Delegation: Helping New Nurses Transition into Practice

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When I've interviewed new graduate nurses about what they find most difficult as they transition from student nurse to professional nurse, the majority admit that they struggle with safe and effective delegation. This is because the artful skill of delegation can take a couple years of experience to master. The mastery of delegation includes transferring responsibility from the nurse to support personnel, while remaining accountable for outcomes of delegated tasks. This role is very different for new grad nurses to get comfortable with, especially since opportunities to practice delegation in nursing school are slim to none.

Considering that new grad nurses are hesitant in transferring responsibility of patient care tasks, this brings on additional stress to the transitioning nurse, which often results in poor time management and overwhelming workloads.

The truth is that nursing is not a one-person job. It takes an entire team to safely and effectively care for patients. Since it is essential for nursing to remain a team effort, it is vital that the new nurse master strategies for safe and effective delegation.

How To Delegate Effectively and Safely

STEP 1: This is a test.  Ask yourself: "When should I delegate?"

When in doubt, you should consider to NEVER delegate what you can E.A.T. Remember that RNs are responsible for Evaluating, Assessing and Teaching. Once the RN has assessed the patient and considers the condition and needs of the patient, delegation can begin. Let's not forget that initial assessment (including vital signs) are to be done by the RN, and therefore should not be delegated to the nursing assistant. Once you have assessed your patients and have considered their needs, now you can begin to think about whom you may delegate to.

STEP 2: Carefully consider competence of support personnel

It is essential for the nurse to understand the skill set of each team member to match the task assignments appropriately. An easy way to accomplish this is to know your co-workers. You will want to be able to answer these questions before choosing whom to delegate to:

• Are they licensed or unlicensed?
• How long have they worked within their role?
• Have they been validated for competence in performing the task?
• Will they feel confident that they can safely and effectively perform the task?
• Do they need any additional training or instruction to complete the task independently?

Once you have asked yourself these questions, you will be able to safely move onto providing instructions for the delegated tasks.

STEP 3: Clearly communicate when delegating

For tasks to be effectively and safely delegated, you must give clear, concise and detailed instruction to the support personnel. This will include purpose, limits and expected outcomes of the task. Additionally, you must ensure that the person to assume the task can complete it within an expected time frame. You should consider that the person you are delegating to will be working with several other patients, so be mindful and set realistic and attainable goals. Finally, you should always ask if there are any questions or concerns which will promote clarification and opportunity for supportive personnel to discuss any questions or concerns related to the task.

STEP 4: Be available to supervise and give feedback

To be sure that the delegated task has been completed appropriately, you will need to offer direct supervision and feedback. You will also need to be available in case an unexpected outcome occurs. Prudent nurses never assume that the task was completed without validating it by checking that all components of the task have been accurately carried out. One way to help the transitioning nurse build strong relationships with nursing support staff, you will want to identify areas of success and offer suggestions for improvement. When your support personnel do a great job, don't forget to say "thank you"-it goes a long way!

STEP 5: Always evaluate the outcomes of delegated tasks

To ensure that the patient received the care needed and that the team worked together efficiently, RNs must evaluate that task completed is effective and that it met the needs of the patient. If an unexpected outcome occurs, it's important that RNs develop a new plan to correct the deficiencies if possible. Sometimes the RN needs to go back to the drawing board by reassessing the patient and their needs. If this is the case, don't fret - patients are complex and ever-changing, so keep your focus on patient-centered care and you'll develop the most appropriate care plan for your patient.

So as you hit the floor running, remember that learning to delegate effectively and safely takes time and diligent practice. One final tip - be sure to always follow the nursing process and find areas to improve upon your practice every single day. Before you know it, you'll be confidently, effectively, and safely delegating tasks to your nursing supportive personnel. Good luck -you got this!

If you have any tips for effective and safe delegation, please feel free to share your thoughts in the comments section below!