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NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’ DELEGATION OF RESPONSIBILITIES IN FOUR TERTIARY HOSPITALS IN ENUGU STATE

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CHAPTER ONE

INTRODUCTION

Background of the study

Delegation of responsibility is one of the vital organizational processes which is inevitable along with the expansion and growth of a business enterprise (Akrani, 2010). It is a management function that can be learned and horned to a fine edge by anyone who is willing to make some effort and able to get some practice (Curtis & Nicholl 2004). In nursing profession delegation is not a new function but it is becoming increasingly important as the profession experiences rapid change. The changes centre on skill mix, structuring how care is delivered and the expanding role of nurses. Crucial to the success of this function is the ability of both the delegator and delegate to perceive their roles and assignments correctly.

 

Okoronkwo (2005) stated that effective delegation is the organizational process that permits the transfer of responsibility and authority from an executive to the subordinate. The author goes on to say that it establishes responsibility on the part of the subordinate, giving her authority to use her discretion on behalf of the superior. Responsibility is a duty or obligation to satisfactorily perform or complete a task (assigned by someone, or created by one’s own premise or circumstance) that one must fulfill and which has a consequent penalty for failure. Effective delegation of responsibilities can be defined as giving someone a task from the delegators practice (Weydt, 2010). It could also be seen as transfer of responsibility, authority, and power to somebody for the performance of an activity while retaining accountability for the outcome (Bylgia & Helga, 2012).

 

Many studies have shown that there is considerable variation in the nurses’ ability to delegate because many practicing nurses were trained at a time when delegation skills were not emphasized (Curtis & Nicholl 2004). Before the team care model, the care model practiced was primary care model where a nurse on each shift had total care responsibility for a small number of patients and there was little need to delegate to others (Powell 2011). Cipriano (2010) pointed out that delegation remains an underdeveloped skill among nurses and one that is difficult to measure. Thus delegation is a complex process in professional practice requiring sophisticated clinical judgment and final accountability for patient care. The variability and complexity of each patient situation require the nurse manager’s assessment to determine what is appropriate for subordinate to perform [National Council of State Board of Nursing (NCSBN), 2010]. In this regard, Diamond (2008) describes the legal responsibility of the nurse manager undertaking delegation by noting that it is the personal and professional responsibility of each practitioner who delegates activity to ensure that the person to carry out that activity is trained, competent, and has the necessary experience. Generally studies show that nurses’ experience has not been the best. However, there may be differences in the way the delegators and the subordinates perceive the process of delegation.

Studies on perception of delegation largely focused on the leader’s perspective rather than the subordinates’. Studies from leaders’ perspective show that delegators sometimes did not completely understand the phenomenon themselves (Abedi, Eslamiani, Salehi and Alawe, 2007); or needed support with developing confidence, understanding role boundaries, accessing knowledge and developing role boundaries (Carin, et al, 2014). An available study on the experiences of the delegates also revealed that negative experiences of delegation were largely due to lack of skill, knowledge, judgment and over-confidence (Standing, Anthony and Hertiz, 2010). When responsibilities are delegated to the appropriate subordinate, it results in productivity and could in fact be said to be synonymous with productivity (Gillen & Graffin, 2010). Therefore, effective delegation results in increased productivity and better caring outcome because several appropriately chosen team members are involved in a particular task at any given time, as such, much can be achieved. Delegation also offers the team members the opportunity to become competent thereby improving their confidence and their job performance (Bylgia & Helga 2012). It can also improve chances of promotion and further career opportunities (Baker, Sullivan & Emery, 2006). In order to achieve effective delegation, the delegator must follow the pattern and process of effective delegation which stated that delegation potentials must be based on what should be delegated, the knowledge, the skill and the experience required to perform the task rather than the traditional assignment pattern that are often based on list of job description (Weydt, 2010).

 

Some guidelines, which must also be followed in the selection of the delegates, are also reported to be neglected, such as selecting the right person (one qualified and competent to do the job) for the right type of activity to ensure that the desired nursing outcomes are achieved (ANA 2006). Selection of the individual is at times based on bias or prejudice (e.g. membership of your church, club or from your ethnic group); good atmosphere that fosters communication, teaching and learning, and organized supervision to ensure that the work is properly done is overlooked (Okoronkwo 2005). When these guidelines are not followed, the delegation is perceived in a negative way despite all the advantages. These results in nurse’s disillusionment, distrust of their managers, decreased morale, high level of stress, lower organization commitment, reduced job satisfaction, increased absenteeism and deterioration the relationship between the younger nurses and their managers. These appear to be on the increase in nursing profession (Kalisch, Landstrom & Hirshaw, 2009).

 

The dynamic exchange between the supervisor and subordinate requires constant evaluation, feedback and modification to achieve the result needed to meet patient care goals (Cipriano 2010). The need for change is urgent because healthcare is becoming increasingly complex in today’s world because of the shortage of nurses and the increase in disease burden. The delegation of care forms part of the complexity (Gillen & Graffin, 2010). Moreover the consumers of healthcare are becoming knowledgeable and aware of their rights. With the high cost of healthcare, consumers shop around to know where they will get the best care at reduced cost (Okoronkwo, 2005). However, the challenges in today’s workplace make greater demands on nurse supervisors to have the effective delegation knowledge and critical thinking skills to effectively delegate to others (ANA 2006). This compels nurse supervisors to be vigilant and action-oriented regarding changes to address nursing practice and delegation (ANA 2006).

 

Despite the advantages of effective delegation, most nurse managers do not use established pattern and process of delegation to delegate duties (Yuki 2006). It may be either due to lack of adequate knowledge of the process of delegation or it may be due to the way they perceive delegation generally. In the same way delegates may also have negative experiences of delegation based on knowledge and previous experiences. Since perception is what one thinks about something, which may be positive or negative depending on the knowledge gained in the past, nurses’ opinion about outcome of delegation of responsibility following established standard of delegation may influence their perception of nurse managers’ delegation of responsibility. It becomes necessary to study how nurses perceive their nurse managers’ delegation of responsibility.

 

 

Statement of Problem

Delegating duties with inadequate authority, without supervision, or assigning inexperienced nurses to a task without pairing with experienced nurse, have been associated with ineffective delegation (Ahmed 2009, Ingal 2010 and Weydt 2010). Kalisch, et al (2009), stated that ineffective delegation leads to missed care, poor caring outcomes, with attendant losses to the organization.

 

Anecdotal reports show that student nurses who come for clinical experiences and newly recruited staff are assigned complex tasks without necessary assistance, supervision or monitoring. Ahmed (2009) and Ingal (2010) had observed that assigning inexperienced staff to a duty without paring with an experienced staff can lead to poor caring outcome, negligence of duty, missed care and care errors.

 

The researcher has observed that patient relations perform core nursing activities for the patient while some of the tasks performed by the nurses were done haphazardly and very poorly. Does this imply that nurse managers do not assign responsibilities for such procedures to the subordinates to perform? Or that even when assigned, they are not supervised

These observations and reports call for attention. The questions being raised by this study are as follows: are nurse managers in these hospitals knowledgeable about the processes of delegation? Do they have the skills for effective delegation of responsibilities? What are the perceptions of nurses of their nurse managers’ delegation of responsibilities? This study is geared towards proffering answers to the above questions. Since many studies on delegation focuses on the delegators perspective, and the researcher is not aware of any such study done in Nigeria, the researcher wants to examine nurses’ perception of their leaders’ delegation of responsibility in the four tertiary hospitals in Enugu State.

 

Purpose of Study

The purpose of this study is to determine nurses’ perception of their nurse managers’ delegation of responsibilities in tertiary health Institution in Enugu State.

 

Objectives of the study         

 Specifically, the study objectives are set to:

 

  1. Determine nurses’ perception of their nurse managers’ adherence to stipulated guidelines/criteria in delegating responsibilities.
  2. Assess nurses’ perception of their nurse managers’ use of job description in delegating responsibilities.
  3. Assess nurses’ perception of their managers’ practice the transfer of authority when delegating responsibilities.
  4. Determine how nurse managers use accountability in the process of delegating responsibilities.
  5. Ascertain nurses’ perception of their nurse managers’ supervision of delegated responsibilities.

 

Research Questions

Based on the specific objectives formulated for this study, the following research questions were asked.

  1. What are the nurses’ perceptions of their nurse managers’ adherences to stipulated guidelines/criteria in delegating responsibilities?
  2. What are the nurses’ perceptions of their nurse managers’ use of nursing job description in delegating responsibilities?
  3. What are the nurses’ opinions of their nurse managers’ practices of transfer of authority when delegating responsibilities?
  4. What are the nurses’ perceptions about their nurse managers’ use of accountability in the process of delegating responsibilities?
  5. What are the nurses’ perceptions of their nurse managers’ supervision of delegated responsibilities.

 

Hypothesis

Ho1:  There is no significant difference in the nurses’ perception of their managers’ delegation of responsibility based on their ages.

Ho2:  There is no significant difference in the nurses’ perception of nurse manager’s delegation of responsibilities based on their rank.

Ho3:  There is no significant difference in the nurses’ perception of their nurse manager’s delegation of responsibility based on their years of experience.     Ho4:    There is no significant difference in the nurses’ perception of their nurse managers’ delegation of responsibility based on their institution.

 

 

Significance of the Study                 

 The importance of this study in nursing administration can not be overemphasized because the quality of the nurse manager determines the efficiency and overall work output of the organization. This study will give information on the nurses’ perception of their nurse managers’ delegation of responsibility on areas of adherence to stipulated guidelines/criteria in delegation, use of nursing job description, practice of transfer of authority, practice of accountability, and supervision. This will provide information on whether nurse managers’ delegation of responsibility is adequate or inadequate and therefore highlight areas where nurse managers need more information and education.                                                                                                                                               

The information provided will assist the nursing services to enhance the delegation skills of the nurse managers through seminars, workshops and update courses. With improved/effective practice of delegation, there will be proper planning and implementation of patient care and consequently improved quality of patient care and outcome of care. Moreover, effective delegation reduces the managers’ volume of work and consequently work stress thus helping them to diligently and efficiently focus on the managerial activities.

 

It also has implications for delegates; if delegation of work is properly done, it will not only improve their commitment and efficiency at work but will ensure smooth succession of human resources, serve as a forum for learning the art of delegation which will become an asset in their ability to delegate as future nurse managers.

 

Its significance for patients can never be overemphasized as effective delegation with its consequent improved caring outcome and patient safety will reduce the present high cost of health care and prolonged hospital stay of patients. For educators, this information may emphasize the need to include some managerial skills/abilities such as effective delegation in the curriculum study for student nurses.  Finally the information obtained in this study will serve as a source of literature and guide for future researchers as well as empirical references for further studies.

 

Scope of Study

This study is delimited to nurses between the ranks of nursing officers to senior nursing officers working in tertiary hospitals in Enugu State. It is delimited to nurses’ perception of their nurse managers’ delegation of responsibilities, their managers use of stipulated guideline/criteria in delegating responsibilities, use of nursing job description in delegating, practice of transfer of authority in delegating responsibility, practice of accountability in delegating process, managers supervision of delegated responsibility.

 

 

Operational Definition of Terms

Delegation of Responsibilities by the Nurse Managers

It refers to appropriately assigning nursing task to the subordinates. This involves use of stipulated guidelines/criteria, use of nursing job description, practice of transfer of authority, practice of accountability and practice of supervision.

 

Nurses’ perception of Delegation of Responsibility

It means how nurses understand and interpret delegation of responsibility of their nurse managers. For instance what or how they feel, understand and interpret the nurse managers use of stipulated guidelines/criteria, use of nursing job description, practice of transfer of authority, practice of accountability and supervision by the nurse managers in delegating responsibility.

 

 Use of stipulated guidelines/criteria in Delegating of Responsibility

This refers to nurse managers basing their delegation decision on the already made standard of delegation. This involves the consideration of the following: specific circumstances, nature of the task, patient needs and responsibilities associated with the task with the subordinates, etc.

Transfer of authority in Delegating Responsibility

This refers to the nurse managers granting the necessary power/support to the subordinate to carry out assigned task, which includes specifying the extent of authority granted, allowing subordinate access to the resources needed to accomplish the task assigned, allowing delegate freedom to use his/her discretion and creativity to accomplish the task, ensuring that each person working on a project/task gets to understand the individual roles and responsibilities involved, etc.

 

Accountability in Delegating Responsibility

It means that the nurse manager is answerable to the appropriateness of delegation decision made and outcome in terms of patients’ needs, conditions and safety. It involves selecting appropriate task to delegate to subordinate, basing the selection on the skill/experience of the delegate, communicating early to the subordinate the expectations of the task to be accomplished, etc.

 

Practice of supervision in Delegating Responsibility

It refers to the nurse manager overseeing how the subordinate is carrying out the delegated task. This involves stating and communicating the objectives clearly to the subordinates, the supervisor should be physically present to monitor work performance of the subordinates, supervision should be carried out during and after each procedure to ensure that subordinates do

the right thing at the right time, reassessing the condition of the person in care of subordinate at appropriate interval to determine if the client is stable, to observe the competence of the caregiver, to determine if the caregiver remains competent to continue the care, to evaluating whether or not to continue delegation, and/or support the person by giving the required information as the case may be, etc.

 

Use of Nursing Job Description in Delegating Responsibility

It means a guide/reference point which the nurse manager looks at while delegating nursing task to the subordinate. This includes clear, concise, detailed description of each task, consideration of subordinate education, skill, competence, etc.

 

Demographic characteristics

Demographic characteristics of the nurses to be used in this study are age, cadre (rank) and years of experience.

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