Delegation and direction is vital role of a registered nurse in the nursing

process which includes responsibility, accountability and authority (Sullivan &

Decker 2009,p.135). According to Nursing Council of New Zealand(2012,p.5),
delegation is defined as the transfer of responsibility for the performance of
an

activity

from

one

person

to

another

with

the

former

retaining

accountability for the outcome while direction is the active process of

guiding, monitoring and evaluating aspects of nursing care performed by
another.
To be effective in delegating and directing a task, the five principles should be
observed as cited by Mcloughlin (2013a,p.11). The first principle is the right
task. The task should be under the scope on the health worker provided that
he has the experience and skills to accomplish the task. The task should also
be routine to the client with expected outcome like delegating the health care
assistant to perform personal hygiene to the resident. Cases like patients with
complex disabilities should not be delegated by the nurse (Patrons-Jones,
2007,p.350). The right person is the second principle. It includes the specific
person qualification and job description, the role, the competency and the
accountability in accomplishing the task (Carroll, 2006,p260). For example, in
the rest home settings, an enrolled nurse can give ordinary habitual
medications provided that he passed the competency for drug administration
approved by the nursing council and the rest home policies. Administration of
drugs like epidural controlled drugs should never be delegated to the
subordinates

like

the

enrolled

nurse

(Fleming,

2015,p9.

The

right

circumstance is the third principle. It covers the task appropriate in the health
setting by utilizing the available resources Mcloughlin (2013b,p.11). A good
example is feeding the client is usually done by the health care assistant but
when a client has a nasogastric tube, the feeding cannot be assigned unless
the health care has a necessary training. The fourth principle is the right
communication

involving

giving

clear

and

accurate

instruction

and

description of the delegated task (Patrons-Jones, 2007,p.353). For example,

when the nurse instructs to monitor the blood sugar of the client to the
enrolled nurse it must include the time to be monitored, if any food taken and
reporting the result to the nurse. The last principle is the right supervision

NMIT I.D. NO: 13477859

and evaluation to ensure that the task is completed as agreed and providing
the opportunity for feedback of the task (Sullivan & Decker 2009,p.138).
A successful delegation and direction benefits the nurse, the delegate and
the organization. For nurses, there would be additional time that will be spent
on complicated cases requiring critical thinking that cannot be delegated. The
delegate who can be a health care assistant or an enrolled nurse acquires
further knowledge and skills that helps in boosting their self-esteem and
confidence leading to a trusting relationship in the organization. Furthermore,
it will also help the delegate to advance on the next level of hierarchy. The
trust and support observed in the organization makes a good teamwork in
achieving common goals and providing quality care to the clients (Sullivan &
Decker,2009,p.136). Moreover, to meet the optimum level of nursing care
the nurse should follow series of steps. The nurse should first start to assess
and plan taking into account the client case, the activity that will be done and
the ability of the delegate to performed the task before assigning to the
delegate. This is followed by giving a clear, accurate and complete instruction
to

the

delegate

ensuring

the

understanding

of

the

task

(LeFevre,

2010a,p.112). To safeguard the client and to ensure the completeness of the

activity, the nurse should provide guidance and supervision to the delegate
(Patrons-Jones, 2007,p.354). The final step is to evaluate the result of the
delegation and give feedback or teaching to the delegate to help improve the
skills (LeFevre, 2010b,p.112).

According to Oceana Healthcare policy and

procedure (personal communication, 2016), the registered nurse acts as a

leader and nursing care plan delegator making sure that the tasks are
completed. In our placement, the rest home and the hospital had a policy for
the health care assistant to complete first the competency like manual
handling and safety precaution before being qualified to perform the task.
During handover, the nurse already knows the capability of the subordinates
like the health care assistance and the enrolled nurse working together with
him and able to identify and give them the appropriate assignment.
Sullivan & Decker (2009,p.141) cited that, even though, delegation and
direction generate lots of advantages; there are still barriers to be
considered. A strict and autocratic organization, poor job descriptions, lack of
NMIT I.D. NO: 13477859

resources and lack of trust hinder in practicing delegation within the

workplace. Barriers also may arise when the delegator is inexperience, lack
of trust and confidence and afraid of criticism, liability, loss of control and
overburdening others.

Untrained delegate and over dependence to other

staffs result to refusal to perform the task.

On the other hand, errors may arise when these barriers are remained
unsolved and the process of delegation is unsuccessful which includes
unnecessary duplication. In this case, the activity should only be given to one
person to prevent disagreement among the subordinates and to have specific
person to follow up regarding the outcome of task Sullivan & Decker
(2009,p.142). Marquis&Huston (2012,p.452) also identified under delegation,
over delegation and improper delegation as common mistakes. Under
delegation can be seen when the delegator is inexperience in the job or in the
delegation process, lack of trust and failure to identify need for help. Over
delegation happens when there is poor time management and insecurity is
observe to the delegator to do the activity leading for the delegate to be
overworked, exhausted and less helpful. Delegating with insufficient data and
beyond the capability and responsibility of the delegate are examples of
improper delegating.
For all we know, practicing delegation and direction plays a very essential
part in delivering health care to the health consumers. This can be observed
in the hospital assigned to us for our placements, take for example the
registered nurse takes the responsibility to assess the accomplishment and
effectiveness on the task being delegated like monitoring the health status of
the residents, providing direction and evaluating the activity. On the other
hand, the delegate who does the activity is also accountable to his actions
and should not performed tasks that are beyond the capabilities, complex
and activities that need trainings or seminars. The hospital itself, will ensure
the standard and safety of delivering care imposing policies and by providing
seminars

and

trainings

to

the

employees

(Nursing

Zealand(2012,p.6).
References:

NMIT I.D. NO: 13477859

Council

of

New

Alfaro-LeFevre, R.,

&

Alfaro-LeFevre, R.(2013). Critical

thinking,

clinical

reasoning, and clinical judgment: A practical approach. St. Louis, MO:

Saunders/Elsevier.
Carroll, P. (2006). Nursing leadership and management: A practical guide.
New York, NY: Thomson Delmar Learning.
Fleming, C. (2015). Student nurse/midwife responsibilities with fluid and
medication management (1). Nelson.
Marquis, B. L., & Huston, C. J. (2012). Leadership roles and management
functions in nursing. Philadelphia: Wolter Kluwer Health.
McLoughlin, N. (2013). Reading, reflection and application in reality. Kai Tiaki
Nursing New Zealand, 19(10), 11-13.
Nursing Council of New Zealand.(2012). Guideline: delegation of care by a
registered nurse to a health care assistant. Retrieved from
http://www.nursingcouncil.org.nz/Publications/Standards-and-guidelines-fornurses.
Patronis-Jones, R. A.

(2007). Nursing

leadership

and

management.

Philadelphia: FA Davis Company.

Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in
nursing(7th ed.). New Jersey, NJ: Pearson Education Inc.

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