Running head: DELEGATION

A Closer Look at the Nursing Skill of Delegation

Maggie M. Fabry
California State University, Stanislaus

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A Closer Look at the Nursing Skill of Delegation

As a student nurse, the importance of mastering a large variety of skills has

played a central role in my education. These skills have ranged from simpler skills like
proper patient handling to more complicated ones such as effective patient teaching. A
skill that has been less emphasized, but that is perhaps one of the most complex is that of
delegation. The National Council of State Boards of Nursing (NCSBN) defines
delegation as, the transferring of authority (Weiss & Tappen, 2015, p.104). This
shifting of authority may involve assigning tasks to individuals who would not normally
be permitted to perform them. As the scope of nursing practice continues to expand, the
ability of nurses to effectively delegate tasks to others is becoming increasingly
important. The significance of proper delegation can be observed by utilizing a personal
case study taken from my own experience as a student nurse extern.
On a particularly busy day in the emergency department, I was assigned to
shadow Nurse Jane. Upon receiving our assignment, Nurse Jane and I came to realize
that we would be caring for four Intensive Care Unit (ICU) patients all awaiting
placement upstairs. Normally, the ratio of patients to nurse would decrease with the high
acuity of these patients, but there were not enough nurses on staff to provide this relief.
Throughout the day, as one of our patients would be taken upstairs, another patient of
equal or higher acuity would take his/her place in our assignment. About half way
through the shift, Nurse Jane asked me to help her by catching up on the documentation
for two of her ICU patients. Upon receiving this instruction, I became anxious and began
to wonder if I was capable of properly completing this task.

DELEGATION

The five rights of delegation should be used in combination with professional

judgment when delegating any and all tasks. These five rights include right task, right
circumstances, right person, right direction and communication, and right supervision and
evaluation (Weiss & Tappen, 2015). In the case of the task delegated to me by Nurse
Jane, the task itself was appropriate and is within my scope of practice as long as all
documentation is reviewed and co-signed by the registered nurse. The second right
involving correct circumstances may not have been entirely appropriate in this case when
considering the high acuity of patients I was asked to document on. One of the purposes
of health records and patient documentation is to provide evidence that safe and high
quality care was provided to patients (Beach & Oates, 2014). As a student nurse, I lack
the necessary documentation skills to accurately and thoroughly convey that the
standards of care are met. In addition, an American Nurses Associations principle
regarding delegation describes appropriate delegation as being based on the nurses
judgment of the state of the patient and the abilities of the member being assigned the
task (Weiss & Tappen, 2015). Neither the condition of the patient nor my skills would be
consistent with the delegation of this task. In regards to the right person, the primary
nurse and I were the only individuals assigned to provide nursing care for these patients,
and would be the only ones able to properly document. Although the documentation
skills of an experienced nurse would have been preferable in this situation, I was the most
appropriate alternative. The communication used to convey this direct delegation was
short and contained very little information. However, this communication was suitable
for the situation given my knowledge of the electronic patient record, and of how to
gather appropriate patient information. Unfortunately, the right of supervision and

DELEGATION

evaluation was not utilized, and Nurse Jane co-signed for my documentation without
reviewing or inquiring about what I had written. An unfortunate outcome is that I was
unable to gain any feedback about my documentation. The exact consequences of
documenting on these ICU patients, and of not having proper supervision remain
unidentified.
The prospect of delegating a task involving documentation terrifies me. For me,
the word documentation is almost synonymous with the word liability, and delegating
this task would carry too much risk. If our roles were reversed, I believe I would have
delegated a different and more fitting task to the student nurse so that I would be
available to document on the patients myself. In a case where an extern did document for
me, I would certainly make sure that I had enough time to thoroughly inspect the
documentation before putting my signature at the bottom of the screen. In addition, I
would use the right of communication to specify the exact documentation I wanted
completed and restrict it to simpler areas such as vital signs and pain assessments.
It isnt difficult to critique the delegation skills of others, having not been in a
stressful situation like this myself. Understandably, nurses become overwhelmed and
dont always have time to think about the five rights of delegation when faced with a
patient load like the one Nurse Jane had on this particular day. Like any other nursing
skill, the skill of delegation must be learned and improved upon until it becomes a natural
and integrated part of the nursing process.

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References

Beach, J. & Oates, J. (2014). Maintaining best practice in record-keeping and

documentation. Continuing Professional Development, 28(36), 45-50.
Retrieved from: http://web.a.ebscohost.com.ezproxy.lib.csustan.edu:2048/ehost
/pdfviewer/pdfviewer?vid=3&sid=9cdc1d2f-17f9-4539-a57a-e9130d53e735%4
0sessionmgr4003&hid=4104
Weiss, S. A. & Tappen, R. M. (2015). Essentials of nursing leadership and management.
Philadelphia: F.A. Davis Company.