The Role of Delegation by Registered Nurses in Patient Care: A Report

This report delves into the critical role of delegation by registered nurses (RNs) in healthcare, emphasizing its impact on patient outcomes and team performance. It defines delegation, accountability, responsibility, and authority as core components of the RN's role, highlighting the importance of effective clinical judgment and the assignment of appropriate tasks to skilled team members. The report analyzes the delegation process, discussing the RN's responsibility for patient care and the influence on team member performance. It examines potential conflicts between RNs and team members, addressing issues related to rapport, age, cultural differences, and hierarchical structures. The report underscores the need for RNs to build trust and foster collaborative relationships to ensure quality patient care. The report also stresses the importance of monitoring delegation and providing necessary education to the team members.

Running head: DELEGATION BY REGISTERED NURSES
DELEGATION BY REGISTERED NURSES
Name of the Student
Name of the University
Author Notes

1DELEGATION BY REGISTERED NURSES
Executive Summary
This report provides a description of the roles and responsibilities of registered nurses. Among
these roles, the most important and complex is the ability to carry out effective delegation. The
components of effective delegation are accountability, responsibility and authority. The
registered nurses are responsible for effective delegation of nursing tasks to appropriate and
skilled personnels with the aim to enhance favourable patient outcomes. Moreover, effective
rapport building is also essential in enhancing the quality and the performance output of the team
members. This involves providing respect, generating trust and providing status equity all
members of the team.

2DELEGATION BY REGISTERED NURSES
Table of Contents
Introduction......................................................................................................................................3
Delegation........................................................................................................................................4
Accountability..............................................................................................................................5
Responsibility..............................................................................................................................6
Authority......................................................................................................................................7
Theme: Conflict between registered nurse and team members.......................................................8
Conclusion.....................................................................................................................................10
Reference List................................................................................................................................11

3DELEGATION BY REGISTERED NURSES
Introduction
A registered nurse is defined as a graduate trained nurse, who has obtained the license
from state authorities after qualifying in the license registration process. According to the
NMBA, a registered nurse is defined as an individual who has qualified a particular education,
demonstrates the necessary skills required for practice and is registered under the “Health
Practitioner Regulation Law as a registered nurse in Australia” (Nursingmidwiferyboard.gov.au,
2018). The roles and responsibilities of a registered nurse are performing physical exams, and
maintaining health histories of patients, carry out health promotion, provide counselling as well
as education. Registered nurses are also involved in administering medications, provide
interventions, carry out analysis of patient data and showcase critical decision making skills,
carry out co-ordination of care with a large number of healthcare professionals, supervise the
care provided by, enrolled nurses, license practical nurses and other nurse aides and also carry
out research in order to contribute to evidence based care (Salmond & Echevarria, 2017, pp. 12;
Flinter, Hsu, Cromp, Ladden & Wagner, 2017, pp. 287). Registered nurses function in a wide
variety of settings like hospital, medical offices, nursing homes, ambulatory care setting,
community health clinics, schools, among others (Rondinelli, Omery, Crawford & Johnson,
2014, pp. e108).
The most complex responsibility that needs to be effectively carried out by registered
nurses is delegation (Hasson, McKenna & Keeney, 2013, pp. 229-235). The registered nurses
have the responsibility of understanding the needs of the patient and in turn delegate the
necessary activities to the care givers. These care givers then under the efficient supervision of
the registered nurse carries out the necessary activities that form a part of the care plan for the

4DELEGATION BY REGISTERED NURSES
patient. Effective delegation not only enhances the favourable clinical outcomes but also
encourages the team members under the registered nurse to carry out their duties effectively and
efficiently, thereby influencing both clinical and financial outcomes (Mueller & Vogelsmeier,
2013, pp. 20-27).
This report provides an analysis of the role of the registered nurses in delegating effective
care to patients and also assesses the role of the registered nurse in influencing the performance
of the team members.
Delegation
It is defined as the transfer of duties to another individual, while retaining the
accountability and the responsibility for any outcome whether favourable or unfavourable with
respect to the performance of the duties. Effective delegation is part of the decision making
process where the registered nurse (also referred to as the delegator) carries out proper judgment,
assesses the patient data and uses the critical thinking and analysis skills to provide efficient and
safe treatments to patients (Anf.org.au, 2018). The concept of effective delegation by registered
nurses is based on the accountability, responsibility and authority (Mueller & Vogelsmeier,
2013, pp. 20-27). Delegation forms an important part of the professional practice of registered
nurses. It involves their ability to carry out effective clinical judgment and be responsible for the
final outcome associated with the patient. Registered nurses have the role to understand the
patient needs and assign suitable members of the team for the care of the patient. The registered
nurses can assign patient care duties to enrolled nurses or ENs, license practical nurses or LPNs,
nursing assistants, nursing aides and even to other registered nurses. The registered nurses have
the responsibility to determine the patient needs and assign the skilled individual with the care of

5DELEGATION BY REGISTERED NURSES
the patient. Delegation of nursing duties can only be given to individuals who are skilled and
qualified to carry out the desired nursing task or intervention (Nursingmidwiferyboard.gov.au,
2018). Healthcare organizations usually face the problems associated with lack of effective care
provided to patients by nurses. This not only results in unfavourable patient outcomes but also
results in loss of healthcare resources apart from negatively impacting the patient and the
healthcare organization in a financial perspective. Delegation is based on the concepts of
Accountability, Responsibility and Authority (Rcn.org.uk, 2018).
According to the Nursing and Midwifery board of Australia or NMBA, delegation is a
relationship that exists between a registered nurse and other nursing professionals, such that the
registered nurse can entrust that nursing professional with the care of a patient, although
retaining the accountability of any outcomes (Nursingmidwiferyboard.gov.au, 2018). Apart from
delegating the various duties of patient care, the registered nurses are also required to monitor
whether the communications of the delegations has reached the desired individual. Moreover,
they are also involved in monitoring the care provided to the patients by the relevant
professionals so that favourable patient outcomes are obtained (Health.vic.gov.au, 2018).
Delegation also involves assessing the risks and the capabilities of the nursing professionals
before being assigned the responsibility of caring for patients. Moreover, delegation also
involves the role of the registered nurses to provide necessary education to the nursing
professional or the team members and also carrying out assessments of their competence
(Mueller & Vogelsmeier, 2013, pp. 20-27).
Accountability
Accountability of registered nurses involves their ability to review their own judgments
and decisions along with evaluating the effectiveness of such decisions so that efforts can be

6DELEGATION BY REGISTERED NURSES
made in the future to prevent any unfavourable patient outcomes with respect to decision making
(Nursingmidwiferyboard.gov.au, 2018). Accountability is also associated with a sense of
ownership for the entire care team by virtue of which the registered nurse effectively delegates
patient care responsibilities with the aim to influence the activities of the nursing professional in
appositive way. Accountability refers to the ability of the registered nurse to be responsible for
the patient outcomes, while the team members are accountable to carry out their duties
effectively as instructed by the registered nurse. With respect to any patient outcome the
registered nurse remains legally answerable not only to the patients and their families but also to
the healthcare organization. Thus, before delegating care duties, the registered nurse is required
to assess the competencies of the team members and if needed provide the respective knowledge
and skills training in order to enhance their competencies (Babiker et al., 2014, pp. 9).
According to the NMBA, accountability refers to the role of the registered nurses in
providing effective decisions and also be responsible for their actions, decisions, responsibilities
and behaviour. Thus the registered nurse remains “accountable for the decision to delegate, for
monitoring the level of performance by the other person and for evaluating the outcomes of what
has been delegated” (Nursingmidwiferyboard.gov.au, 2018).
Responsibility
Responsibility is defined as the liability of the registered nurses with respect to
performance of duties by members of the care team. Sometimes, responsibilities are shared
among members of the care team if they were equally involved in the situation (Zahedi et al.,
2013, pp. 1-8). Before delegating the activity of patient care, it is the responsibility of the
registered nurses to assess the complexity of the patient problem and in turn predict the
outcomes, which in turn would help them to delegate the appropriate skilled personnel with the

7DELEGATION BY REGISTERED NURSES
duty of patient care. Responsibility is a process which involves both the registered nurse as well
as the team member to whom the duty has been allocated (Imison, Castle-Clarke & Watson,
2016).
Registered nurses can influence the nursing practices of the team members by
encouraging and rewarding their work with the aim to increase safe nursing practices (Xu, 2017,
pp. 155-157). Poor teamwork which involves disrespectful behaviour, which is both rude and
insulting on the part of the registered nurses can have a negative impact on the workings of the
team members and can result in adoption of unsafe practices. It also gives rise to loss of trust and
reduced turnover and morale of the team members (Reyka et al., 2015). Supportive and
transformational leadership on the part of the registered nurses is essential in order to ensure that
issues associated with nursing practices or problems in the working environment are sorted in
order to foster collaborative relationships. All these in turn ensure positive outcomes for patient,
self as well as the healthcare organization in general. Encouragement by the registered nurses
constitutes a part of transformational leadership with the help of which the registered nurses aim
to increase the productivity and the quality of the work of the team members involved in care
provision (Roberts-Turner et al., 2014, pp. 236).
Authority
Authority is defined as the ability of the individual to carry out a task after they have
been given the responsibility and they have accepted the responsibility. The registered nurses
have the authority to supervise the performance of the team members to whom the tasks have
been delegated. During supervision, the registered nurses play an important role in directing,
influencing and guiding the team members with the aim to achieve high quality patient outcomes
and also improve the skills of the team members and boost their confidence (Ncsbn.org, 2018).

8DELEGATION BY REGISTERED NURSES
The registered nurses have the authority or the legitimate power to transfer a particular nursing
activity to a competent member of the team and also to analyze the performance, plan and
evaluate the nursing care and provide safe and effective judgment (Crnns.ca, 2017). The levels of
authority include data gathering, which involves instructions to team members to monitor the
vital signs of the patients and reporting it to the registered nurse. The next step is data gathering
and recommendation, which involves assessment of patient data and providing recommendations
in order to achieve best outcomes for the patient. The next level is data gathering,
recommendation and act, which involves validation of the recommended interventions before
administration. The last level involves acting and informing others in the team after carrying out
the necessary action (Armstrong, Rispel & Penn-Kekana, 2015, pp. 26243).
Theme: Conflict between registered nurse and team members
Conflicts can arise between the registered nurse and the nursing professionals in the care
team with respect to differences related to age, work ethics, roles, situation management and
personality (Ghiyasvandian, Zakerimoghadam & Peyravi, 2014, pp. 294). Conflicts can also
arise if the nursing professionals refuse undertaking of any task delegated by the registered
nurse. The willingness of the team members to respond to the registered nurse depends on the
ability of the registered nurse to build a rapport with the team members. Differences in age,
cultural background and gender acts as a barrier to developing rapport. Inability to develop a
proper rapport with the team members, which is built on trust impacts the ability of the registered
nurse to carry out effective delegation as well as supervision. For example if the enrolled nurse is
older than the registered nurse and is also from a different cultural background then development
of an effective rapport becomes challenging for the registered nurse. In such situations, it is
necessary for the registered nurse to establish a proper rapport with each and every one in the

9DELEGATION BY REGISTERED NURSES
care team by respecting their values and competencies and also providing them with the effective
support they need to enhance their skills and carry out their duties effectively (Akpabio, John,
Akpan, Akpabio & Uyanah, 2015, pp. 106).
Hierarchical structures play an important role in influencing the delegation abilities of the
registered nurse, which in turn affects the quality of care meted out to the patients (Babiker et al.,
2014, pp. 9). Some of the factors that are found to affect the performance of the healthcare team
and their willingness to respond and perform depends on the manner in which the registered
nurse delegates the care duties. These factors are respect, trust building, status equity and time.
Inconsistencies in these factors affects the communication accuracy of the registered nurses and
in turn affects the performances of the nursing professionals of the team (Taylor, Clay-Williams,
Hogden, Braithwaite & Groene, 2015, pp. 244). Respect to all members of the team with respect
to age and cultural background as well as competency has a positive effect on the willingness of
the individuals to respond as well as perform effectively. With enhanced trust and respect, the
team members also remain willing to share their opinions with respect to the care needs of the
patient. This results in sharing of information freely among the team members, thereby resulting
in effective care coordination that in turn is highly beneficial for the patient. However,
environments lacking mutual respect, trust and status equity prevents the staff to communicate
their ideas with respect to patient needs to the registered nurse. Additionally, time availability
also helps in proper communications, which in turn can result in development of strong rapport
between the registered nurse and the care team members with respect to delegation of care
(Tschannen & Lee, 2012, pp. 1-7).

10DELEGATION BY REGISTERED NURSES
Conclusion
This report provides an overview of the role played by registered nurses in carrying out
effective delegation. Registered nurses are entitled to follow the three concepts of delegation,
which are accountability, responsibility and authority. The role of the registered nurses is to
delegate care responsibilities to the care team members based on assessment of patient data,
assessment of competencies of the team members, critically analysing the risks associated with
the decision and providing effective decisions with respect to delegating appropriate tasks to
appropriate members of the team with the aim to obtain favourable patient outcomes. However,
negative attitudes, lack of respect, trust and status equity can hamper the effective delegation
process. It is therefore necessary for the registered nurse to build trust, generate respect and
implement status equity within the team with the aim to build a strong rapport that enhances
communication and timely interventions for effective patient care.

11DELEGATION BY REGISTERED NURSES
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managers and quality of patient care in South African hospitals: a paradox?. Global
health action, vol. 8, no. 1, pp. 26243, doi: 10.3402/gha.v8.26243
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