Essentials of Nursing Leadership and Management, 5th Edition

chapter 9 | Delegation of Client Care 125

staff nurse at a small local hospital. The hospital had

just opened its new birthing center. The f irst day on

the job went well. The other staff members seemed

cordial. As the weeks went by, however, Laura began

to have problems getting other staff to help her. No

one would offer to relieve her for meals or a break.

She noticed that certain groups of staff members

always went to lunch together but that she was never

invited to join them. She attempted to speak to some

of the more approachable coworkers, but she did not

get much information. Disturbed by the situation,

Laura went to the nurse manager. The nurse man-

ager listened quietly while Laura related her experi-

ences. She then asked Laura to think about the last

staff meeting. Laura realized that she had alienated

the staff during the meeting because she had said

repeatedly that in “her hospital ” things were done in

a particular way. Laura also realized that, instead of

asking for help, she was in the habit of demanding it.

Laura and the nurse manager discussed the diff icul-

ties of her changing positions, moving to a new place,

and trying to develop both professional and social

ties. Together, they came up with several solutions to

Laura’s problem.

Staff Preferences

Considering the preferences of individual team
members is important but should not supersede
other criteria for delegating responsibly. Allowing
team members to always select what they want to
do may cause the less assertive members’ needs to
be unmet.
It is important to explain the rationale for deci-
sions made regarding delegation so that all team
members may understand the needs of the unit or
organization. Box 9-4 outlines basic rights for pro-
fessional health-care team members. Although
written originally for women, the concepts are
applicable to all professional health-care providers.

Barriers to Delegation

Many nurses, particularly new ones, have difficulty
delegating. The reasons for this include experience
issues, licensure issues, and quality-of-care issues.

Experience Issues

Many nurses received their education during the
1980s, when primary care was the major delivery
system. These nurses lacked the education and skill
needed for delegation (Mahlmeister, 1999). Nurses

educated before the 1970s worked in settings with

LPNs and nursing assistants, where they routinely

delegated tasks. However, client acuity was lower

and the care less complex. Older nurses have con-

siderable delegation experience and can be a

resource for younger nurses.

The added responsibility of delegation creates

some discomfort for nurses. Many believe they are

unprepared to assume this responsibility, especially

in deciding the competency of another person. To

decrease this discomfort, nurses need to participate

in establishing guidelines for UAP within their

institution. The ANA Position Statements on

Unlicensed Assistive Personnel address this.

Table 9-1 lists the direct and indirect client care

activities that may be performed by UAP.

Licensure Issues

The current health-care environment requires

nurses to delegate. Many nurses voice concerns

about the personal risk regarding their licensure if

they delegate inappropriately. The courts have usu-

ally ruled that nurses are not liable for the negli-

gence of other individuals, provided that the nurse

delegated appropriately. Delegation is within the

scope of nursing practice. The art and skill of dele-

gation are acquired with practice.

Legal Issues and Delegation

State nurse practice acts establish the legal bound-

aries for nursing practice. Professional nursing

organizations define practice standards, and the

policies of the health-care institution create job

descriptions and establish policies that guide appro-

priate delegation decisions for the organization.

box 9-4

Basic Entitlements of Individuals in the

Workplace

Professionals in the workplace are entitled to:

• Respect from others in the work setting


• A reasonable and equitable workload


• Wages commensurate with the job


• Determine his or her own priorities


• Ask for what he or she wants


• Refuse without guilt


• Make mistakes and be accountable for them


• Give and receive information as a professional nurse


• Act in the best interest of the client


• Be human
  Adapted from Chevernet, M. (1988). STAT: Special Techniques in Assertiveness
  Training for Women in Healthcare Professions, 2nd ed. St. Louis, Mo.: Mosby.