Abstract
Delegation and coordination of patient care challenge registered nurses (RNs) practicing in capitated, managed care environments. Complicating the RN role is the fact that most RNs were not taught delegation skills while in nursing school. This study addressed the effect of a structured teaching intervention on RN delegation decision making and its enhancement of knowledge and confidence in delegation to team members. The intervention significantly increased RN delegation knowledge and overall confidence in decision making. Teaching strategies are explicated for staff development educators who are charged with providing substantive leadership approaches for staff and management nurses who have been out of nursing school and in the practice setting. The role of the RN in directing the workforce has become increasingly complex in capitated, managed care systems.
Staff development educators are in a unique position to provide pragmatic continuing education programs to RNs practicing in capitated healthcare settings. Most RNs were not taught delegation skills in nursing school and find it difficult to delegate to lesser skilled team members (Conger, 1993; Parsons, 1997; Sovie, 1990). Complicating the problem of inadequate education in nursing school is the fact that many nurses were socialized from a primary care model in the 1970s and 1980s to "do everything myself" when delivering care to patients. Delegation is a skill that can be taught, and research has proven that education sessions on delegation increase delegation knowledge and confidence in decision making for RNs in multiple patient-care settings (Conger, 1994; Parsons, 1998).
Hospitalized patients in the 1990s are more acutely ill, have shorter lengths of hospital stay, and require high technologic care (Millar, 1991). Historically, RNs provided all clinical skills needed to meet requisite patient care needs and now find themselves in the position of delegating noninvasive, basic tasks to lesser skilled workers (Blegen, Gardener, & McCloskey, 1992). Most RNs do not have confidence with delegation skills, and staff development educators must provide education sessions on delegation decision making to facilitate delivery of competent, safe patient care.
The purpose of this article is to present the findings of a structured teaching intervention for delegation decision making and its effect on RN confidence and delegation knowledge. This study adds to the literature on nurse delegation and the limited research on the concept of delegation decision making in acute medical-surgical settings.