assistant may not be prepared for the tasks or may not believe the task is within the assistant’s scope of practice. In addition, the assistant may not be able to complete all the tasks, especially if the person is assigned to several nurses.
Reverse Delegation In reverse delegation, someone with a lower rank delegates to someone with more authority.
Thomas is a nurse practitioner for the burn unit. He recently arrived on the unit to find several patients whose dressing changes have not been completed due to a code situa- tion earlier in the morning. Dawn, LPN, asks Thomas to help the staff complete dressing changes before physician rounds begin.
Overdelegation Overdelegation occurs when the delegator loses control over a situation by providing the del- egate with too much authority or too much responsibility. This places the delegator in a risky position, increasing the potential for liability. In this instance, the nurse assumes that any task that doesn’t involve nursing assessment or judgment should be assigned to assistive personnel.
Ellen, GN, is in her sixth week of orientation in the trauma ICU. Her mentor, Dolores, RN, notes that Mr. Anderson is scheduled for an MRI off the unit. Dolores delegates the task of escorting Mr. Anderson to the MRI unit to Ellen who is not ACLS certified. During the MRI, Mr. Anderson is accidentally extubated and suffers respiratory and cardiac ar- rest. A code is called in the MRI suite and ER nurses must respond since an ACLS certified nurse is not with the patient.
Not delegating appropriately negatively affects other staff on the unit as well. Here are two examples:
Sally, RN, always says she “likes to do everything herself” for her patients. She doesn’t like to ask aides for assistance. Her patients are usually happy, but Sally is ex- tremely busy all day and doesn’t ever have time to help a peer RN when asked or answer call lights to help the team. Sally’s peers get frustrated because her lack of delegating
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appropriate tasks to her nurse’s aide partner makes the aide feel not valued, Sally feels too busy in her job, and her peers feel like they get no help from Sally when needed.
Bridgett, RN, feels that she has spent her time doing aide work while she was in nurs- ing school. Now that she has taken NCLEX boards and is working as a nurse, she won’t help patients to the bathroom or empty a bedpan, or change bed linens. She will call an aide to do these tasks even if she is in the room and has time to do the tasks herself. Bridgett’s inappropriate delegation causes aides to be angry, peer RNs to be frustrated because the aides don’t have time to help them because they are always doing Bridgett’s work, and results in inconsistency in the practice between Bridgett and other nurses, which Bridget’ patients’ notice.