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More delegation training needed for new nurses who often try to ‘do it all’

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Newly qualified nurses are often failing to delegate to healthcare assistants, preferring to “do it all” themselves”, which is leading to them feeling overworked, a new study has found.

The research, which looked at different delegation styles among nurses new to the profession at three NHS hospital trusts in England, identified five approaches.

“Delegation falls into the category of essential nursing task which has for many years gone unacknowledged and unvalued”

Helen Allan

Some nurses – referred to as “justifiers” – over-explained the reasons behind decisions and could be defensive, while others – known as “buddies” – would avoid assuming responsibility for tasks, as they wanted to be everybody’s friend.

Meanwhile, nurses who adopted a “role model” approach hoped others would copy their best practice, but had no way of ensuring this would happen.

Others – referred to as “inspectors” – were acutely aware of their accountability and constantly checked the work of others.

The majority of newly qualified nurses included in the study used the “do it all” approach, which saw them complete most of the work themselves, because they lacked confidence in delegation.

“There should be greater clarity for nurses about what constitutes safe delegation and supervision, and how this can be achieved”

Research paper on styles of delegation

Those behind the study found all styles had disadvantages leading to problems such as healthcare assistants working unsupervised and making clinical decisions beyond their role, or nurses feeling overwhelmed by their own workload.

They concluded delegation was an “underdeveloped skill” and that pre-registration education “only partially prepares nursing students for the demands of supervision, delegation and accountability”.

The researchers – from Middlesex University, University of Surrey, University of Salford, and University College London Institute of Education – called for an increased focus within university courses for students to practice delegation.

This was particularly important, as there was an “increasing significance” for nurses to pass on tasks to other workers, they said.

“In addition, there should be greater clarity for nurses about what constitutes safe delegation and supervision, and how this can be achieved,” added the paper called An analysis of delegation styles among newly qualified nurses.

The research involved observations of 33 nurses working on hospital wards including emergency assessment, those for older people, trauma, surgical, high dependency, and gastroenterology.

“[Pre-registration education] only partially prepares nursing students for the demands of supervision, delegation and accountability”

Research paper on styles of delegation

It also featured interviews with 28 newly qualified nurses, 10 healthcare and 12 ward manager and matrons.

Helen Allan, professor of nursing at Middlesex University, who helped to lead the study, said: “Our research focuses on a little understood area of nursing – the delegation of key nursing tasks to untrained and unregistered care staff.

“Delegation falls into the category of essential nursing task which has for many years gone unacknowledged and unvalued,” she said.

“It is important because patients’ safety rests on effective delegation between nurses and care assistants. In fact, delegation is important across the whole healthcare team,” she added.

She noted that the Nursing and Midwifery Council’s code of conduct stated effective delegation was a key task for nurses and required registrants to be sure delegated tasks were within the scope of practice of assistants.

“Always feel confident that you know how to do what’s expected of you – and that anybody you ask to do something is competent too,” said Professor Allan.

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Readers' comments (1)

  • I was newly qualified in a very different world where student nurses did the bulk of the work on the wards overseen by a qualified 'staff nurse'. We knew what a student at each stage of her training was able to do and therefore delegation was much easier. Yes we did check because we knew we were responsible, but we knew what the student had done and learnt because we had been there. Now we are asking newly qualified registered nurses, who have had a lot less practical ward work that we had, to delegate to health care assistants tasks, many that require a fairly high degree of expertise and understanding of the human body, without having any idea of what they are capable of, or how competent they are. The healthcare assistant has probably worked on the ward for a good deal longer than the registered nurse, and may well be used to a different way of working. Oh how glad I am that I am not qualifying today!!

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