Both the American Nurses Association and the National Council of State Boards of Nursing describe delegation as a process in which a nurse directs an individual to perform nursing duties and tasks (Barrow & Sharma, 2020). When it comes to delegation, there is a delegator and a delegate. The registered nurse is the delegator in which he or she shifts the responsibility of certain care tasks to be completed. There are five rights of delegation that can help assist nurses in distinguishing between safe decisions. They include: the right task, the right circumstance, the right person, the right supervision, and the right direction and communication (Barrow & Sharma, 2020).
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If a nurse delegates a task improperly, it can cause patient harm and also opens the nurse up to legal ramifications. It is not uncommon for nurses to delegate, especially practicing in our current times with the increased nursing shortages, patient acuity, and time constraints. Delegating inappropriate tasks to nursing assistants is a common trend. I know that during my time as a nursing assistant, I was asked many times to complete tasks that should have been completed by the nurse. This would occur because the nurse was too busy or was not fond of the patient or their family members in the room. I learned a lot during my time as a nursing assistant, of what not to do as a nurse.
I think the most frequent examples of over-delegation include med passes or single dose medications when the delegator is crunched for time or maybe under pressure dealing with some emergent issue. I would only delegate this task to someone I knew would complete it properly and correctly. I know many nurses that under-delegate. They prefer to do everything themselves no matter if they are falling behind with their assignments. I guess this can be a good attitude to have because it ensures you are completing all your tasks and know they will be done. However, if stress builds up because you repeatedly do not ask for help, it can possibly lead to a medical error or some form of adverse event.
Barrow, J., Sharma, S. Five Rights of Nursing Delegation. [Updated 2020 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519519/
Delegation can improve your strengths as a leader -out and fatigue resulting in the nurse making safe decisions regarding patient care. Resources and relationships with staff. When tasks are delegated, team members feel that their strengths are being recognized. Providing patient care involves a team effort. When the leader enforces delegation effectively, respect is displayed among all members of the team. Delegation allows you to shift responsibilities. The appropriate delegation will prevent nursing burn-out and fatigue resulting in safe decision-making. The five rights of the delegation are delegating the right task, delegating under the right circumstances, delegating to the right person, delegating the right communication, and delegating under the right supervision and evaluation (Snyder, 2018).
If frequent miscommunication or misunderstanding of how your team set priorities exist, it is a sign that you have delegated too much. One example of over-delegation in nursing would be: The RN is the unit nurse manager and is awaiting a new admission to come. The discharging nurse calls and states that the new admission will be an hour late. While waiting for the new resident to arrive, the nurse manager realizes that she had an appointment that she had forgotten about. So, before the admission arrives, the nurse manager leaves and delegates the assessments to the floor nurse who is an LPN. The RN tells the LPN that she is a strong nurse and she trusts that she could complete the new admission assessment completely. The LPN is left to complete an admission assessment and document the assessment. In this case, I would have stayed to complete the assessment. I may have asked for the LPN’s assistance, but it would have been asking her to perform duties within her scope of practice.
Under-delegating may result if the leader feels that there is a lack of trust, lack of experience, or the leader has the desire to complete the entire job. Under-delegating could reflect on your weakness and insecurity as a leader. An example of this type of delegation would be taking on tasks as the RN manager that the LPN could take on in an effort not to overwhelm the LPN. I would delegate all that could be delegated and monitor for an even and balanced workload compared to other LPN’s an attempt to prevent unnecessary fatigue of any team member.
Refusal to accept and assignment of legitimate delegation may be due to burn-out, poor communication, or laziness. An example would be: one nurse falling behind on her duties near shift end due to patient behaviors and increased need for 1:1 intervention, and she asked her co-worker assist by helping her to draw the labs that were ordered on their shift. The co-worker replies “I would, but I feel that you are much better at needle sticks than I am”. In this situation, I would have assisted the nurse and enforced good teamwork.
Snyder, K. (2018). Delegating in Nursing: Steps, Skills, and Solutions for Creating Balance at Work. Retrieved from https://www.berxi.com
Everyone has different stress triggers in their life. Money, family problems, and health issues are at the top of my list. Any major life change can be stressful including a joyful event like getting married or a job advancement. It is important to understand that stress levels will differ based on personalities and how individuals respond to situations.
Nursing is naturally a stressful job. Job stress can be defined as negative emotive and physical responses and occurs when the job requirements do not match with abilities, resources or needs of employees (Najimi & Sharifirad, 2012). For nurses, job stress includes side effects in the form of tiredness, harsh behavior, anxiety, increase of blood pressure, lack of self-confidence, lack of job satisfaction, decrease in efficiency (Golshiri, 2012). In fact, work stress has been cited as a significant health problem (Muller, 1986). Job stress combined with personal life stress has led me to call out for work on multiple occasions. I hate to leave my coworkers short staffed however if I don’t care for my own mind, body and stress system, burnout can occur quickly. I’m a firm believer that taking intermittent mental health days can prevent a more chronic burnout in nurses.
Stress management can be complicated because there are different types of stress including acute stress, episodic acute stress, and chronic stress. Each type of stress comes with its own characteristics, symptoms, duration, and treatment approaches. My stress often comes from me becoming overwhelmed with things that I need to do or address. I find that I can manage this type of stress by creating a list from most to least important things that need to be done. Some activities that I find help me de-stress include relaxing with my chihuahua, getting my nails done, and watching a television show that I enjoy. Taking steps to manage my stress is just as important as taking care of my physical health.
Golshiri, P., (2012). Job stress and its relationship with the level of secretory IgA in saliva: a comparison between nurses working in emergency wards and hospital clerks. JPMA. The Journal of the Pakistan Medical Association, 62(3 Suppl 2), S26–S30.
Muller C. (1986). Health and health care of employed adults: occupation and gender. Women & health, 11(1), 27–45. https://doi.org/10.1300/J013v11n01_03
Najimi, A., Goudarzi, A. M., & Sharifirad, G. (2012). Causes of job stress in nurses: A cross-sectional study. Iranian journal of nursing and midwifery research, 17(4), 301–305.
Response2: Effects of stress as a nurse
Stress can be a part of life, but how you handle it is what matters the most. Working in a hospital or healthcare facility can be challenging and very stressful at times. I find myself having numerous stresses that are hard to deal with in most cases. For instance, working a long shift and attending to many patients other nurses won’t see can be very stressful and demanding. Furthermore, I am working every day in very stressful conditions, especially during this COVID-19 pandemic. Stress can impact one’s blood pressure and heart rate because when you are overwhelmed with stress, the fight and flight mode kicks in. It triggers your adrenal glands that will release adrenaline and cortisol hormones, causing a rise in your blood pressure and heart rate (Mattaliano, 2010).
In times of emergencies, I rush from one place to another, trying to attend to incoming patients that need immediate attention. When I am required to lift or transfer a patient from a lying position to standing them on their feet, it becomes very tiresome and stressful (Riley & Collins, 2019). Most of the time, we get exposed to toxic and hazardous substances regularly, which may threaten us; therefore, it may give us stress because of the fear of contracting a disease. As a nurse, I am occupied with family issues and obligations which can be very much draining, especially when needed by the family and at the same time patients or colleagues require you urgently.
Exercise outside the work schedule is usually essential and has been tried and has proven to reduce stress. More so, not taking things too personal, especially when dealing with aggressive patients or stressed colleagues who sometimes retort to harsh statements. Sharing my worries and stress with my loved ones helps me reduce a lot of stress. I always receive emotional support from my families and friends. Taking short breaks, reading, listening to music, and dancing are other ways to relieve my stress.
Taking an intense breath has proven helpful because it relieves tension and provides more endorphins due to the extra oxygen taken in. Visiting a therapist or counselor has helped a lot since they can help you better handle your stress and found holistic remedies to manage it. However, what has helped manage stress is dealing with one task at a time, especially when the work seems too much and very overwhelming other than concentrating on what needs to be accomplished, making things much more unmanageable.
Mattaliano, R. (2010). Depression and Stress in the Workplace—How Can Case Managers Help? Professional Case Management, 15(6), 337-339. https://doi.org/10.1097/ncm.0b013e3182005e62
Riley, J., Collins, D., & Collins, J. (2019). Nursing students’ commitment and the mediating effect of stress. Nurse Education Today, 76, 172-177. https://doi.org/10.1016/j.nedt.2019.01.018