The role of the director of nursing services (DNS) in a skilled nursing facility (SNF) can be stressful due to the number of competing priorities in each day. Delegation, when done properly, can help relieve some stressors while ensuring tasks are completed. In contrast, failure to delegate can lead to a decrease in the quality of one’s own work over time. Further, without delegation, burnout can occur, which often precipitates the decision to leave the role. Therefore, delegation is a key skill that every DNS must learn and master. This blog will discuss tips regarding what the DNS should consider before delegating to others to ensure staff and resident safety, as well as strategies for overcoming a few common challenges with the delegation process.
What is delegation?
To learn the skill of delegation, the DNS must first understand its definition. According to the American Nurses Association (ANA) and the National Council of State Boards of Nursing, delegation is the process for a nurse to direct another person to perform nursing tasks and activities (Barrow and Sharma, 2023).
ANA’s Five Rights of Nursing Delegation
According to ANA, safe delegation of nursing tasks must start with the Five Rights of Delegation (Barrow and Sharma, 2023), which include:
- Right tasks – Ensure the tasks can be delegated. Facility policy or the State’s nurse practice act may not allow delegation of a task.
Before delegating, the DNS should always be sure that the task is within an employee’s scope of practice. For example, there are some tasks that can only be performed by licensed staff. When considering who to delegate wound rounds to when the wound nurse is on medical leave, the DNS cannot delegate this task to a certified nursing assistant (CNA), because CNAs cannot provide wound care or treatments. Therefore, the DNS must choose a staff member who is at least a licensed practical nurse (LPN) for this task. The unit manager is an LPN, so they are qualified to take on this task. - Right circumstances – Make sure the delegatee has appropriate resources and a favorable environment to complete the delegated task.
The DNS needs to ensure the delegatee has the resources necessary to complete the task. For example, if a resident has a complex wound treatment with several types of dressings, does the unit manager have the supplies necessary to perform the treatment?
A favorable environment is also needed to delegate a task. If the wound treatments are too complex or the unit manager has too many other tasks that they won’t have time to dedicate to wound rounds, then the DNS should consider additional delegation of the unit manager’s tasks or consider a different delegatee. - Right person – Ensure the delegatee has the right knowledge and experience to complete the delegated task.
When determining who to delegate tasks to, the DNS should consider the person’s skills and competency. The delegatee must possess the skills and competency to effectively carry out any task being asked of them. In the example, if the unit manager is being asked to cover wound rounds, she must have the skills and competency to accurately assess wounds. If she lacks that skill, it is likely that the wound assessments will look very different from that of the wound nurse. This can lead to changing wound descriptions, not because the wound actually changed but because the new assessor lacked the proper skills and competency to measure and assess the wound bed appropriately. This error could lead to more work later for the wound nurse to fix the inconsistencies and also improper care of residents.
If there is a lack of skill, the DNS has two choices. Provide education and check for competency of the appropriate knowledge before delegating or look for a new delegatee. - Right supervision – State nurse practice acts require RN supervision of delegated tasks. Ensure proper supervision before and after delegating.
The state nurse practice act requires an RN to provide supervision of delegated tasks. In the example, since the wound nurse is on leave, the DNS would need to supervise the unit manager’s work conducted during and after the wound rounds to ensure proper action and completion. - Right direction and communication – Provide clear, concise direction and communicate in a manner that the delegatee will understand.
When delegating a task, it is important to ensure that the delegatee understands what is being asked of them. This direction should include the task being asked of the delegatee, the expected outcome, and the timeframe in which the task needs to be completed.
In the example, the unit manager should be told how long she is expected to cover wound rounds, when the wound rounds are due, who gets a copy of the wound round reports, and any other nuances about how to carry out the task. When expectations are not clear, portions of the task are more likely to be missed.
Strategies to overcome common delegation challenges
To avoid burnout, stress, quality, and safety issues, let’s examine some strategies to help the DNS master the art of delegation.
Be willing to let go
To delegate, the DNS must first be willing to give up control and let others help. Although it can be stressful to let go of control, the DNS can still be involved through supervision of the task.
As an extra benefit of letting go, when a leader tasks staff with new problem-solving opportunities, it increases their use of critical thinking. Better critical thinking skills can lead to increased autonomy, which may boost staff satisfaction.
Grow the pool of delegatees
If the DNS is only comfortable delegating to a limited set of individuals in the facility, he or she should consider improving the skills of the nurses. Staff development and growth can not only increase the number of delegatees, but it can also improve quality and increase retention as well.
Check in and provide feedback
Once the DNS delegates a task, he or she should periodically check in with the delegatee to make sure they don’t have questions or concerns. It’s best not to assume the person will come to their leader with questions. Instead, the DNS should create opportunities for regular follow-ups to check on the progress. Once the task is complete, provide feedback and appreciation. Let the delegatee know how they did and thank them for helping.
Conclusion
Starting the delegation process can feel like a daunting task, but it can also provide the DNS a break from having too many competing priorities at one time and helps combat burnout. It is also a chance to allow staff to grow, learn, and become more autonomous in their role. Once the DNS gets started and ensures a safe process, effective delegation can be a benefit to all.
References
Barrow, J., and Sharm, S. (2023). Five rights of nursing delegation. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK519519/ on October 10, 2023.