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NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’
Ebere Omeje
NZE EDITH CHIZOBA
PG/M.Sc/107/46894
NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’DELEGATION OF RESPONSIBILITIES IN FOUR
TERTIARY HOSPITALS IN ENUGUSTATE
DEPARTMENT OF NURSING SCIENCES
FACULTY OF HEALTH SCIENCES TECHNOLOGY
Ebere Omeje Digitally Signed by: Content manager’s
DN : CN = Webmaster’s name
O= University of Nigeri
OU = Innovation Centre
1
NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’ DELEGATION OF RESPONSIBILITIES IN FOUR
TERTIARY HOSPITALS IN ENUGUSTATE
DEPARTMENT OF NURSING SCIENCES
FACULTY OF HEALTH SCIENCES AND
: Content manager’s Name
Webmaster’s name
O= University of Nigeria, Nsukka
OU = Innovation Centre
2
NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’
DELEGATION OF RESPONSIBILITIES IN FOUR
TERTIARY HOSPITALS IN ENUGUSTATE
BY
NZE EDITH CHIZOBA
PG/M.Sc/107/46894
A DISSERTATION PRESENNTED TO THE DEPARTMENT OF NURS ING SCIENCES, FACULTY OF HEALTH SCIENCES AND TECHNOLOGY, UNIVERSI TY OF NIGERIA
ENUGU CAMPUS, IN PARTIAL FULFILLMENT OF THE AWARD O F MASTER OF SCIENCE (MSc) DEGREE IN
NURSING
SUPERVISOR: DR. NWANERI, A.
DECEMBER, 2015
3
CERTIFICATION
This is to certify that this dissertation is the original work carried out by Nze Edith Chizoba with
Reg. No:PG/M.Sc/07/46894 in the Department of Nursing Sciences, University of Nigeria, Enugu
Campus, except as specified in acknowledgement and references, and what the dissertation contains
there in has not been submitted to this University or any other institution for the award of a degree.
Student Date
Supervisor Date
4
DEDICATION
Dedicated to God almighty who has made this study possible.
5
ACKNOWLEDGEMENT
I am grateful to God Almighty who has shown me his faithfulness throughout the time of this
research.
I sincerely appreciate my project supervisor, Dr. A. Nwaneri, for her efforts and friendly
cooperation throughout the period of this work. Thank you very much. I am also grateful to Dr. A.
U. Chinweuba and Mrs. P. Iheanacho for their contribution to the work.
I thank my research assistants for their co-operation and time dedicated during data collection.
Special appreciation goes to my entire family for their immense prayers and support in all my
academic activities, especially my husband Prof. U. Nze. I love you all.
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ABSTRACT
Delegation of responsibilities is the organized process that permits the transfer of responsibilities and authority form an executive to the subordinates. This study investigated nurses’ perception of their nurse managers’ delegation of responsibilities in four purposively selected tertiary health institutions in Enugu state, Nigeria: University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State University of Science and Technology (ESUT) Teaching Hospital, FederalNeuropsychiatryHospital and NationalOrthopedicHospital, all in EnuguState. Six objectives were raised to guide the study. Descriptive survey design was used for the study. A sample size of 300 nurses was drawn from the population of 943 nurses (nursing sisters and senior nursing sisters) in the four tertiary health institutions selected. Pre- tested 54 item researchers developed questionnaire was used for data collection. The Split half method using Cronbatch alpha was employed to test for reliability which yielded 0.895 and 0.959 respectively. Data collected were subjected to descriptive statistic and analyzed using SPSS version 20. T-test and ANOVA were used to test for hypothesis. Results were presented in tables, means and standard deviation. Findings revealed that mean age of the respondents was 38.44 (±6.77) year and nurses involved in this study perceived that their nurse managers adhere to stipulated guidelines/ criteria in delegating responsibilities,which had grand mean of 3.20 ± 1.21, use of nursing job description had grand mean of 3.00 ± 0.76, practice of transfer of authority had grand mean of 2.88 ± 1.03, practice of accountability had grand mean of 3.00 ± 1.32 and also practice of supervision had grand mean of 2.97 ± 0.87 Hypothesis results indicates that there is no significant difference in the nurses’ age and their nurse managers’ delegation of responsibilities, p-value (> 0.05). No significant difference was found in nurses’ perception of their nurse managers’ delegation of responsibilities based on their rank, p-value (0.391 > 0.05). Also no significant difference was found between nurses’ year of experience and their perception of their nurse managers’ delegation of responsibilities, (p-value) of the F statistics are greater than 0.05 level of significance for all the items tested. These results with P-values greater than level of significance (0.05), indicates there is no difference in age, rank and years of experience. However, there is a significance difference in nurses’ perception of their nurse managers’ delegation of responsibility based on their institution,p-value(< 0.05) Based on the findings, suggestions were made for further studies.
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TABLE OF CONTENTS
Title page i
Approval ii
Certification
iii
Dedication iv
Acknowledgement v
Abstract iv
Table of contents v
CHAPTER ONE: INTRODUCTION
Background of the Study 1
Statement of Problem 5
Purpose of Study 6
Research Questions 6
Significance of the Study 7
Scope of Study 9
Operational Definition of Terms
10
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review
12
Concept of Delegation
12
8
Delegation of Responsibility in Nursing
13
Delegation Guidelines/Criteria in Delegation of Responsibility
15
Use of Job Description in Delegating Responsibility
17
Benefit of Job Description
18
Delegation of Responsibility Going With Authority
19
Practice of Accountability in the Process of Delegation of Authority
21
Supervision of Delegated Responsibility
22
Delegation and Assignment Patterns
23
Benefits of Delegation of Responsibilities
29
Barriers of effective delegation
30
Theatrical review
34
Empirical review
32
CHAPTER THREE: RESEARCH METHODS
Research Design
48
9
Area of Study
48
Population of Study
48
Sample Size
51
Inclusion Criteria
51
Sampling Procedure
51
Instrument for Data Collection
52
Validity of Instrument
53
Reliability of the Instrument
54
Ethical Consideration
54
Procedure for Data Collection
54
Method of Data Analysis
55
CHAPTER FOUR: PRESENTATION OF RESULTS
Summary of Findings
56
CHAPTER FIVE: DISCUSSION OF FINDINGS
10
Implication for nursing
81
Limitation
82
Suggestion for further research
82
Summary
85
Conclusion
84
Recommendation
85
REFERENCES
86
APPENDICES
11
LIST OF TABLES
Table 2.1 Unit Based, Paired, and Partnered Scenario Descriptions, Outcomes, and Challenges --------- 28
Table 3.1 Target Population ------------------------------------------------------------------------
---50
Table 3.2 Representation of sample Size sub group NOHE, ESUTH, UNT and FNPH ------
---52
Table 4.1: Demography of the respondents ------------------------------------------------------------- 86
Table 4.2 Nurses’ perceptions of their nurse manager’s adherence to stipulated
guideline/criteria in delegating responsibilities -----------------------------------------------------
------------------------- 58
Table 4. 3: Nurses’ perception of their nurse managers’ use of nursing job description in
delegating responsibilities ------------------------------------------------------------------------------
--- 61
Table 4.4 : Nurses’ perception of their nurse managers’ practice of transfer of authority in
delegating responsibilities ----------------------------------------------------------------------------------------
---------------- 63
Table 5: Nurse Managers’ use of accountability in the process of delegating responsibilities -- 66
Table 6: Nurses’ perception of their nurse managers’ supervision of delegated responsibilities-68
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CHAPTER ONE
INTRODUCTION
Background of the study
Delegation of responsibility is one of the vital organizational processes which is inevitable
along with the expansion and growth of a business enterprise (Akrani, 2010). It is a
management function that can be learned and horned to a fine edge by anyone who is
willing to make some effort and able to get some practice (Curtis & Nicholl 2004). In
nursing profession delegation is not a new function but it is becoming increasingly
important as the profession experiences rapid change. The changes centre on skill mix,
structuring how care is delivered and the expanding role of nurses. Crucial to the success of
this function is the ability of both the delegator and delegate to perceive their roles and
assignments correctly.
Okoronkwo (2005) stated that effective delegation is the organizational process that
permits the transfer of responsibility and authority from an executive to the subordinate.
The author goes on to say that it establishes responsibility on the part of the subordinate,
giving her authority to use her discretion on behalf of the superior. Responsibility is a duty
or obligation to satisfactorily perform or complete a task (assigned by someone, or created
by one’s own premise or circumstance) that one must fulfill and which has a consequent
penalty for failure. Effective delegation of responsibilities can be defined as giving
someone a task from the delegators practice (Weydt, 2010). It could also be seen as transfer
of responsibility, authority, and power to somebody for the performance of an activity
while retaining accountability for the outcome (Bylgia & Helga, 2012).
Many studies have shown that there is considerable variation in the nurses’ ability to
delegate because many practicing nurses were trained at a time when delegation skills were
13
not emphasized (Curtis & Nicholl 2004). Before the team care model, the care model
practiced was primary care model where a nurse on each shift had total care responsibility
for a small number of patients and there was little need to delegate to others (Powell 2011).
Cipriano (2010) pointed out that delegation remains an underdeveloped skill among nurses
and one that is difficult to measure. Thus delegation is a complex process in professional
practice requiring sophisticated clinical judgment and final accountability for patient care.
The variability and complexity of each patient situation require the nurse manager’s
assessment to determine what is appropriate for subordinate to perform [National Council
of State Board of Nursing (NCSBN), 2010]. In this regard, Diamond (2008) describes the
legal responsibility of the nurse manager undertaking delegation by noting that it is the
personal and professional responsibility of each practitioner who delegates activity to
ensure that the person to carry out that activity is trained, competent, and has the necessary
experience. Generally studies show that nurses’ experience has not been the best. However,
there may be differences in the way the delegators and the subordinates perceive the
process of delegation.
Studies on perception of delegation largely focused on the leader’s perspective rather than
the subordinates’. Studies from leaders’ perspective show that delegators sometimes did
not completely understand the phenomenon themselves (Abedi, Eslamiani, Salehi and
Alawe, 2007); or needed support with developing confidence, understanding role
boundaries, accessing knowledge and developing role boundaries (Carin, et al, 2014). An
available study on the experiences of the delegates also revealed that negative experiences
of delegation were largelydue to lack of skill, knowledge, judgment and over-confidence
(Standing, Anthony and Hertiz, 2010). When responsibilities are delegated to the
appropriate subordinate, it results in productivity and could in fact be said to be
synonymous with productivity (Gillen & Graffin, 2010). Therefore, effective delegation
14
results in increased productivity and better caring outcome because several appropriately
chosen team members are involved in a particular task at any given time, as such, much can
be achieved. Delegation also offers the team members the opportunity to become
competent thereby improving their confidence and their job performance (Bylgia & Helga
2012). It can also improve chances of promotion and further career opportunities (Baker,
Sullivan & Emery, 2006). In order to achieve effective delegation, the delegator must
follow the pattern and process of effective delegation which stated that delegation
potentials must be based on what should be delegated, the knowledge, the skill and the
experience required to perform the task rather than the traditional assignment pattern that
are often based on list of job description (Weydt, 2010).
Some guidelines, which must also be followed in the selection of the delegates, are also
reported to be neglected, such as selecting the right person (one qualified and competent to
do the job) for the right type of activity to ensure that the desired nursing outcomes are
achieved (ANA 2006). Selection of the individual is at times based on bias or prejudice
(e.g. membership of your church, club or from your ethnic group); good atmosphere that
fosters communication, teaching and learning, and organized supervision to ensure that the
work is properly done is overlooked (Okoronkwo 2005). When these guidelines are not
followed, the delegation is perceived in a negative way despite all the advantages. These
results in nurse’s disillusionment, distrust of their managers, decreased morale, high level
of stress, lower organization commitment, reduced job satisfaction, increased absenteeism
and deterioration the relationship between the younger nurses and their managers. These
appear to be on the increase in nursing profession (Kalisch, Landstrom & Hirshaw, 2009).
15
The dynamic exchange between the supervisor and subordinate requires constant
evaluation, feedback and modification to achieve the result needed to meet patient care
goals (Cipriano 2010). The need for change is urgent because healthcare is becoming
increasingly complex in today’s world because of the shortage of nurses and the increase in
disease burden. The delegation of care forms part of the complexity (Gillen & Graffin,
2010). Moreover the consumers of healthcare are becoming knowledgeable and aware of
their rights. With the high cost of healthcare, consumers shop around to know where they
will get the best care at reduced cost (Okoronkwo, 2005). However, the challenges in
today’s workplace make greater demands on nurse supervisors to have the effective
delegation knowledge and critical thinking skills to effectively delegate to others (ANA
2006). This compels nurse supervisors to be vigilant and action-oriented regarding changes
to address nursing practice and delegation (ANA 2006).
Despite the advantages of effective delegation, most nurse managers do not use established
pattern and process of delegation to delegate duties (Yuki 2006). It may be either due to
lack of adequate knowledge of the process of delegation or it may be due to the way they
perceive delegation generally. In the same way delegates may also have negative
experiences of delegation based on knowledge and previous experiences. Since perception
is what one thinks about something, which may be positive or negative depending on the
knowledge gained in the past, nurses’ opinion about outcome of delegation of
responsibility following established standard of delegation may influence their perception
of nurse managers’ delegation of responsibility. It becomes necessary to study how nurses
perceive their nurse managers’ delegation of responsibility.
16
Statement of Problem
Delegating duties with inadequate authority, without supervision, or assigning
inexperienced nurses to a task without pairing with experienced nurse, have been
associated with ineffective delegation (Ahmed 2009, Ingal 2010 and Weydt 2010). Kalisch,
et al (2009), stated that ineffective delegation leads to missed care, poor caring outcomes,
with attendant losses to the organization.
Anecdotal reports show that student nurses who come for clinical experiences and newly
recruited staff are assigned complex tasks without necessary assistance, supervision or
monitoring. Ahmed (2009) and Ingal (2010) had observed that assigning inexperienced
staff to a duty without paring with an experienced staff can lead to poor caring outcome,
negligence of duty, missed care and care errors.
The researcher has observed that patient relations perform core nursing activities for the
patient while some of the tasks performed by the nurses were done haphazardly and very
poorly. Does this imply that nurse managers do not assign responsibilities for such
procedures to the subordinates to perform? Or that even when assigned, they are not
supervised
These observations and reports call for attention. The questions being raised by this study
are as follows: are nurse managers in these hospitals knowledgeable about the processes of
delegation? Do they have the skills for effective delegation of responsibilities? What are
the perceptions of nurses of their nurse managers’ delegation of responsibilities? This study
is geared towards proffering answers to the above questions. Since many studies on
delegation focuses on the delegators perspective, and the researcher is not aware of any
17
such study done in Nigeria, the researcher wants to examine nurses’ perception of their
leaders’ delegation of responsibility in the four tertiary hospitals in Enugu State.
Purpose of Study
The purpose of this study is to determine nurses’ perception of their nurse managers’
delegation of responsibilities in tertiary health Institution in Enugu State.
Objectives of the study
Specifically, the study objectives are set to:
1. Determine nurses’ perception of their nurse managers’ adherence to stipulated
guidelines/criteria in delegating responsibilities.
2. Assess nurses’ perception of their nurse managers’ use of job description in delegating
responsibilities.
3. Assess nurses’ perception of their managers’ practice the transfer of authority when
delegating responsibilities.
4. Determine how nurse managers use accountability in the process of delegating
responsibilities.
5. Ascertain nurses’ perception of their nurse managers’ supervision of delegated
responsibilities.
Research Questions
Based on the specific objectives formulated for this study, the following research questions
were asked.
1. What are the nurses’ perceptions of their nurse managers’ adherences to stipulated
guidelines/criteria in delegating responsibilities?
18
2. What are the nurses’ perceptions of their nurse managers’ use of nursing job
description in delegating responsibilities?
3. What are the nurses’ opinions of their nurse managers’ practices of transfer of authority
when delegating responsibilities?
4. What are the nurses’ perceptions about their nurse managers’ use of accountability in
the process of delegating responsibilities?
5. What are the nurses’ perceptions of their nurse managers’ supervision of delegated
responsibilities.
Hypothesis
Ho1: There is no significant difference in the nurses’ perception of their managers’
delegation of responsibility based on their ages.
Ho2: There is no significant difference in the nurses’ perception of nurse manager’s
delegation of responsibilities based on their rank.
Ho3: There is no significant difference in the nurses’ perception of their nurse manager’s
delegation of responsibility based on their years of experience. Ho4: There is no
significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their institution.
Significance of the Study
The importance of this study in nursing administration can not be overemphasized because
the quality of the nurse manager determines the efficiency and overall work output of the
organization. This study will give information on the nurses’ perception of their nurse
managers’ delegation of responsibility on areas of adherence to stipulated
guidelines/criteria in delegation, use of nursing job description, practice of transfer of
19
authority, practice of accountability, and supervision. This will provide information on
whether nurse managers’ delegation of responsibility is adequate or inadequate and
therefore highlight areas where nurse managers need more information and education.
The information provided will assist the nursing services to enhance the delegation skills
of the nurse managers through seminars, workshops and update courses. With
improved/effective practice of delegation, there will be proper planning and
implementation of patient care and consequently improved quality of patient care and
outcome of care. Moreover, effective delegation reduces the managers’ volume of work
and consequently work stress thus helping them to diligently and efficiently focus on the
managerial activities.
It also has implications for delegates; if delegation of work is properly done, it will not
only improve their commitment and efficiency at work but will ensure smooth succession
of human resources, serve as a forum for learning the art of delegation which will become
an asset in their ability to delegate as future nurse managers.
Its significance for patients can never be overemphasized as effective delegation with its
consequent improved caring outcome and patient safety will reduce the present high cost of
health care and prolonged hospital stay of patients. For educators, this information may
emphasize the need to include some managerial skills/abilities such as effective delegation
in the curriculum study for student nurses.Finally the information obtained in this study
will serve as a source of literature and guide for future researchers as well as empirical
references for further studies.
20
Scope of Study
This study is delimited to nurses between the ranks of nursing officers to senior nursing
officers working in tertiary hospitals in Enugu State. It is delimited to nurses’ perception of
their nurse managers’ delegation of responsibilities, their managers use of stipulated
guideline/criteria in delegating responsibilities, use of nursing job description in delegating,
practice of transfer of authority in delegating responsibility, practice of accountability in
delegating process, managers supervision of delegated responsibility.
Operational Definition of Terms
Delegation of Responsibilities by the Nurse Managers
It refers to appropriately assigning nursing task to the subordinates. This involves use of
stipulated guidelines/criteria, use of nursing job description, practice of transfer of
authority, practice of accountability and practice of supervision.
Nurses’ perception of Delegation of Responsibility
It means how nurses understand and interpret delegation of responsibility of their nurse
managers. For instance what or how they feel, understand and interpret the nurse managers
use of stipulated guidelines/criteria, use of nursing job description, practice of transfer of
authority, practice of accountability and supervision by the nurse managers in delegating
responsibility.
Use of stipulated guidelines/criteria in Delegating of Responsibility
This refers to nurse managers basing their delegation decision on the already made
standard of delegation. This involves the consideration of the following: specific
circumstances, nature of the task, patient needs and responsibilities associated with the task
with the subordinates, etc.
21
Transfer of authority in Delegating Responsibility
This refers to the nurse managers granting the necessary power/support to the subordinate
to carry out assigned task, which includes specifying the extent of authority granted,
allowing subordinate access to the resources needed to accomplish the task assigned,
allowing delegate freedom to use his/her discretion and creativity to accomplish the task,
ensuring that each person working on a project/task gets to understand the individual roles
and responsibilities involved, etc.
Accountability in Delegating Responsibility
It means that the nurse manager is answerable to the appropriateness of delegation decision
made and outcome in terms of patients’ needs, conditions and safety. It involves selecting
appropriate task to delegate to subordinate, basing the selection on the skill/experience of
the delegate, communicating early to the subordinate the expectations of the task to be
accomplished, etc.
Practice of supervision in Delegating Responsibility
It refers to the nurse manager overseeing how the subordinate is carrying out the delegated
task. This involves stating and communicating the objectives clearly to the subordinates,
the supervisor should be physically present to monitor work performance of the
subordinates, supervision should be carried out during and after each procedure to ensure
that subordinates do
the right thing at the right time, reassessing the condition of the person in care of
subordinate at appropriate interval to determine if the client is stable, to observe the
competence of the caregiver, to determine if the caregiver remains competent to continue
22
the care, to evaluating whether or not to continue delegation, and/or support the person by
giving the required information as the case may be, etc.
Use of Nursing Job Description in Delegating Responsibility
It means a guide/reference point which the nurse manager looks at while delegating nursing
task to the subordinate. This includes clear, concise, detailed description of each task,
consideration of subordinate education, skill, competence, etc.
Demographic characteristics
Demographic characteristics of the nurses to be used in this study are age, cadre (rank) and
years of experience.
23
CHAPTER TWO
LITERATURE REVIEW
This chapter discuses related literature materials reviewed from text books and journals,
unpublished and published articles from libraries internet materials. The review will be
organized thus: Conceptual, Theoretical and Empirical Review.
Concept of Delegation
Delegation has been defined as subdivision and sub-allocation of power to subordinate in
order to achieve effective result (Agrawal, 2011). Yukl (2006) asserted that delegation is a
tool of organizational effectiveness that involves the assigning of important tasks to
subordinates and giving them authority related to decision making. It could also be seen as
the ability to get results through others (Acharya, 2013). Again Allen (2010) saw it as the
dynamics of management and a process managers follow in dividing the work assigned to
him so that he performs that part which only he can perform because of his unique
organizational placement. It can be seen from the above definitions that author differ in
their conception of delegation and these differences are mainly in the area emphasized by
the authors. However, in delegation, an attempt is being made to have a meaningful
participation and cooperation from subordinates for achieving certain well defined results
(Gauraw, 2010).
When responsibility is delegated, all it means is that someone has been granted permission
to carry out task, the superior must ensure that the subordinate has sufficient authority to do
the task and he has been told how the authority is to be used. These make delegation a
broad concept that encapsulates freedom of choice, discretion over the task and feeling of
independence. On the other hand, delegation is not absolute because the person who
delegated the task remains accountable for the outcome of the delegated task. Therefore
24
without delegation, formal organization cannot exist, that is no organized accomplishment
of organizational goals could take place. Delegation involves the following processes:
assignment of duties to subordinate, transfer of authority to perform the duty, acceptance of
the assignment, creation of obligation, accountability and responsibility. Through effective
delegation the managers use their staff resources to the best advantage because in
delegation, additional responsibilities of decision-making power and control over critical
management functions build both competence and confidence in subordinates. These
increased competence and confidence improve employee morale, develop team spirit, lead
to motivation of subordinates, maintain cordial relationship, etc. Effective delegation is an
important ingredient in the development process. Developing management resources to
best advantage is central to delegation.
Delegation of Responsibility in Nursing
According to Sullivan and Decker (1997) in Okoronkwo (2005), delegation of
responsibility involves defining the task, determining who can perform the task, describing
the expectation, seeking agreement, monitoring performance and providing feedback to the
delegate regarding performance. It requires critical clinical judgment and accountability for
patient care. Effective delegation of responsibility is based on one’s State Nurse Practice
Act (SNPA) and an understanding of the concepts of responsibility, authority and
accountability (NSCBN, 2005). The ANA code of Ethics (2001) notes that delegation is
based on the nurse managers’ judgment concerning a patient’s condition, the competence
of all members of nursing team, and the degree of supervision required. This statement
coincides with the five rights of delegation developed by the NCSBN (2005). These rights
of delegation include: (a) the right task, (b) the right circumstance, (c) the right person, (d)
the right direction/communication and (e) the right supervision.
25
Koloroutis (2004), stated that delegation requires nurse managers to make decisions based
on patient needs, complexity of the work, competency of the individual accepting the
delegation, and the time that the work is done. Delegation requires that timely information
regarding the individual patient be shared. It defines specific expectations, clarifies any
adaptation of the work in the context of the individual patient situation, and provides
needed guidance and support by the nurse manager. Ultimate accountability for process
and outcomes of care, even though he or she has delegated responsibilities, is retained by
the nurse manager. Nurse Managers make assignments and the care provider accepts
responsibility, authority, and accountability for the work assigned. However, if the nurse
manager delegates responsibility based on the list of tasks found in job description, such as
vital signs, bathing, ambulation of patients and so on without using professional judgment
(critical thinking skill) to match the staff member’s skill and expertise to patient needs, it
means the nurse manager is assigning tasks rather than delegating responsibility. Matching
the staff member’s expertise to patients needs, it is essential for sound delegation decision
(Weydt 2010).
Delegation of responsibility requires healthy interpersonal relationship between the nurse
manager and the subordinate (Nelson 1994 in Cutis & Nichol 2004). Each member of the
healthcare team has a valuable contribution to make to patient care [Creative Health Care
management, (CHCM) 2006]. This contribution is magnified when the nurse manager has a
healthy interpersonal relationship with the team providing care. Delegation of
responsibility is the invitation for participation. The manager in which a team member is
asked to perform care by the delegating nurse manager influences the team member’s
willingness to respond.
26
Koloroutis (2004), noted that communication style influences team work and
relationships. He goes on to say that engaging in direct, open and honest communication
is a characteristic of good team work. Thus the ability to delegate responsibility and quality
of the delegation is influenced by healthy interpersonal relationships, the manner in which
the activity is delegated, and the openness of the communication. Healthy interpersonal
relationships among all personnel on the shift promote a synergy between team members,
enabling them to work together more effectively.
Trust is an important element in delegating responsibility. Kolorontis (2004), has noted that
effective delegation is based on both trust and on understanding of professional practice.
Trust, a critical factor in relationships, is based on knowledge of one another’s capabilities
and confidence in these abilities. Care giver consistency, which builds trust, is achieved by
staffing schedules and methods of patient assignment which directly impact on how work
is delegated. The staffing schedule and patient assignment methods that promote
consistency among caregivers and between care givers and their patients become the
foundation for enhancing the quality of work relationships (Koloroutis, 2004, CHCM
2006).
Delegation Guideline/ criteria in delegation of responsibility
In the process of delegation, deciding to delegate is only the beginning of the delegation.
Effective delegation of responsibility requires significant investment in terms of thought,
planning and commitment. The process can appear complex initially but a consistent
approach to delegation using the guideline will bring success. The following stages of
delegation were stated by [Curtis and Nicholl (2004), Gillen and Graffin (2010), Akrani
(2010)]
27
Stage 1: deciding what to delegate- The delegators must decide what tasks should be
delegated based on the nature of the task in the specific circumstance. This enables
managers who are overloaded with other responsibilities to manage time better.
Stage 2: Selecting delegates- Delegators must identify what skills are needed for particular
tasks and decide whether delegates are the best people to carry them out. It is necessary to
match the skills required for the tasks with delegates skills. It is also important that
delegators take into account the experience and competence of the delegates and decide
whether they need extra training before undertaking the task. Selecting the right people can
enhance the professional development of delegates.
Stage 3: assigning tasks- Delegators should describe the particular task in detail and offer
an explanation as to why delegates were selected. They must also discuss the
responsibilities associated with the task and outline clearly the level of responsibilities
associated with it. It is important at this stage to check that carrying out the delegated tasks
and the responsibilities are within the skill and experience of the delegates. The activities
involved in this stage are important because they promote trust between delegators and
delegates.
Stage 4: assessing and discussing- Delegators need to include delegates actively in the
delegation process so that delegates are given an opportunity to assess the tasks and
determine whether they are happy to undertake them. This may include further discussion
of the skills required and the delegates may like some time to consider whether the task
have well defined goals, whether they are competent to undertake them and whether further
training and education are required. Delegates may also want to establish how the tasks or
projects affect overall workload and what new responsibilities and levels of authority
associated with them. If the activities at this stage are followed through, duplication of
effect and the possibility of team members working at cross purposes can be reduced.
28
Stage 5: executing the task- Delegates should keep delegators informed of how the tasks
progress and it is important that delegators inform other team members of the level of
authoritythat has been assigned to delegates while they undertake the tasks. Delegators
must also decide on the supervision and feedback that is necessary during the process.
Stage 6: completion of the task- It is essential that delegators share with the rest of the
team the success or shortcomings of the completed task or projects. Celebrating success
can increase the delegates’ commitment and self esteem.
Use of Job Description in Delegating Responsibility
Mader-clark (2014) defined job description as a clear, concise depiction of a job’s duties
and requirements. It can also be defined as a clear concise statement of duties,
responsibilities, authorities, relationships and environment built into a job. To manage
effectively, managers must be able to identify the work that needs to be done, then delegate
it to others and control its progress and accomplishment. Job description can take many
forms but they typically have at least four parts: job summary, list of job function,
requirement section and section of other important information.
Job summary: It is an overview or a brief description of the most important functions and
responsibilities of a job, usually identifying the immediate subordinate and superior officer
(Business Dictionary, 2014).
A list of job functions: This gives a more detailed description of duties. Monster (2014),
identified the following registered nurses job functions such as promoting and restoring
patient health by completing the nursing process, collaborating with physicians and
multidisciplinary team members, providing the psychological support to patients, friends
and families, supervising assigned team members to identify patient care requirement by
establishing personal rapport with potential and actual patients needs. Patient independence
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is also promoted by establishing patient care goals, helping patients, friends and family to
understand conditions, medications and self care skills. The list also assures quality of care
by adhering to therapeutic standard, measuring health outcomes against patient care goals
and standards and making or recommending necessary adjustments following hospital and
nursing philosophy. The registered nurse is also expected to maintain a safe and clean
environment by complying with the procedures, rules and regulations, calling for assistance
from health care support personnel.
A requirements section: A list of the education, certification, licenses and experience to
go with the job.
A section for other important information: It is about position such as location, working
hours, travel requirements and reporting relationship.
Benefit of Job Description
The following benefits were stated by Mader-Clark (2014): It provides the manager and
subordinates with a blue print for success. It is a basic tool the organization uses to bring
measure and manages the performance of each employee and of the team as a whole. It
helps the manager in every role he/she plays in hiring, management and compensation.
Properly drawn job description can help in recruitment, selection and hiring of new
workers, supervision, of personnel because they spell out the exact qualification,
education, skills and experience candidates need in order to be successful on the job. Job
description helps direct the question interviewers will ask job applicants by focusing only
on relevant facts. It helps a growing organization plan future manpower needs by
comparing current requirements with those jobs and skills expected to be important in
future. Training and development are also administered with the help of job descriptions.
Qualification of current job holders can be compared to the ideal standard describe and
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appropriate training given to fill the gaps. It can be instrumental in planning or changing
workflow patterns. Workflow design shows what should be done, step between input and
output. Job description can be used to help construct flow diagrams which in turn, may
uncover tasks needed to be done that have been overlooked in describing certain jobs.
For effective delegation the nurse manager should be able to indentify the job that is to be
done and ascertain that, that job is within the delegate’s job description. It is through well
defined job description that the nurse manager will be able to monitor and control the
progress and accomplishment of the assigned duty (Mader-Clarky2014).
Delegation of Responsibility Going with Authority
Delegation of responsibility is an obligation of individual to perform assigned duties to the
best of his ability under the direction of the executive leader (Kaylan 2010). Furthermore,
delegation of responsibility is the obligation of a subordinate to perform the duty as
required by his superior. In the process of delegation, the manager transfers some of his
duties, responsibilities to his subordinate and also gives necessary authority for performing
the responsibilities assigned. At the same time the superior retains the accountability for the
performance of his subordinate (Akrani, 2010). Shrikrishna (2014), started that balancing
responsibilities, authority and accountability to ensure organization success is essential in
any organization. It becomes necessary to clearly define the authority, responsibility and
accountability of all the people involved to ensure success. However, many people get
confused with the terms. While authority is the formal or legitimate power to take action,
responsibility is the obligation to accomplish the goals related to the position.
Accountability on the other hand is the commitments to honesty and to accept the
consequences of decision made.
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A good match is maintaining a fine balance between them. Quite often people are made
responsible for the outcome but not given sufficient authority to take decision
independently in order to achieve the outcome. A lack of balance between authority,
responsibility and accountability leads to failure (Kalyan 2010). Kalyan goes on to state the
following simple measures: successful organization ensure that people are given enough
authority to achieve the tasks for which they are responsible and accountable. The
managers see that each person working on a project gets to understand the individual roles
and responsibilities. The scope of their authority and accountability is clearly defined.
Executives are imparted training to enhance their skill in expressing expectations clearly.
Also develop accurate methods to measure results. The basic idea is to make sure that the
subordinate knows what is expected of them (responsibilities) and how the results are
measured (accountability). They are in the better position to check if the authority given to
them is enough to produce the desired result, if not they can negotiate for more authority
with their higher ups to enable them succeed in achieving given goals. No blame rule-
successful organizations also see that a blaming culture does not exist in the workplace.
This is because when a blaming culture exists it is only natural that people avoid taking
responsibility and all efforts to match authority and responsibility go waste. Therefore
these organizations first try to remove fear of failure and rebuke from the minds of the
people by allowing them the necessary space to learn, experiment and grow. When fear is
replaced with words of encouragement, people act independently and quite successful.
Freedom to use their discretion and creativity, works as an effective motivator and brings
out the best from the subordinate (Kalyan 2010).
Good organizations, while assigning responsibility to their employees also coach them on
proper professional behavior .This implies that people should discharge their
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responsibilities independently without wasting time waiting for green signed from superior
at every juncture. Consequently, employees are discouraged from dumping problems
upwards and are asked to come up with their own solutions. They are made to understand
that they should always focus on results and to achieve those results, they must take action
in time. Also if the employees are in the habit of complaining about various issues, they are
taught to work constructively to bring the issues to a closure. A good work culture and a
perfect match between authority, responsibility and accountability are absolutely
essentially for people to be willing to take on new responsibilities, demonstrate ownership
and exceed the expectations. Delegation requires a clear description of the task, the
responsibilities and authority associated with it, time limits and expected outcomes or
goals. Keep in mind the task delegated must be in alignment with their scope of practice
and competence level (Shrikrishna, 2014).
Practice of Accountability in the Process of Delegation of Authority
Accountability involves a retrospective review which includes critical thinking to
determine if the action was appropriate and giving an answer for what has occurred (Weydt
2010). Health service providers are accountable to both the criminal and civil courts to
ensure that their activities conform to legal requirement. Registered practitioners are also
accountable to regulatory bodies in terms of standard of practice and patient care (Royal
College of Nursing (RCN) 2006). Nurses hold the position of trust and responsibility
within the community. As registered health practitioner, nurses are answerable to their
decisions and actions. They are professionally accountable to the Nursing council and
accountable under legislation for their actions. They must also answer to their employer
and to health consumer and must be able to justice their decision. Therefore registered
nurses use their professional knowledge, judgment and skills to make decisions in
partnership with health consumer based on their best interest. Furthermore the supervisor,
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delegator must have a view of the big picture in the care of the assigned patients. Select the
appropriate activities to delegate, select the appropriate staff to carry out the activities
(Early communicate the expectations) and required follow up while the task is being
completed. Evaluate and provide feedback on the effectiveness of the delegation to staff
(Supriya, 2011).
Supervision of Delegated Responsibility
Supervision may be defined as provision of guidance by a qualified Nurse for the
accomplishment of a nursing task with periodic observation and evaluation of the
performance of the task including validation that the nursing task has been performed
according to established standards of practice (Kentucky Board of Nursing [K BN] 2012).
Okoronkwo (2005) defined supervision as the act of overseeing, observing and assessing
performance of workers in their activities to ensure adequacy of standard and achievement
of objectives already stated. She goes on to say that it is a process of helping the
subordinate to improve on her knowledge and skill through objective monitoring of her
work performance to ensure that one delivers the best possible care to the client. ANA and
NSCBN stated that the supervisor shall provide supervision of a delegated nursing task.
The degree of supervision required shall be determined by the delegator after an evaluation
of appropriate factors involved. The factors include the following: the stability and acuity
of the clients condition, the training and competency of the delegate, the proximity and
availability of the delegator to the delegate when the task is performed, the setting where
care occurs, the availability of resources and support infrastructure(ANA and NSCBN
2006).
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However, the supervisor is responsible for timely intervention and follow-up on problems
and concerns. Examples of the need for intervening include: 1, alertness to subtle signs and
symptoms which allow supervisor and subordinate to be proactive, before the clients
condition deteriorates significantly and 2, awareness of subordinates difficulties in
completing delegated activities. Gillen and Graffin (2010), opined that it is the
responsibility of the supervisor to: reassess the condition of the person in the care of the
subordinate at appropriate intervals and determines that the condition is stable and
predictable, observe the competence of the caregivers and determine that they remain
competent to perform the delegated task of care safely and effectively, and evaluate
whether or not to continue delegation of the task.
Delegation and Assignment Patterns
In the delegation assignment pattern, the correlation between consistency of care givers and
delegation potential (the amount of nursing care that can legally and safely be assigned to
staff member) is explored in the Work Complexity Assessment (WCA) Program. WCA is a
consultant-led process, developed by Tom Ingalls and licensed through Creative Health
Care Management (2007); it helps define and quantify various levels of care complexity
based on the knowledge and skill required to perform the work. The delegation potential is
based on what could be delegated rather than on traditional delegation practices that are
often task based. WCA uses the three scenarios (three different ways of assigning
personnel) to determine the delegation potential and examine the impact of staffing
schedules and methods of patient assignment on delegation. The three scenarios, namely
unit based, pairing, and partnering, vary in the amount of time in which nurses and other
personnel work the same shifts and care for the same patients (Koloroutis, 2004). Each
scenario is described below.
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Unit-Based Scenarios: In the unit-based scenario, a junior nurse (JN) serves the unit. The
JN works off a task list usually found in the job description, and has minimal direction
from, or interaction with the senior nurse (SN). The JN is often left to prioritize the
multiple tasks given by differing SNs who are unaware of one another’s requests of the JN.
This lack of communication can cause conflicts. The SNs do not know what their fellow
SNs have also asked the JN to do and the JN has no way of knowing to which SN they are
ultimately accountable. JNs express frustration with conflicts and work expectations that
cannot be negotiated. SNs express frustration about not knowing the JNs whereabouts or
what they are doing. An example of the unit based scenario is assigning a JN to take all the
vital signs or bathe all the patients. The JN understands what is expected, but may be
interrupted in completing the vital signs and baths and asked to ambulate a patient by one
SN, who does not know that another SN has just requested the JN to help with a dressing
change. Meanwhile, the JN is trying to complete the bathes and take all patients’ vital
signs, while the SN is questioning why the JN hasn’t responded to their requests for help.
In these scenarios the emphasis is on completing tasks of care, rather than focusing on the
care process. It is difficult to develop healthy relationships and trust under these conditions.
Pairing: Pairing is the second scenario in which senior nurse work with a junior nurse for
the shift (Koloroutis, et al 2007). However, the SN and JN are not intentionally scheduled
to work the same shift each day. Although they may all work the same shift on the next
day, they may not be paired on the next day to care for the same patients. For a given shift,
however, they work together, or are paired, and care for the same group of patients.
Delegation usually increases with pairing. In this scenario, the SN and the JN discuss how
care is to be prioritized and how it is to be done, and identify expected individualized
outcomes for the shift. For instance, a patient’s therapeutic goal for the shift might be for
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the patient to ambulate the length of the hall 30 minutes after the pain medication has been
administered, with a pain rating no greater than 2 on a scale of 1 to 10 at the end of the
walk. The JN would report observations and the pain scale rating to the SN who would
then determine if the plan for pain control is adequate. Pairing increases the delegation
potential and promotes healthy relationships.
Partnering: The third scenario is partnering (Koloroutis, et al 2007). In partnering, one SN
and one JN are consistently scheduled to work together, making a commitment to maintain
healthy interpersonal relationships, trust each other, and advance each other’s knowledge.
It is recognized that the SN has the responsibilities to make the delegation decisions. In this
model, the JN and SN know one another well enough to anticipate what is going to be
needed for patient care. The junior who works in a partnership with the SN knows that the
SN will want a specific patient to ambulate and to achieve pain control by a certain time
within a eight hour shift and/or will need a particular piece of equipment or certain supplies
at a certain time. This knowledge enables the assistant to have the information or
equipment available even before the SN asks for it. Compared to the assistant in the paired
assignment, the assistant who is partnered could anticipate that the SN will want the patient
walked within a given timeframe after a pain medication has been administered, and could
plan to be available to walk the patient at the appropriate time. Together the SN and the JN
care for “our patients” rather than “your patients” and “my patients.” This reflects a major
shift in thinking and in the method assignments are made. Had partnering been used in the
scenario at the beginning of the article, the staff involved would have known each other’s
needs and expectations and would have been able to coordinate their efforts more
effectively. Partnering is supported by a staffing schedule that is developed so as to
consistently have care givers working together and by the method of patient assignments
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that ensures the same staff cares for the same group of patients for their length of stay.
Partnering reflects a philosophy of care that values continuity and relationships, with
management and staff honoring the partnership.
The delegation potential is generally highest when staff partner with each other because
consistent relationships over time enhance knowledge about capabilities and help to foster
trust between members of the nursing staff (Koloroutis` et al, 2007). Thus staffing
schedules and patient assignments impact the delegation potential. When this connection is
understood and valued, staff members see how work can be done differently. This becomes
especially effective when staffs at the point of care take ownership of a staffing schedule
that promotes continuity of care and when the patient assignment matches the talents of the
caregivers to the needs of the patient and family. The amount of work delegated can be
expanded when direct care givers work together consistently. Because the depth of
expertise varies within roles, including the SN role, delegation is more difficult when the
junior nurse is not known by the SN. Pairing and partnering increase delegation because
trust is developed, relationships are fostered, and growth is supported. In partnering, there
is increased commitment to one another and confidence that complex situations can be
managed. The partnership enables SNs to perfect their delegation skills more fully. Some
staff members have shared with me that having limited junior nurses available with whom
they can partner poses a challenge to implementing this partnering scenario. Creativity is
needed to make this scenario work using existing resources. For example, in situations with
predominately senior nurses, more experienced SNs could mentor new junior nurses using
pairing or partnering, thus enhancing care and helping the new junior nurses to grow
professionally. However, Work Complexity Assessment consultants have demonstrated
that the amount of work delegated can be expanded when direct care givers work together
consistently. Delegation potentials are significantly higher when caregivers are paired or
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partnered, with the partnered scenario generally having the highest delegation potential. In
analyzing the findings from delegation potential studies, SNs frequently cite trust with their
co-workers as a key factor when delegating. They state that delegation requires an
understanding of one another’s knowledge and skills. Direct care givers who work together
consistently have been found to experience the following gains in the work setting: (a)
more knowledge about each other’s competence and continued growth in competence; (b)
increased commitment to each other and ability to deal with more complex situations; and
(c) increased efficiency in getting the work done through natural synergy (Weydt, 2009).
The Table compares the description, outcomes, and challenges of the unit-based, pairing,
and partnering assignment patterns.
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Table. Unit Based, Paired, and Partnered Scenario Descriptions, Outcomes, and Challenges Unit Based Paired Partnered Description Less experienced
personnel work from a list of tasks that serves the unit with little direction from SNs.
Junior nurses work with an SN for the shift caring for the same patients with care being directed by the SN and with negotiation about how to best meet patient care needs. SNs can also be paired.
Junior nurses and SN intentionally have the same schedule and care for the same patients with an understanding that the SN has the responsibilities to delegate and direct the plan of care. SNs can also be partnered.
Outcomes
Minimal time is spent with direction JNs prioritize their work Relationship issues frequently arise Attention is not given to scheduling or patient assignments affecting continuity of care
Increased interaction between the SN, or JN with SN directing care for the shift Delegation increases Shift outcomes are identified Accountability is increased Attention is not given to scheduling or patient assignments
More knowledge about each other’s competence and continued growth in competence Increased commitment to each other and ability to deal with more complex situations Increased efficiency in getting the work done through natural synergy with potential to maximize delegation Length of stay outcomes are emphasized Increased accountability and continuity of care are noted Attention is given to scheduling and patient assignments
Challenges Accountability is more difficult Emphasis on task completion vs. care processes and outcomes
Continuity of staff providing care is not emphasized. Relationships are shift based variation in the length of the shifts, i.e. 12 hour, 8 hour, increase time needed for coordination
Scheduling and patient assignments must be intentional. Partners work same shifts, weekends, holidays, and vacations. Variations in the length of the shifts, e.g. 12 hour, 8 hour, increase time needed for coordination. Partnerships require staff and leadership support. Healthy interpersonal relationships must be maintained.
Source Weydt, 2009
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Benefits of Delegation of Responsibilities
Curtis and Nichol (2004) states that delegation of responsibilities benefits the delegator, the
delegate and the organization
Benefits for delegators
Effective delegation gives delegators more time for their other managerial activities, which
enables them to focus on doing few tasks well rather than many tasks poorly. (McInnis and
Parsons [2009], ANA and NCSBN [2006]). Even if managers believe they can perform
tasks better than delegates, it is a more use of managers’ time to concentrate on these other
managerial activities. Effective delegation can also result in increased productivity because
several team members are involved in particular tasks or projects at any given time so that
more can be achieved than would be possible by one individual. Marquis and Huston
(2000) suggest that for many managers the volume of work becomes too much for one
person and that delegation is a necessity not an option. They further suggest that in such
situations delegation is often regarded as synonymous with productivity. The development
of effective delegation skills can enhance the personal and professional advancement of
delegators. For example, delegating allows managers to concentrate on improving their
specific skills, including policy making, managing people, conflict resolution and
evaluation.
Benefits for delegates
Effective delegation offers team members the opportunity to become competent and this
can improve confidence. Participation in decision making by all team members results in
greater employee motivation, morale and job performance. Effective delegation can also
result in a greater understanding and appreciation of the work of wards and organizations.
In undertaking
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delegated tasks, delegates often have to work with other members of staff and may need to
develop further their negotiation and interpersonal skills. It also enables delegate to manage
tasks that are of particular interest to them, thereby increasing initiative and enthusiasm.
The development of these skills can improve chances of promotion and future career
opportunities (Corazzini et al 2010, McInnis and Parsons 2009).
Benefits to wards and organizations
A major consideration of any organization is efficiency. Through effective delegation,
tasks and projects are matched against the skills and knowledge of delegates thereby
producing higher levels of work (CRNBC, 2007). In such scenarios, delegators make the
best use of available human resources. Effective delegation can result in faster and more
effective decision making, and team members tend to respond better to change when they
are involved in decision making processes. This is because team members can undertake
tasks that interest them and use the knowledge and skills required to complete the tasks
successfully. Effective delegation also enables many team members to perform the same
tasks so that, for example, if one becomes ill or an emergency requires them to perform
tasks that are not usually part of their remit, they are familiar with the task elements.
BARRIERS OF EFFECTIVE DELEGATION
Okoronkwo (2005), Stated that in spite of the fact that delegation is a key organization
process, some mangers find it difficult to delegate. From research findings some of the
reasons includes-Lack of confidence in their subordinate, Lack of trust, fears that
delegation will diminish their responsibilities, Fear that the effectiveness of their
subordinates will be made prominent and noticed, they do not want to take chances. Curtis
and Nichol (2004) identified the following barriers:
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Working in a hierarchy
Regardless of how well delegation is executed, the process presumes a superior subordinate
relationship between delegators and delegates. This difference in status can conflict with
the ideals of democratic states in which citizens expect to be treated equally. Traditional
nursing hierarchies can conflict with this notion that everybody should be treated equally.
This can cause delegators to feel guilty so that, in order to reduce this guilt, they try to take
on a greater share of the work. It is important therefore that team members appreciate the
difference between equality as human beings and unequal status in organizational
hierarchies.
Doubting delegates’ abilities
Some managers do not trust team members to undertake tasks, and may hold the view that
‘if you want a job done well, you have to do it yourself. Yuki suggests that, if managers
doubt delegates’ abilities, they are unlikely to delegate. Fear of having to deal with the
consequences of mistakes made by delegates is another reason for inadequate delegation,
and managers who are insecure or who are regarded as perfectionists are least likely to
delegate. This can be avoided however by delegating difficult or large tasks to more
experienced team members.
Difficulties delegating
Some delegators may not realize that they have difficulty delegating; they may consider
themselves hardworking and be unaware that they are restricting the effective functioning
of the team. Some refuse to let delegates share the leadership role or let them become
proficient in too many tasks because of their strong need to maintain control or dominate
others. This sometimes leads to important information being withheld from team members.
One way of overcoming this problem is to focus on it. Delegators should begin by sharing
43
small amounts of responsibility and power with team members. Team members,
meanwhile, can help by taking on more responsibilities, thereby reducing their dependency
on the delegators.
Inadequate staffing
Inadequate staffing can be a common problem in health care, where ‘inadequate’ means
there are too few members of staff in a team, or too many who are insufficiently educated
or experienced. The problems associated with inadequate staffing vary at different times
but it is important to stress that where they exist, unless staffing improves, team members
cannot fulfill their responsibilities effectively. When staffing is inadequate, workload may
have to be reduced temporarily to safe levels, and new projects or ventures should be
suspended until staffing improves.
Dustbin delegation
Delegating pleasant tasks or projects is easier than delegating unpleasant ones. Some
delegators deal with this problem by delegating undesirable tasks to team members who
seldom refuse. This violates the principles of fairness and team members lose respect for
delegators if this continues. Delegators must use other strategies. For example, they must
analyze the task or project to identify its advantages with the hope of reducing staff
resistance. An alternative strategy is to give staff the responsibilityto decide how such tasks
or projects are allocated. This tends to work well if staffs are mature and familiar with the
principles of decision making and fairness. Delegators should avoid pretending that tasks
are desirable when they are not because this can increase animosity. They must also avoid
delegating only boring, trivial or unappealing tasks. Delegated tasks should include both
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enjoyable and appealing tasks and these should be delegated equally among team members
according to skill and ability.
Under-delegating
Under-delegating can occur if delegators believe that delegation can be interpreted as a
lack of ability on their part to accomplish the jobs at hand. Delegation does not necessarily
reduce delegator control, prestige or power. It can in fact extend delegator influence and
capabilities by increasing the amount of work that can be accomplished Fear that
delegates will resent having work delegated to them is another reason for under-delegating.
It can also arise if delegators are inexperienced in both their jobs or in delegation, or
because they fear losing control (Marquis and Huston 2000).
Over-delegating: dumping
While under-delegating places excessive burden on delegators,over-delegating places
excessive burden on delegates.Delegators may over-delegate if they are poor at time
management and waste time trying to organizethem. Others do so because they are unsure
of theirability to perform given tasks.It is important to remember that over-delegating
canoverwork and exhaust competent staff, which can affecttheir overall productivity
(Marquis and Huston 2000).
Resistance to delegation
When delegate resist delegation, delegators can choose to do the tasks themselves to avoid
confrontation. This should be discouraged. Delegators should instead determine why
delegated tasks are not being accomplished andact immediately to reduce or eliminate
obstructing factors.One of the most common reasons for resistance todelegation is failure
by delegators to appreciate the perspective of delegate. Delegate may have workloads so
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heavy that the delegation to them of additional tasksis inappropriate. Other delegates may
resist delegationbecause they feel that they are incapable of completingthe tasks. If
delegators feel that delegates are capable, yet the delegates themselves do not believe they
are, thedelegators should undertake to boost the self confidenceof the delegates (Marquis
and Huston 2000). If, on the other hand, delegates are likelyto fail in their endeavors to
perform the tasks giventhem, perhaps the tasks were not delegated to the
appropriatepeople.Another reason for resistance to delegation is resistance to
responsibilities. In such situations, delegators must remain calm but assertive about what is
expected from delegates and, where necessary, clear guidelines for the delegated task
should be provided (Marquis and Huston 2000). Resistance can occur if delegates believe
that delegators are over-delegating. Finally, all staff needs to know that there is room for
creativity and independent thinking in relation to delegation. Delegators who fail to provide
this risk staff becoming disinterested in delegation.
Theoretical Review
Models of delegation in nursing
Models of delegation in nursing provide guidance for defining variables and specifying the
relationships between them. Two models have been used in nursing to explain delegation
process: the American Nurse Association and National Council State Board of Nursing
(2006) delegation model and Gillespie & Patterson (2009) Situated Clinical Decision
Making process. In this study, situated clinical decision making framework will be used to
explain the variables under study. Ruff (2011) stated that situated clinical decision making
framework was used in acute care setting to help practicing nurses in delegation decision
making.
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The Situated Clinical Decision-making Framework
The Situated Clinical Decision-Making Framework was developed by Gillespie and
Paterson (2009). The framework was based on the Tanner (2006) model of clinical
judgment and Lave & Wenger (2003) situated learning theory, the framework is used to
assimilate context, foundational knowledge, decision-making process and thinking
processes in making decisions in clinical area. Therefore, it provides the modus operandi to
help nurses reflect on the decisions they make in clinical practice (Ruff, 2006). According
to the framework, Situated Clinical Decision-Making is based on the following factors-
1. Context
2. Foundational knowledge
3. Decision-making process
4. Thinking process
Context: This construct speaks about patients’ needs, the organization (i.e. type of facility,
available resources both man, material and organizational policies). According to Saks and
Johns (2011), three factors influence perception: experience, motivational state and
emotional state. Based on this the nurse’s past experience of the managers’ delegation
decisions and the outcome will influence her opinion of whether their nurse managers
consider context in delegation decision for effective outcome. This involves selecting
appropriate subordinate with required education, training skill and experience to deliver
care in a particular situation. Ray (2001),in Kozier & Erb’s( 2008), opines that caring in
nursing is contextual and is influenced by the organizational structure.
Foundational knowledge: The “house” in the conceptual schematic represents the
foundational knowledge that informs nurses’ clinical decision-making process. This
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knowledge arises from various dimensions: the nursing profession, self, general and
specific aspects of the patient situation.
Knowing the profession: This construct speaks about the nurses’ knowledge of the scope
and standards of nursing practice determined by the state and national legislation and
regulatory bodies in clinical delegation decisions and knowledge of the consequences of
going against the standard. Knowledge of professional legislation and standard will enable
nurse managers to apply this in their decision to delegate e.g. in deciding what to delegate,
the delegator must decide what tasks should be delegated based on the nature of the task in
the specific circumstance. This will help subordinate to form opinion about how nurse
managers delegate responsibility; whether they consider the professional standard of
practice in selecting delegates for a specific situation for effective outcome.
Knowing the self: This construct talks about nurses knowing their strength, limitation,
skills experiences, belief, values, assumptions, preconceptions, learning and need in
making delegation decision. Knowing self therefore, offers a critical contribution to the
provision of safe patient care that leads to positive outcome. That is to say that self analysis
and reflection on past experience of outcome of delegation made whether they are negative
or positive will lead to new understanding and influence his/her delegation decision.
Knowing the case: This construct speaks about general knowledge of specific disease
condition. This involves manager knowing the patient baseline data, pattern that exists in
an individual’s laboratory results and other diagnostic data which will in return influence
his/her delegation decision of selecting subordinate that will render individualized care to
get positive outcome. When the nurse manager is aware of the patients’ population,
pathophysiology of the case, pattern that exists in typical cases, patients’ response and
predicted trajectory, this will influence his/her selection of appropriate subordinate for the
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specific caring encounter to achieve positive outcome. The subordinate working with the
nurse manager from the previous delegation decisions made by the manager will help
him/her to know whether the manager considers the resources available in delegation
decisions for effective outcome. This construct focuses on understanding the individual
client clinical state.
Knowing the person: This construct speaks about manager being aware of the individuals
past experience in relation to health and illness, preferences, support and resources. This
knowledge is important because it affects patient behavior which in turn affects speed of
recovery. Kozier & Erb’s (2008) opines that caring attends to the totality of the client
experiences. Delegating the subordinate who will be able to adopt strategies that will lead
to positive outcome will be most appropriate.
Decision Making Process
This talks about nurse managers getting several possible decisions and acting on one. When
the desired outcome is not reached, the manager will implement an alternative delegation
decision.
Thinking Process
This construct centers on critical thinking which supports the nurse in identifying and
challenging the assumptions, values and beliefs in a specific situation considering context,
knowledge, imaging possibilities and maintaining reflections. It talks about creative
thinking as the reality of present day nursing in terms of nurses’ ability to review
information, learn new information and organize information in systematic manner that
support sound judgment.
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Modifying factors: Situated clinical decision making framework has been expanded to
include various demographic, psychological and social factor variables. Demographic
variables – age, gender, education, experiences and economic status, social structure
variable, and knowledge about health problems, etc are termed the modifying factors. The
modifying factors influence the other four constructs. It can enhance or impede their
occurrence. Demographic status such as age affects the individual response to illness and
pathophysiology which in turn affects patient behavior. The nurse manager considers this
in the selection of subordinate in a specific caring encounter to achieve positive outcome.
Furthermore, social structure includes education, economy, and experience. Increased
educational attainment influences patient power in decision making as regards to treatment
preferences. This will also affect managers’ delegation decision in the selection of
appropriate subordinate to deliver care that will help to achieve expected outcome.
Economy relates to the monetary reserves of an individual. This affects client selection of
context of care because this determines the type of treatment available etc.
Judgment: This talk about further care collection about client conditions which inform
nurse managers towards the best conclusion of client needs and making of appropriate
delegation decisions. The judgments change as more cues are gathered. This is to say client
needs is a dynamic process. Therefore the nurse manager should remain open to revising
the judgment as information emerges to be able to make better delegation decision for
positive outcome.
50
The Situated Clinical Decision-making Framework
Gillespie & Paterson, (2009)
51
CONCEPTUAL MODEL FOR THE STUDY
Independen
Variables
Developed by Nze (2015)
Independent
Variables Intervening
Variables
Dependent
Variables
Situated Clinical Decision-Making
• Context
• Foundational knowledge
- Knowing the profession
- Knowing self
- Knowing the
case/client/person
• Decision making process
• Thinking process
Social Demographic Factors
Age
Gender
Education
Experience
Economic status
Knowledge
Environmental Factors
Types of facility (primary,
secondary, tertiary, valuable
resources, nurses,
equipment and materials)
Culture
Cue to action
Past experience
Observation
Conversation
Judgment
Decision
Evaluation
Critical thinking
Behavioral intention
Effective delegation decision
making
Positive caring outcome
Increased patient flow
Overall organization improvement
52
The independent variables are three classes of factors of situated clinical nursing
decision-making framework based on Tanner model of clinical judgment and Lave &
Wenger situated learning theory: knowing the profession, knowing self and knowing the
case/client/person. It is theorized that situated clinical nursing delegation decision making
is dependent on simultaneous occurrences of these classes of factors: knowing the
profession, knowing self and knowing the case/client/person in delegation of responsibility
in nursing.
The intervening variables are those factors which may affect manager’s decision making
model of knowing the profession, knowing self and knowing the case/client/person. Cue to
action will enhance the manager’s delegation of responsibility in nursing. These
intervening variables are divided into two parts; androgenic (socio-demographic factors)
and environmental factors. The androgenic factors are the first order of intervening
variables in the individual. They include age, education, gender, experience and economic
status. The environmental factors are the second order of intervening variables and they
include material and human resources, types of health facility, society/culture. These
variables will determine the effect of the independent variables and the dependent
variables.
The dependent variables are described as expected outcome of the stud(Nurses’
Perception of Their Nurse Managers Delegation of Responsibilities). They include
effective delegation decision making in nursing, positive caring outcome, increased patient
flow and overall organizational improvement. These outcomes are based on the
independent variables (effective delegation decision making, positive caring outcome,
increased patient flow and overall organization improvement) which have been mediated
by the intervening variables.
53
EMPIRICAL REVIEW
Carr (2005) conducted a study on the delegation perception and practice in community
nursing in UK. The aim was to find how delegation is practice in community nursing using
qualitative descriptive design and comparative approach analysis managed by NUD 1st
software. A Population of 8 was interviewed using two focus groups and inter-group
discussions as instrument. Findings revealed a diversity of delegation practices and
experiences. Decision was driven by both pragmatic and need assessment factors. Issues
around the delegate, delegator, patient need and structural factors were strongly influential.
Hasson, McKenna and Keeney (2012) conducted a study on delegation and supervising
unregistered professionals: student nurse experience in the UK. The purpose of the study
was to analyze the extent student nurses understand the act of delegating a responsibility to
a subordinate. Period of study was 2005-2011. Sequential transformative mixed methods
(qualitative and quantitative) were used in a population of 707 across three levels of student
nurses. Purposive sampling procedure used in pilot study and semi-structured questionnaire
was used in second phase. 662 phase two semi-constructed questionnaires were distributed
to participants. From 662 questionnaires distributed, 439 were returned giving 66%
response rate. 43% (n-190) were first year pre-registered students, 17% (n-74) were second
year and 40% (n-174) were third year students. Of 439 students, 92% (n-403) were
females within the age of 24. The low response rate from the second year students was as
the result of their being away on clinical posting in the pilot study. Training did not prepare
them for delegation of responsibilities in clinical practices. However, as the students
progressed in their practice, they became aware of such issues. They also identified fear as
hindrance to delegate.
54
Another study was conducted by Corazzini, Anderson Rapp, McConnell and Lekan (2010),
to examine how registered nurses in leadership roles in long term care setting delegate care
in USA. This is to evaluate delegation practice of nurses in leadership roles. Qualitative
descriptive design was used in a population of 33 participants. Convenience sampling
technique was used to select participants. Instrument used was structured individual in-
depth interview for 30 respondents and 3 person groups interviewed together. Data were
analyzed using grinded hermeneutics. Findings revealed two key approaches: one which
utilizes job description while the other considers the scope of practice of caregiver. While
the former approach resulted in more clarity and certainty for RN, the latter facilitated a
focus on quality of resident care outcome as linked to delegation process. Perceived
barriers to effective delegation were comparable among RNs using either approach to
delegation and almost all RN could describe benefit of delegation for long term care.
Abedi, et al (2007), conducted a study on delegation as experienced by nurse managers at
Isfahan University Iran. The purpose was to investigate how nurse managers delegate care.
Phenomenological qualitative design was used on population of 14 matrons. Unstructured
interview method was used as instrument to collect data. Data was analyzed using collizie
method. Findings revealed that nurse managers had three forms of experience on
delegation phenomenon that were as follows: lack of authority for delegation and
frustration experiences, delegation in minor affairs and lack of authority with supervisor’s
sporadic unessential interference. Neither of them was perfectly acquainted with this
phenomenon. Benefits of delegation were categorized in four dimensions: benefit
concerning supervisor, subordinate, hospital and patients.
55
Standing, et al (2010), studied the nurses’ perception of the outcome of delegation of care
to unlicensed personnel. It is an evaluation study to determine the outcome of delegation of
care to unlicensed personnel. Qualitative design was employed. Thirty-five participants
were drawn from the population of 148. Questionnaire were used as an instrument to
collect data. The result revealed that delegated tasks were categorized as lower or higher
activities. 54.2% of negative outcomes were represented by lower level activities while
67.6% of higher level activities resulted in positive outcomes. The negative outcomes
ranging from emotional upset to fracture injuries and death were attributed to nurse
assistive personnel (NAP) not receiving or not following directions or not adhering to
policy. Conversely, positive outcomes are attributed to NAP following directions, protocols
and being attentive. 75% of positive outcomes to NAP performance followed
characteristics such as competency, integrity and motivation. 76.4% of nurses indicated
that NAP were implicated in the negative narratives due to lack of knowledge, judgment
and over confidence.
Carin, et al (2014) conducted a study to investigate the newly qualified nurses ability to
recontextualise knowledge to allow them to delegate and supervise care in the University
of Surrey. The aim was to understand how newly qualified nurses (NQNs) use the
knowledge learnt in the university to organize, delegate and supervise care on the wards
when working with and supervising health care assistants. Ethnographic design was used
on a population of 116 participants. Data was collected with three ethnographic case
studies in three selected hospital sites using mixed method (observation and interview) as
instrument in two phases. Participants were n-32 / 2observations each / 230 hours;
interviews with NQNs n-28 interviews with healthcare assistants n-10; interviews with
ward managers n-12. Organizational learning context,
56
delegation in context and learning processes guide their data collection. Data were
analyzed using thematic analysis aided by the qualitative software NVIvo. Findings in
phase one revealed that areas which NQNs need support were developing confidence
understanding role boundaries, assessing knowledge and developing communication care
outcome. From the findings in phase one, evidence-based tool was developed for phase two
to focus on areas where NQNS needed support plus areas of reflection and supportive
conversation relating to organization, delegation and supervision of care of patient.
Findings were presented on relation to the project conceptual framework – organization
learning context, delegation in context and learning processes.
Gravlin and Bittner (2010), conducted a study on nurses’ and nursing assistants(NA)
reports of missed care and delegation in College of Nursing Weston Massachusetts. The
aim was to measure RN and NAs reports of frequency and reasons for missed nursing care
and identify factors related to successful delegation. Quantitative, descriptive design was
used. Population of study was 568 RN and232 NAS. Questionnaire was used to collect
data. Data collated were analyzed using descriptive statistic of frequencies, percentages and
Pearson correlation. Finding reveal that there is a widespread of missed care including
turning, mouth care and toileting. Frequency of report were due to unexpected increase in
volume acuity, heavy admissions or discharge activities and inadequate support staff.
Factors for successful delegation were communication and cordial relationship.
Summary of Literature Review and Analysis of Empirical Review
The literature review provided an overview of the concept of delegation, delegation
guidelines/criteria, delegation of responsibility in nursing, nursing job description,
responsibility going with authority, practice of acceptability in nursing, practice of
supervision and benefit of delegation, Curtis and Nicholl (2010) defined delegation of
57
responsibility as transfer of responsibility, authority and power to somebody for the
performance of an activity while retaining accountability for outcome. Effective delegation
of responsibility results in increased productivity and better caring outcome because
several appropriately chosen team members were involved in a particular task at any given
time, as such, more can be achieved.The problem and major obstacle affecting delegation
of responsibility in nursing is the gap between knowledge and practice (Ruff 2011).
However, effective delegation of responsibility benefits the delegator, the delegate, the
organization and the patient. The delegators will have more time for other managerial
activities, which enable them to focus on doing few tasks well rather than many tasks
poorly. The delegate will have opportunity to become competent, improve confidence,
increase chances of future career opportunities, and also job satisfaction and this will result
in overall organization efficiency.
The situated clinical decision-making framework served as the theoretical framework of
the study. It was considered suitable for study because it explains how context,
foundational knowledge, decision-making process and thinking process are incorporate in
delegation process. It provides a modus operandi to help nurses reflect on the decisions
they make in their clinical practice. Review of previous related studies showed that earlier
researchers in this field basically looked at delegation as experienced by nurse managers,
how nurses in long term care setting delegate care, how nurses perceive delegating care to
unlicensed personnel and outcome, and how nurses practice delegation in community
health nursing. However, in Nigeria no study has been done on nurses’ perception their
nurse managers’ delegation of responsibility. To remedy this, more studies are advised to
be carried out especially in those areas which have not been adequately looked into.
58
Therefore, the researcher aimed at determining the nurses’ perception of their nurse
managers’ delegation of responsibility.
59
CHAPTER THREE
Research Method
This chapter presents the research design, area of study, population of study, sample and
sampling technique, instrument for data collection, validity and reliability of instrument,
ethical consideration and procedure for data collection and method of data analysis.
Research Design
The descriptive survey method was the research design used for this study. According to
Shuttleworth (2010), it is a scientific, non-experimental method which involves observing
and describing the behavior of a subject without influencing it in any way. . The design was
considered appropriate for this study to determine the status of the phenomenon as it exist
at the time of study which is Nurses’ Perception of their nurse managers’ delegation of
responsibilities. This design was successfully used by Carr (2005), to carry out a study
titled Nurses delegation perception and practice in community nursing in UK.
Area of Study
This study was carried out in the four tertiary hospitals in Enugu State in the South East
geopolitical zone of Nigeria. They are Enugu State University Teaching Hospital
(ESUTH), University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla, National
Orthopedic Hospital Enugu (NOHE), and Neuro-Psychiatric Hospital Enugu.
ESUTH is under Enugu State Ministry of Health located along Park Avenue in the
Government Reserved Area (GRA) of Enugu within Enugu North Local Government of
Enugu State. It is bounded in the north by Shoprite Shopping Mall Enugu State, at the
south by Ekulu River and
60
Bishop Onyeabor Street GRA, at the east by Salvage Crescent Street GRA and at the west
by forest crescent GRA. It covers 600 hectares of land. There are more than 30 departments
in the hospital. The hospital has a School of Nursing, a School of Midwifery, College of
Medicine, a church and a students’ hostel. The hospital community comprises of
professionals like doctors, nurses, pharmacists, laboratory scientists, radiographers,
engineers, etc. and semi-skilled workers like orderlies, derivers.
UNTH is a federal government owned hospital under the Federal Ministry of Health within
the community of Awgu, and Nkanu West local government area of Enugu State .It is
about 21 kilometers from Enugu city along Enugu-Port Harcourt express way. It is
bounded in the north by Ozalla town, in the south by Ituku town, in the west by Ahiaigbo
village and in the east Enuguagu village. It covers 306 hectares of land. It comprises of 41
main departments, three outposts (Nsukka, Abagana, and Isuochi), a church, a market and
various schools such as biomedical school of technology, school of nursing, school of
midwifery, post basic schools like peri operative school, school of anesthesiology. The
hospital community comprises of professionals such as doctors, nurses, pharmacists,
laboratory scientists, physiotherapists, radiographers, etc. semi-skilled workers like drivers
and unskilled workers e.g. cleaners and orderlies.
The National Orthopaedic Hospital Enugu is also a federal hospital under the Federal
Ministry of Health. It is located within Enugu East Enugu along-Abakaliki express way. It
is bounded in the north by Area Command of Nigeria Police Enugu State, in the south by
Abakpa Community of Enugu State, in the west by 82 Division of Nigerian Army Enugu
and in the east by Thinkers Corner community of Enugu State. It covers 750 hectares of
land. The hospital community comprises of different professionals such as doctors, nurses,
pharmacists, laboratory scientists, radiographers, etc. semi-skilled workers like drivers and
unskilled workers like orderlies and porters. Located within the hospital are School of
61
Orthopedic Nursing, School of Burns and Plastic, Administrative block, staff quarters and
various in patient wards and departments.
Neuro Psychiatric Hospital is another federal hospital under the Federal Ministry of Health
located along Upper Chime Avenue of New Haven community of Enugu State. It is
bounded in the north by St. Mulumbu Catholic Church, in the south by Enugu-Abakaliki
expressway, in the west by Akalaka House and in the east by Hotel Cordial. It covers about
400 hectares of land, located within the hospital are various departments, School of
Psychiatric Nursing and in patient wards. It comprises of different professionals such as
doctors, nurses, laboratory scientists, occupational therapists, social workers, clinical
psychologist, and psychiatrist etc. Semi-skilled workers like drivers and unskilled workers
e.g cleaners and orderlies.
Population of Study
The population of all the nursing sisters, and senior nursing sisters, in the four tertiary
hospitals in Enugu State at the time of study were 943. From ESUTH 253, UNTH 388,
National Orthopedic Hospital (NOHE) 196, Neuro psychiatric hospital 106,
Table 1 Target Population
s/n Name of Hospitals Designation No of Nurses
1 NOHE Nursing Sisters
Senior Nursing Sisters
153
43
2 ESUTH Nursing Sisters
Senior Nursing Sisters
108
145
3 UNTH Nursing Sisters
Senior Nursing Sisters
133
255
4 Neuro Psychiatric Hospital Enugu Nursing Sisters
Senior Nursing Sisters
87
19
Total 943
Sample Size
A sample size of 300 nurses from the four tertiary hospitals in Enugu State was used for
study. Sample size for the study was calculated using Krejcie and Morgan (1970) power
formula as follows
n = 2NP (1-P)/ d2 (N-1) +
Where
n = required sample size
2 = the table value of chi-square for one degree of freedom at the desired confidence level
N = the population size
P = the population proportion (assumed to be .50 since this would provide the maximum
sample size)
d = the degree of accuracy expressed as a
n = 3.841 x 943 x 0.5 x 0.5 / (0.05)
n = 273
The required sample size is 273
A 10% attrition was added to give a sample size of 300
Inclusion Criteria
1. All the nursing sisters and senior nursing sisters working i
Hospital in Enugu as of 2014
2. Nurses who were willing to participate in the study.
3. Nurses who were present at the time of study.
4. Nurses who have at least 6 months working experience and above.
Sampling Procedure
Purposively nurses from the four tertiary hospitals in Enugu state were chosen among all
the hospitals in Enugu state. Each of the hospitals has its own population of nursing sisters
and senior nursing sisters .NOHE 196, ESUTH 253, UNTH 388 and Neuro Psychiatric
A sample size of 300 nurses from the four tertiary hospitals in Enugu State was used for
Sample size for the study was calculated using Krejcie and Morgan (1970) power
2 P(1-P)
square for one degree of freedom at the desired confidence level
P = the population proportion (assumed to be .50 since this would provide the maximum
d = the degree of accuracy expressed as a proportion (.05)
n = 3.841 x 943 x 0.5 x 0.5 / (0.05)2 x 942 x 3.841 x 0.5 x 0.5
The required sample size is 273
A 10% attrition was added to give a sample size of 300
All the nursing sisters and senior nursing sisters working in the four tertiary
Hospital in Enugu as of 2014
Nurses who were willing to participate in the study.
Nurses who were present at the time of study.
Nurses who have at least 6 months working experience and above.
the four tertiary hospitals in Enugu state were chosen among all
the hospitals in Enugu state. Each of the hospitals has its own population of nursing sisters
and senior nursing sisters .NOHE 196, ESUTH 253, UNTH 388 and Neuro Psychiatric
62
A sample size of 300 nurses from the four tertiary hospitals in Enugu State was used for
Sample size for the study was calculated using Krejcie and Morgan (1970) power
square for one degree of freedom at the desired confidence level
P = the population proportion (assumed to be .50 since this would provide the maximum
n the four tertiary
the four tertiary hospitals in Enugu state were chosen among all
the hospitals in Enugu state. Each of the hospitals has its own population of nursing sisters
and senior nursing sisters .NOHE 196, ESUTH 253, UNTH 388 and Neuro Psychiatric
63
Hospital 106. A stratified proportionate sampling technique was used to select the sample
size from each of the hospital using the following formula :
ns=Ns x n/N
ns= Sample size of each sub group
n= Sample size of the study
N= Total population ( Chinweuba, Iheanacho, Agbapuonwu 2013)
This formula is again applied to select the sub group of the nursing sisters and senior
nursing sisters to build in representative sample size in the study. Convenience sampling
technique was used to reach each participant.
Names of Hospital
Population of Hospitals
Sample size of Hospitals
Sub groups Population of sub group
Sample size of sub group
% of sub group
1. National Orthopedic Hospital Enugu
196 63 Nursing Sisters Senior Nursing Sisters
153 43
44 13
16 5
2. ESUTH 253 80 Nursing Sisters Senior Nursing Sisters
108 145
31 41
12 15
3. UNTH 388 123 Nursing Sisters Senior Nursing Sister
133 255
39 74
14 27
4. Neuro Psychiatric Hospital
106 34 Nursing Sister Senior Nursing Sisters
87 19
25 6
9 2
Total 943 300 943 273 100
Instrument for Data Collection
For this study data were collected using researcher developed questionnaire based on
research objectives relating to nurse’s perception of their nurse manager’s delegation of
responsibilities. The questionnaire is in three sections A, and B. Section A contains
64
questions on demographic characteristic of the respondents such as years of experience,
designation, qualification, marital status, age, religion 1-9 Section B elicited information
on the nurses’ perception of their nurse manager’s delegation of responsibilities. Questions
10-17 obtained information on nurse manager’s use of stipulated guidelines/criteria in
delegating responsibility. Questions 18-27 elicited information on the use of job description
in delegating responsibility. Questions 28-38 obtained information on nurses’ perception of
their nurse managers’ transfer of responsibilities in delegating responsibility. Questions 39-
46 gave information on the nurses’ perception of nurse managers’ practice of
accountability in delegating responsibility. Questions 47-54 obtained information on
nurses’ perception of their nurse manager’s practice of supervision in delegating
responsibility. The questions in Section B are formulated on a four point likert type scale.
Strongly Agreed (4), Agreed (3), Disagreed (2), Strongly Disagreed (1).The mean score
value is 2.5. The item with mean score of 2.5 and above were accepted as positive,
meaning that nurses affirm that the nurse managers conform to the stipulated/standard
practice in delegating responsibilities to the subordinate. Altogether, the structured
questionnaire consisted of 54 questions.
Validity of Instrument
The questionnaire was given to the project supervisor and other experts in nursing
administration in the department of Nursing Sciences University of Nigeria Enugu Campus
to determine face and content validity. The supervisor and experts were given a draft copy
of the questionnaire, purpose of the study and objective to critically assess for relevance
of content, clarity of statements and logical accuracy of the instrument. Changes and
correction were effected.
65
Reliability of the Instrument
A pilot study was conducted in Anambra State Teaching hospital Amaku Awka. 30 copies
of the questionnaire which is 10% of the sample size (300), were administered to 15
nursing sisters and 15 senior nursing sisters. The data obtained were subjected to split-half
method using Conbach’s alpha coefficient. The results for each of the split halves 1 and 2
were 0.90 and 0.96 respectively and the correlation between forms 0.80, indicating a very
strong reliability.
Ethical Consideration
Ethical clearance was obtained from the ethical committee of the University of Nigeria
Teaching Hospital, Ituku-Ozalla, Enugu (UNTH) and National Orthopedic Hospital, Enugu
(NOHE) after sending copies of proposed work chapters 1, 2 and 3, letter of identification
from H.O.D. of nursing and asking for ethical clearance. Also permission to carry out the
study inwards was obtained from the Chief Medical Directors, Heads of Nursing Services
and unit heads of the various hospitals involved. All participants were duly informed and
confidentiality was maintained.
Procedure for Data Collection
With the permission/clearance obtained to carry out the study and informed (written)
consent from the nurses, the questionnaires were administered to the nurses within the rank
of nursing sisters and senior nursing sisters with the help of four (4) trained research
assistants. These were administered to the nurses who were on duty at the time of data
collection. The researcher and the research assistant went to the ward by 8am to be able to
administer copies of the questionnaire to nurses on night duty and to nurses on morning
duty after handing over. The researcher and the assistant also went to the ward in the
66
afternoon around 2pm before the morning nurses’ hand-over to the afternoon nurses to
administer some copies of the questionnaire to those on afternoon duty. The copies of the
questionnaire were retrieved immediately from the nurses who were willing to fill it
immediately while others were collected later. The procedure went on for one month to be
able to get those who were off duty.
Method of Data Analysis
The data obtained from the study were collated, tallied, and subjected to descriptive
statistic ranging from frequency, percentages, and mean scores to standard deviation. This
was done with the aid of SPSS statistical package version 20. The total value of four-point
Linkert scale for nurses’ perception of their nurse managers’ delegation of responsibilities
is 10. The criterion mean (average) is 2.5. Above the 2.5 criterion mean denotes higher
agreement (positive) on the assertion while mean below 2.5 denotes disagreement
(negative). Mean comparison of continuous variables was done using T-test and ANOVA,
p-value less than 0.05 level of significance was regarded as significant and result were
presented in tables for test of hypothesis, Hypotheses was tested using Pearson correlation
to determine relationship between variables and students’ t - test to test for significant
difference. P values less than 0.05 level of significance was regarded as significant and
results were presented in tables.
67
CHAPTER FOUR
PRESENTATION OF RESULTS
This chapter presents the analysis of the research data and interpretation of results. Out of 300 questionnaires shared, 278 were returned which is 92.7% return rate.
Table 1: Demography of the respondents
Frequency Percent Age group
<=25 7 2.5 26 – 30 71 25.5 31 -35 84 30.2 36 – 40 67 24.1 41 – 45 22 7.9 46 – 50 17 6.1 51 – 55 10 3.6
Mean age ± SD = 35.44 ± 6.77
Sex Male
41
14.7
Female 237 85.3
Religion Christianity 277 99.6
Muslim 1 .4 Marital status
Married 213 76.6 Single 64 23.0
Divorce/separated 1 0.4 Widowed 0 0.0
Educational qualification
Registered nurse 38 13.7 Registered nurse/midwife 165 59.4 Bsc nursing/BNSC 73 26.3 Masters degree 2 .7
Place of work University of Nigeria Teaching Hospital Ituku Ozalla 112 40.3 Enugu State Teaching Hospital 74 26.6 Federal Neuro Psychiatric Hospital Enugu 33 11.9 National Orthopedic Hospital Enugu 59 21.2
Unit
Surgical 62 22.3 Medical 37 13.3
Acc & emergency 19 6.8 Maternity 25 9.0
Theatre 37 13.3 Pediatrics 29 10.4
Psychiatric 28 10.1 Ophthalmic 2 .7
GOPD 13 4.7 Orthopedic 26 9.4
Designation Nursing officer 142 51.1
Senior nursing officer 136 48.9 Years of experience 1 – 5 128 46.0 6 – 10 118 42.4 11 – 15 23 8.3 >15 9 3.2
Mean years of experience ± SD =6.64 ± 4.43
68
Table 1 shows that 7 (2.5%), 71 (25.5%), 84 (30.2%) and 67 (24.1%) of the respondents
have ages 25 years and below, 26 to 30years, 31 to 35 years and 36 to 40 years
respectively, while 22 (7.9%), 17 (6.1%) and 10 (3.6%) of them have ages between 41 to
45, 46 to 50 and 51 to 55 years respectively. The mean age is 35.44 ± 6.77. There were 41
(14.7%) male and 237 (85.3%) female respondents. Most of the respondents are Christians
(99.6%). The table also revealed that 213 (76.6%) respondents are married, 64 (23.0%) are
single while just one person is divorced/separated. For educational qualification, 38
(13.7%) are registered nurses, 165 (59.4%) are registered nurses/midwife, 73 (26.3%) have
Bsc nursing/BNSC while 2 (0.7%) have M.Sc. Out of 278 respondents, 112 (40.3%) work
in University of Nigeria teaching hospital Ituku Ozalla, 74 (26.6%) work in Enugu State
Teaching Hospital, 33 (11.9%) work in Federal Neuro Psychiatric Hospital Enugu while 59
(21.2%) work in National Orthopedic Hospital Enugu. In the table, 62 (22.3%) were in
surgical unit, 37 (13.3%) in medical unit, 19 (6.8%) in accident and emergency unit, 25
(9.0%) in maternity unit, 37 (13.3%) in theater unit and 29 (10.4%) in pediatric unit, 28
(10.1%) in psychiatric unit, 2 (0.7%) in ophthalmic unit, 13 (4.7%) in GOPD and 26
(9.4%) in orthopedic unit. According to their designation, 142 (51.1%) are nursing officers
while 136 (48.9%) are senior nursing officers. 128 (46%) of the respondents have 1 to 5
years of experience, 118 (42.4%) have 6 to 10 years of work experience, 23 (8.3%) have 11
to 15 years of experience while 9 (3.2%) have more than 15 years of experience.
Research question 1: What are the nurses’ perceptions of their nurse manager’s adherence
to stipulated guideline/criteria in delegating responsibilities?
Decision rule: Values greater than or equal to 2.5 (≥ 2.5 ) indicate that nurses perceived
their managers as delegating responsibilities correctly or as accepted while values less than
2.5 (< 2.5) indicate that nurses do not perceive their managers as delegating responsibilities
as they should or as expected.
69
Research question 1 was answered using responses from questions 10-17
Table 2: Nurses’ perceptions of their nurse manager’s adherence to stipulated
guideline/criteria in delegating responsibilities
S/n Items Strongly
disagree
n (%)
Disagree
n (%)
Agree
n (%)
Strongly
agree
n (%)
Means ± SD
1 Consider the specific needs of patients
in deciding what tasks should be
delegated
5 (1.8) 12 (4.3) 102 (36.7) 159 (57.2) 3.49 ± 0.67
2 Consider the nature of the task before
delegating it to a particular nurse
5 (1.8) 23 (8.3) 106 (38.1) 144 (51.8) 3.40 ± 0.71
3 Consider if a staff needs extra
training/counseling before undertaking
a task
16 (5.8) 67 (24.1) 107 (38.5) 88 (31.7) 2.96 ± 0.89
4 Discuss the responsibilities associated
with the task with their subordinates
6 (2.2) 65 (23.4) 145 (52.2) 62 (22.3) 2.95 ± 0.74
5 Provide needed guidance/support in
delegating a job
10 (3.6) 38 (13.7) 137 (49.3) 93 (33.5) 3.13 ± 0.78
6 Shares with the rest of the team, the
success or the shortcomings of the
completed task/project
7 (2.5) 35 (12.6) 132 (37.4) 104 (37.4) 3.19 ± 0.75
7 Enquire from delegates how the work is
progressing
12 (4.3) 16 (5.8) 133 (47.8) 117 (42.1) 3.28 ± 0.76
8 Pair experienced and inexperienced
staff in delegating jobs
14 (5.0) 33 (11.9) 113 (40.6) 118 (42.4) 3.21 ± 0.84
GRAND MEAN 3.20 ± 1.21
70
Table 2 shows that 5 (1.8%) of the respondents strongly disagree that nurse managers
consider the specific needs of patients in deciding what tasks should be delegated, 12
(4.3%) disagree, 102 (36.7%) agree while 159 (57.2%) strongly agree. The mean response
for this factor was 3.49 ± 0.67. From the table, 5 (1.8%) respondents strongly disagree that
nurse managers consider the nature of the task before delegating it to a particular nurse, 23
(8.3%) disagree, 106 (38.1%) agree, while 144 (51.8%) strongly agree. The mean response
for this factor was 3.40 ± 0.71. 16 (5.8%) respondents strongly disagree that nurse
managers consider if a staff needs extra training/counseling before undertaking a task, 67
(24.1%) disagree, 107 (38.5%) agree while 88 (31.7%) strongly agree. The mean response
for this factor was 2.96 ± 0.89. 6 (2.2%) respondents strongly disagree that nurse managers
consider if a staff needs extra training/counseling before undertaking a task, 65 (23.4%)
disagree, 145 (52.2%) agree while 62 (22.3%) strongly agree. The mean response for this
factor was 2.95 ± 0.74.
Table 2 also shows that 10 (3.6%) of the respondents strongly disagree that nurse managers
provide needed guidance/support in delegating a job, 38 (13.7%) disagree, 137 (49.3%)
agree while 93 (33.5%) strongly agree. The mean response for this factor was 3.13 ± 0.78.
7 (2.5%) respondents strongly disagree that nurse managers share with the rest of the team,
the success or the shortcomings of the completed task/project, 35 (12.6%) disagree, 132
(37.4%) agree while 104 (37.4%) strongly agree. The mean response for this factor was
3.19 ± 0.75. 12 (4.3%) respondents strongly disagree that nurse managers enquire from
delegates how the work is progressing, 16 (5.8%) disagree, 133 (47.8%) agree while 117
(42.1%) strongly agree. The mean response for this factor was 3.28 ± 0.76. 14 (5.0%)
respondents strongly disagree that nurse managers pair experienced and inexperienced staff
in delegating jobs, 33 (11.9%) disagree, 113 (40.6%) agree while 118 (42.4%) strongly
agree. The mean response for this factor was 3.21 ±
71
0.84. Therefore, comparing all the factors with the criterion mean of 2.50, the nurses have
good perception of the nurse managers’ adherence to the stipulated guideline/criteria in
delegating responsibilities. This was also confirmed by the grand mean of 3.20.
Research question 2: Assess nurses’ perception of their nurse managers’ use of nursing
job description in delegating responsibilities
Decision rule: Values greater than or equal to 2.5 (≥ 2.5)indicate that nurses perceived
their managers as delegating responsibilities correctly or as accepted while values less than
2.5 (< 2.5) indicate that nurses so not perceive their managers as delegating responsibilities
as they should or are expected.
Research question 2 was answered using responses from questions 18-27
72
Table 3: Nurses’ perception of their nurse managers’ use of nursing job description in
delegating responsibilities
S/n Items Strongly disagree n (%)
Disagree n (%)
Agree n (%)
Strongly agree n (%)
Mean ± SD
1 Give required/appropriate information on the task being delegated
12 (4.3) 39 (14.0) 117 (42.1) 110 (39.6) 3.17 ± 0.83
2 Define specific expectation of the jobs to be accomplished
15 (5.4) 39 (14.0) 142 (51.1) 82 (29.5) 3.05 ± 0.81
3 Match subordinates experience with skill needed to carry out task delegated
14 (5.0) 50 (18.0) 122 (43.9) 92 (33.1) 3.05 ± 0.84
4 Match subordinates competence with skill needed to carry out task delegated
18 (6.5) 48 (17.2) 117 (42.1) 95 (34.2) 3.04 ± 0.88
5 Consider the institution (hospital) policies in taking the decision to delegate a task
15 (5.4) 42 (15.1) 113 (40.6) 108 (38.8) 3.13 ± 0.86
6 Consider the professional policies/standard in taking the decision to delegate a task
20 (7.2) 33 (11.9) 118 (42.4) 107 (38.5) 3.12 ± 0.88
7 Take into consideration the level of education before delegating a job to their subordinate
28 (10.1) 76 (27.3) 93 (33.5) 81 (29.1) 2.82 ± 0.97
8 Take into consideration the training attended before delegating a job to their subordinate
20 (7.2) 71 (25.5) 108 (38.8) 79 (28.4) 2.88 ± 0.90
9 Utilize other relevant information such as delegate shift, position and location before delegating task
17 (6.1) 73 (26.3) 119 (42.8) 69 (24.8) 2.86 ± 0.86
10 Match staff skill/expertise to patients need before delegating a task
17 (6.1) 62 (22.3) 110 (39.6) 89 (32.0) 2.97 ± 0.89
GRAND MEAN 3.00 ± 0.76
Table 3 shows that 12 (43%) of the respondents strongly disagree that nurse managers give
required/appropriate information on the task being delegated, 39 (14.0%) disagree, 117
(42.1%) agree while 110 (39.6%) strongly agree. The mean response for this factor was
3.17 ± 0.83. From the table, 15 (5.4%) respondents strongly disagree that nurse managers
define specific expectation of the jobs to be accomplished, 39 (14.0%) disagree, 142
(51.1%) agree, while 82 (29.5%) strongly agree. The mean response for this factor was
3.05 ± 0.81. 14 (5.0%) respondents strongly disagree that nurse managers match
subordinates experience with skill needed to carry out task delegated, 50 (18.0%) disagree,
122 (43.9%) agree while 92 (33.1%) strongly agree. The mean response for this factor was
3.05 ± 0.84. 18 (6.5%) respondents strongly disagree that nurse managers match
73
subordinates competence with skill needed to carry out task delegated, 48 (17.2%)
disagree, 117 (42.1%) agree while 95 (34.2%) strongly agree. The mean response for this
factor was 3.04 ± 0.88.
Table 3 also shows that 15 (5.4%) of the respondents strongly disagree that nurse managers
consider the institution (hospital) policies in taking the decision to delegate a task, 42
(15.1%) disagree, 113 (40.6%) agree while 108 (38.8%) strongly agree. The mean response
for this factor was 3.13 ± 0.86. 20 (7.2%) respondents strongly disagree that nurse
managers consider the professional policies/standard in taking the decision to delegate a
task, 33 (11.9%) disagree, 118 (42.4%) agree while 107 (38.5%) strongly agree. The mean
response for this factor was 3.12 ± 0.88. 28 (10.1%) respondents strongly disagree that
nurse managers take into consideration the level of education before delegating a job to
their subordinate, 71 (25.5%) disagree, 108 (38.8%) agree while 79 (28.4%) strongly agree.
The mean response for this factor was 2.88 ± 0.90. 17 (6.1%) respondents strongly
disagree that nurse managers utilize other relevant information such as delegate shift,
position and location before delegating task, 73 (26.3%) disagree, 119 (42.8%) agree while
69 (24.8%) strongly agree. The mean response for this factor was 2.86 ± 0.86. 17 (6.1%)
respondents strongly disagree that nurse managers match staff skill/expertise to patients
need before delegating a task, 62 (22.3%) disagree, 110 (39.6%) agree while 89 (32.0%)
strongly agree. The mean response for this factor was 2.97 ± 0.89. Therefore, comparing all
the factors with the criterion mean of 2.50, the nurses have good perception of the nurse
managers’ use of nursing job description in delegating responsibilities. This was also
confirmed by the grand mean of 3.00.
Research question 3: Assess nurses’ perception of their nurse managers’ practice of
transfer of authority in delegating responsibilities
Decision rule: Values greater than or equal to 2.5 (≥ 2.5)indicate that nurses perceived their managers as delegating responsibilities correctly or as accepted while values less than
74
2.5 (< 2.5) indicate that nurses so not perceive their managers as delegating responsibilities as they should or are expected.
Research question 3 was answered using responses from questions 28-38
Table 4: Nurses’ perception of their nurse managers’ practice of transfer of authority in delegating responsibilities
S/n Items Strongly disagree n (%)
Disagree n (%)
Agree n (%)
Strongly agree n (%)
Mean ± SD
1 Allow delegates freedom to use their discretion and creativity to accomplish their task
14 (5.0) 52 (18.7) 118 (42.4) 94 (33.8) 3.05 ± 0.85
2 Ensure that each person working on a project/task gets to understand the individual roles and responsibilities involved
7 (2.5) 36 (12.9) 146 (52.5) 89 (32.0) 3.14 ± 0.73
3 Delegate with trust/confidence on the delegates
6 (2.2) 51 (18.3) 135 (48.6) 86 (30.9) 3.08 ± 0.76
4 Allow the subordinate to indicate if authority given to him/her is enough to produce desired results
26 (9.4) 90 (32.4) 114 (41.0) 48 (17.3) 2.66 ± 0.87
5 Make provision for negotiating for more authority if the subordinate consider it necessary
29 (10.4) 94 (33.8) 100 (36.0) 55 (19.8) 2.65 ± 0.91
6 Ensure that a blaming culture does not exist in the work place i.e to remove fear of failure among subordinates
24 (8.6) 69 (24.8) 131 (47.1) 54 (19.4) 2.77 ± 0.86
7 Encourage employee to come up with their own solutions to problems identified (i.e. not to dump problems upwards)
30 (10.8) 49 (17.6) 118 (42.4) 81 (29.1) 2.89 ± 0.94
8 Outline clearly the level of authority associated with the delegated job
22 (7.9) 56 (20.1) 139 (50.0) 61 (21.9) 2.85 ± 0.85
9 Inform other members of the team the level of authority that has been ascribed to the delegates while they undertake the task
22 (7.9) 77 (27.7) 125 (45.0) 54 (19.4) 2.76 ± 0.86
10 Give required/appropriate information in the task being delegated
19 (6.8) 34 (12.2) 136 (48.9) 89 (32.0) 3.06 ± 0.85
11 Delegate responsibilities as an invitation for participation
24 (8.6) 80 (28.8) 124 (44.6) 50 (18.0) 2.72 ± 0.86
GRAND MEAN 2.88 ± 1.03
75
Table 4 shows that 14 (5.0%) of the respondents strongly disagree that nurse managers
allow delegates freedom to use their discretion and creativity to accomplish their task, 52
(18.7%) disagree, 118 (42.4%) agree while 94 (33.8%) strongly agree. The mean response
for this factor was 3.05 ± 0.85. From the table, 4 (2.5%) respondents strongly disagree that
nurse managers ensure that each person working on a project/task gets to understand the
individual roles and responsibilities involved, 36 (12.9%) disagree, 146 (52.5%) agree,
while 89 (32.0%) strongly agree. The mean response for this factor was 3.14 ± 0.73. 6
(2.2%) respondents strongly disagree that nurse managers delegate with trust/confidence on
the delegates, 51 (18.3%) disagree, 135 (48.6%) agree while 86 (30.9%) strongly agree.
The mean response for this factor was 3.08 ± 0.76. 26 (9.4%) respondents strongly disagree
that nurse managers allow the subordinate to indicate if authority given to him/her is
enough to produce desired results, 90 (32.4%) disagree, 114 (41.0%) agree while 48
(17.3%) strongly agree. The mean response for this factor was 2.66 ± 0.87.
Table 4 also shows that 29 (10.4%) of the respondents strongly disagree that nurse
managers make provision for negotiating for more authority if the subordinate consider it
necessary, 94 (33.8%) disagree, 100 (36.0%) agree while 55 (19.8%) strongly agree. The
mean response for this factor was 2.65 ± 0.91. 24 (8.6%) respondents strongly disagree that
nurse managers ensure that a blaming culture does not exist in the work place i.e to
remove fear of failure among subordinates, 69 (24.8%) disagree, 131 (47.1%) agree while
54 (19.4%) strongly agree. The mean response for this factor was 2.77 ± 0.86. 30 (10.8%)
respondents strongly disagree that nurse managers encourage employee to come up with
their own solutions to problems identified (i.e. not to dump problems upwards), 49 (17.6%)
disagree, 118 (42.4%) agree while 81 (29.1%) strongly agree. The mean response for this
factor was 2.89 ± 0.94. 22 (7.9%) respondents strongly disagree that nurse managers
76
outline clearly the level of authority associated with the delegated job, 56 (20.1%) disagree,
139 (50.0%) agree while 61 (21.9%) strongly agree. The mean response for this factor was
2.85 ± 0.85. 22 (7.9%) respondents strongly disagree that nurse managers inform other
members of the team the level of authority that has been ascribed to the delegates while
they undertake the task, 77 (27.7%) disagree, 125 (45.0%) agree while 54 (19.4%) strongly
agree. The mean response for this factor was 2.76 ± 0.86. 19 (6.8%) respondents strongly
disagree that nurse managers give required/appropriate information in the task being
delegated, 34 (12.2%) disagree, 136 (48.9%) agree while 89 (32.0%) strongly agree. The
mean response for this factor was 3.06 ± 0.85. 24 (8.6%) respondents strongly disagree
that nurse managers delegate responsibilities as an invitation for participation, 80 (28.8%)
disagree, 124 (44.6%) agree while 50 (18..0%) strongly agree. The mean response for this
factor was 2.72 ± 0.86. Therefore, comparing all the factors with the criterion mean of
2.50, the nurses have good perception of the nurse managers’ practice of transfer of
authority in delegating responsibilities. This was also confirmed by the grand mean of 2.88.
Research question 4: Determine how nurse managers use accountability in the process of
delegating responsibilities
Decision rule: Values greater than or equal to 2.5 (≥ 2.5)indicate that nurses perceived
their managers as delegating responsibilities correctly or as accepted while values less than
2.5 (< 2.5) indicate that nurses so not perceive their managers as delegating responsibilities
as they should or are expected.
Research question 4 was answered using responses from questions 39-46
77
Table 5: Nurse Managers’ use of accountability in the process of delegating responsibilities
S/n Items Strongly disagree n (%)
Disagree n (%)
Agree n (%)
Strongly agree n (%)
Mean ± SD
1 Ensure subordinate know what is expected of them
14 (5.0) 20 (7.2) 118 (42.4) 126 (45.3) 3.28 ± 0.81
2 Develop accurate methods of measuring results in delegated job
15 (5.4) 62 (22.3) 126 (45.3) 75 (27.0) 2.94 ± 0.84
3 Select the appropriate job to delegate to a subordinate
12 (4.3) 42 (15.1) 137 (49.3) 87 (31.3) 3.08 ± 0.80
4 Selects appropriate staff based on skill/experience to carry out the task
18 (6.5) 44 (15.8) 122 (43.9) 94 (33.8) 3.05 ± 0.87
5 Communicate early the expectation of the task to be accomplished
15 (5.4) 66 (23.7) 115 (41.4) 82 (29.5) 2.95 ± 0.87
6 Ensure the required follow-up while the task is being completed
19 (6.8) 63 (22.7) 132 (47.5) 64 (23.0) 2.87 ± 0.85
7 Take ultimate accountability for the process and outcome of the care in delegated task
17 (6.1) 59 (21.2) 113 (40.6) 89 (32.0) 2.99 ± 0.88
8 Evaluate and give feedback on the effectiveness of delegation to staff
17 (6.1) 50 (18.0) 120 (43.2) 91 (32.7) 3.03 ± 0.87
GRAND MEAN 3.02 ± 1.32
Table 5 shows that 14 (5.0%) of the respondents strongly disagree that nurse managers ensure
subordinate know what is expected of them, 20 (7.2%) disagree, 118 (42.4%) agree while
126 (45.3%) strongly agree. The mean response for this factor was 3.28 ± 0.81. From the
table, 15 (5.4%) respondents strongly disagree that nurse managers develop accurate
methods of measuring results in delegated job, 62 (22.3%) disagree, 126 (45.3%) agree,
while 75 (27.0%) strongly agree. The mean response for this factor was 2.94 ± 0.84. 12
(4.3%) respondents strongly disagree that nurse managers select the appropriate job to
delegate to a subordinate, 42 (15.1%) disagree, 137 (49.3%) agree while 87 (31.3%)
strongly agree. The mean response for this factor was 3.08 ± 0.80. 18 (6.5%) respondents
strongly disagree that nurse managers selects appropriate staff based on skill/experience to
carry out the task, 44 (15.8%) disagree, 122 (43.9%) agree while 94 (33.8%) strongly
agree. The mean response for this factor was 3.05 ± 0.87.
Table 5 also shows that 15 (5.4%) of the respondents strongly disagree that nurse managers
communicate early the expectation of the task to be accomplished, 66 (23.7%) disagree,
78
115 (41.4%) agree while 82 (29.5%) strongly agree. The mean response for this factor was
2.95 ± 0.87. 19 (6.8%) respondents strongly disagree that nurse managers ensure the
required follow-up while the task is being completed, 63 (22.7%) disagree, 132 (47.5%)
agree while 64 (23.0%) strongly agree. The mean response for this factor was 2.87 ± 0.85.
17 (6.1%) respondents strongly disagree that nurse managers take ultimate accountability
for the process and outcome of the care in delegated task, 59 (21.2%) disagree, 113
(40.6%) agree while 89 (32.0%) strongly agree. The mean response for this factor was 2.99
± 0.88. 17 (6.1%) respondents strongly disagree that nurse managers evaluate and give
feedback on the effectiveness of delegation to staff, 50 (18.0%) disagree, 120 (43.2%)
agree while 91 (32.7%) strongly agree. The mean response for this factor was 3.03 ± 0.87.
Hence, comparing all the factors with the criterion mean of 2.50, the nurses have good
perception of the nurse managers’ use of accountability in the process of delegating
responsibilities. This was also confirmed by the grand mean of 3.02.
Research question 5: Ascertain nurses’ perception of their nurse managers’ supervision of
delegated responsibilities
Decision rule: Values greater than or equal to 2.5 (≥ 2.5)indicate that nurses perceived
their managers as delegating responsibilities correctly or as accepted while values less than
2.5 (< 2.5) indicate that nurses so not perceive their managers as delegating responsibilities
as they should or are expected.
79
Research question 5 was answered correct responses from questions 47-54
Table 6: Nurses’ perception of their nurse managers’ supervision of delegated responsibilities
S/n Items Strongly disagree n (%)
Disagree n (%)
Agree n (%)
Strongly agree n (%)
Mean ± SD
1 Involve stating and communicating the objectives clearly to the subordinate
12 (4.3) 38 (13.7) 124 (44.6) 104 (37.4) 3.15 ± 0.81
2 Evaluate if the task has been performed according to established standards of practice
11 (4.0) 40 (14.4) 118 (42.4) 109 (39.2) 3.17 ± 0.82
3 Oversees/observe performance of delegates during their activities to ensure achievement of objective already set
17 (6.1) 53 (19.1) 124 (44.6) 84 (30.2) 2.99 ± 0.86
4 Decide/discuss the supervision that is necessary during the process of delegation
16 (5.8) 95 (34.2) 109 (39.2) 58 (20.9) 2.75 ± 0.85
5 Supervise during and after each procedure to ensure that the subordinate do the right thing at the right time
17 (6.1) 69 (24.8) 101 (36.3) 91 (32.7) 2.96 ± 0.91
6 Determine/vary the degree of supervision required depending on the training/skill/experience of the delegate
15 (5.4) 87 (31.3) 108 (38.8) 68 (24.5) 2.82 ± 0.86
7 Observe if the delegate remains competent to perform the delegated task when client condition deteriorates
14 (5.0) 63 (22.7) 126 (45.3) 75 (27.0) 2.94 ± 0.83
8 Takes necessary steps to discontinue the delegation of the task when a delegate is observed to be incompetent
21 (7.6) 66 (23.7) 99 (35.6) 92 (33.1) 2.94 ± 0.93
GRAND MEAN 2.97 ± 0.87
Table 6 shows that 12 (4.3%) of the respondents strongly disagree that nurse managers
involve stating and communicating the objectives clearly to the subordinate, 38 (13.7%)
disagree, 124 (44.6%) agree while 104 (37.4%) strongly agree. The mean response for this
factor was 3.15 ± 0.81. From the table, 11 (4.0%) respondents strongly disagree that nurse
managers evaluate if the task has been performed according to established standards of
practice, 40 (14.4%) disagree, 118 (42.4%) agree, while 109 (39.2%) strongly agree. The
mean response for this factor was 3.17 ± 0.82. 17 (6.1%) respondents strongly disagree that
the nurse managers Oversees/observe performance of delegates during their activities to
ensure achievement of objective already set, 53 (19.1%) disagree, 124 (44.6%) agree while
80
84 (30.2%) strongly agree. The mean response for this factor was 2.99 ± 0.86. 16 (5.8%)
respondents strongly disagree that nurse managers Decide/discuss the supervision that is
necessary during the process of delegation, 95 (34.2%) disagree, 109 (39.2%) agree while
58 (20.9%) strongly agree. The mean response for this factor was 2.75 ± 0.85.
Table 6 also shows that 17 (6.1%) of the respondents strongly disagree that nurse managers
supervise during and after each procedure to ensure that the subordinate do the right thing
at the right time, 69 (24.8%) disagree, 101 (36.3%) agree while 91 (32.7%) strongly agree.
The mean response for this factor was 2.96 ± 0.91. 15 (5.4%) respondents strongly disagree
that nurse managers determine/vary the degree of supervision required depending on the
training/skill/experience of the delegate, 87 (31.3%) disagree, 108 (38.8%) agree while 68
(24.5%) strongly agree. The mean response for this factor was 2.82 ± 0.86. 14 (5.0%)
respondents strongly disagree that nurse managers observe if the delegate remains
competent to perform the delegated task when client condition deteriorates, 63 (22.7%)
disagree, 126 (45.3%) agree while 75 (27.0%) strongly agree. The mean response for this
factor was 2.94 ± 0.83. 21 (7.6%) respondents strongly disagree that nurse managers takes
necessary steps to discontinue the delegation of the task when a delegate is observed to be
incompetent, 66 (23.7%) disagree, 99 (35.6%) agree while 92 (33.1%) strongly agree. The
mean response for this factor was 2.94 ± 0.93. Hence, comparing all the factors with the
criterion mean of 2.50, the nurses have good perception of the nurse managers’ supervision
of delegated responsibilities. This was also confirmed by the grand mean of 2.97.
HYPOTHESES TESTING Ho1: There is no significant difference in the nurses’ perception of their nurse managers’ delegation of responsibility based on their ages
81
Table 8: Difference in the nurses’ perception of their nurse managers’ delegation of responsibility based on their ages Age group
≤25 Mean±SD
26-30 Mean±SD
31-35 Mean±SD
36-40 Mean±SD
41-45 Mean±SD
46-50 Mean±SD
51-55 Mean±SD
Use of stipulated guidelines/criteria in delegation of responsibilities
3.23±0.33 3.18±0.46 3.19±0.45 3.18±0.45 3.21±0.34 3.36±0.34 3.23±0.34
Use of nursing job description in delegation of responsibilities
2.90±0.34 3.03±0.50 3.03±0.52 2.95±0.57 3.11±0.41 3.04±0.83 2.84±0.88
Practice of transfer of authority in delegation of responsibilities
2.79±0.36 2.93±0.49 2.80±0.54 2.91±0.62 3.00±0.51 2.99±0.59 2.55±0.72
Practice of accountability in delegation of responsibilities
2.73±0.78 3.08±0.59 2.93±0.68 3.05±0.65 2.97±0.76 3.24±0.66 3.10±0.60
Practice of supervision in delegation of responsibilities
2.66±0.80 2.98±0.58 2.88±0.71 3.07±0.56 2.89±0.83 3.21±0.69 2.84±0.96
Managers' delegation of responsibility
2.86±0.34 3.03±0.42 2.96±0.45 3.02±0.47 3.04±0.45 3.15±0.53 2.88±0.51
82
Decision rule Since the significant values (p value) of the F statistic are greater than 0.05 level of significance
for all the items tested, the null hypothesis is hereby accepted. Therefore, there is no significant
difference in the nurses’ perception of their nurse managers’ delegation of responsibility based
on their ages
Ho2: There is no significant difference in the nurses’ perception of their nurse managers’
delegation of responsibility based on their rank
Table 9: Difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their rank
Rank N Mean Std. Deviation t P value
Managers' delegation
of responsibility
nursing officer 142 3.03 0.40 0.858 0.391
senior nursing officer 136 2.98 0.49
Decision rule Since the significant value (p = 0.391) of the t statistic is greater than 0.05 level of significance,
the null hypothesis is hereby accepted. Therefore, there is no significant difference in the nurses’
perception of their nurse managers’ delegation of responsibility based on their rank.
83
Ho3: There is no significant difference in the nurses’ perception of their nurse managers’
delegation of responsibility based on their years of experience
Table 10: Difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their years of experience
Years of Experience 1 - 5 Mean±SD
6 - 10 Mean±SD
11 – 15 Mean±SD
>15 Mean±SD
Practice of transfer of authority in delegation of
responsibilities
3.18±0.47 3.22±0.39 3.20±0.44 3.19±0.42
Practice of accountability in delegation of responsibilities 3.00±0.59 3.05±0.48 2.87±0.59 2.89±0.79
Practice of supervision in delegation of responsibilities 2.92±0.52 2.89±0.53 2.62±0.73 2.74±0.71
Managers' delegation of responsibility 3.04±0.68 3.04±0.62 2.86±0.66 2.96±0.85
Practice of transfer of authority in delegation of
responsibilities
3.00±0.70 2.98±0.65 2.79±0.61 2.72±0.24
Practice of accountability in delegation of responsibilities 3.02±0.44 3.03±0.43 2.85±0.51 2.89±0.65
Decision rule Since the significant values (p value) of the F statistic are greater than 0.05 level of significance
for all the items tested, the null hypothesis is hereby accepted. Therefore, there is no significant
difference in the nurses’ perception of their nurse managers’ delegation of responsibility based
on their years of experience
lxxxiv
Ho4: There is no significant difference in the nurses’ perception of their nurse managers’
delegation of responsibility based on their institution.
Table 10: Difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their institution
UNTH Mean ± SD
ESUTH Mean ± SD
FNHE Mean ± SD
NOH Mean ± SD
F P value
Use of stipulated guidelines/criteria in delegation of responsibilities
3.22 ± 0.46 3.13 ± 0.47 3.22 ± 0.29 3.24 ± 0.40 0.884 0.450
Use of nursing job description in delegation of responsibilities
3.01 ± 0.66 2.91 ± 0.49 3.15 ± 0.44 3.07 ± 0.44 1.786 0.150
Practice of transfer of authority in delegation of responsibilities
2.93 ± 0.59 2.68 ± 0.51 3.02 ± 0.46 2.96 ± 0.53 4.864 0.003
Practice of accountability in delegation of responsibilities
3.19 ± 0.62 2.73 ± 0.61 3.17 ± 0.49 2.98 ± 0.75 8.745 < 0.001
Practice of supervision in delegation of responsibilities
3.11 ± 0.62 2.67 ± 0.62 3.11 ± 0.55 2.98 ± 0.77 7.599 < 0.001
Managers' delegation of responsibility
3.08 ± 0.48 2.82 ± 0.38 3.13 ± 0.37 3.04 ± 0.46 6.565 < 0.001
Decision rule Since the significant values (p value) of the F statistic are less than 0.05 level of significance for
four out of six items tested, the null hypothesis is hereby rejected and the alternative accepted.
Therefore, there is no significant difference in the nurses’ perception of their nurse managers’
delegation of responsibility based on their institutions. The items where the variations occurred
were: practice of transfer of authority in delegation of responsibilities, practice of accountability
in delegation of responsibilities, practice of supervision in delegation of responsibilities and
managers' delegation of responsibility.
lxxxv
Summary of findings The nurses perceive that their nurse manager’s adhere to stipulated guideline/criteria in
delegating responsibilities. (grand mean = 3.00).
The nurses perceive that their nurse manager’s use nursing job description in delegating
responsibilities (grand mean = 3.00).
The nurses perceive that their nurse manager’s practice transfer of authority in delegating
responsibilities (grand mean = 2.88).
The nurses perceive that their nurse manager’s use accountability in the process of delegating
responsibilities (grand mean = 3.02).
The nurses perceive that their nurse manager’s supervise delegated responsibilities (grand mean
= 2.97).
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their ages
(P > 0.05).
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their rank (P > 0.05).
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their years of experience (P > 0.05).
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their institutions (P < 0.05).
lxxxvi
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter presents discussion of findings, implication for nursing, limitation of the study, suggestion
for further research, summary, conclusions and recommendations.
Research Question 1:
What are the nurses’ perceptions of their nurse manager’s adherence to stipulated
guideline/criteria in delegating responsibilities?
The results from table 2 revealed that majority of the respondents believed that the nurse
managers adhere to stipulated guidelines/criteria in delegating responsibilities. Most of the
respondents agreed that the nurse managers consider the specific needs of the patients in
deciding what tasks should be delegated. In assessing whether the nurse managers consider the
nature of the task before delegating it to a particular nurse, a greater number of the respondents
believed that the nurse managers always consider the nature of a task before delegating it to a
particular nurse.
Most of the respondents also had good/positive perception on the remaining six (6) items on
research question 1, namely; if nurse managers consider if a staff needs extra training/counseling
before undertaking a task, whether nurse managers discuss the responsibilities associated with
the task with subordinates, whether the nurse managers provide needed guidance/support in
delegating a job, whether the nurse managers share with the rest of the team the successes or the
shortcomings of the completed task/project, whether the nurse managers enquire from delegates
how the work is progressing and whether the nurse managers pair experienced and inexperienced
lxxxvii
staff in delegating jobs. Findings from this study corroborated those in Anthony and Hertz
(2010), who found that the nurses have positive perception of their nurse managers’ adherence to
protocols and guidelines. The result was expected since the 4 tertiary health institutions under
study have established protocols that the nurse managers were taught through seminars,
workshops and continuing education programmes. Conversely, Corazzini et al (2010)
documented nurses’ poor perception of their managers’ leadership and delegation of duties based
on stipulated guidelines. The difference in findings could be due to the fact that Corazzini et al
used qualitative descriptive design in a small population of 33 participants. Their instrument was
structured individual indept interview as against the questionnaire administered on a large
population of 278 participants in this study.
Research question 2
What are the nurses’ perception of their nurse managers’ use of nursing job description in
delegating responsibilities?
Findings from this study revealed that the nurses perceived that their nurse managers use nursing
job description in delegating responsibilities.Majority of the respondents held the opinion that
their nurse give required/appropriate information on the task being delegated, define specific
expectation of the jobs to be completed. Most of the respondents also believed that their nurse
managers match subordinate’s experience/competence with skill needed to carry out task
delegated. Assessment on whether thenurse managers consider institution’s policies, professional
policies, delegates’ level of education/training attended before delegating responsibilities,
majority of the respondents answered in the affirmative. Findings from research question 2
agreed with the findings of Corazzini et al (2010) that nurse managers make use of nursing job
lxxxviii
description in delegating responsibilities and that the benefits for the delegates included
enhanced knowledge and skills, increased competence, confidence, high morale and motivation.
Years of experience in work places, seminars and workshops must have taught the nurse
managers in the 4 tertiary health institutions the practice of using job description in delegating
responsibilities.
Research question 3
What are the nurses’ perception of their nurse managers’ practice of transfer of authority
in delegating responsibilities?
Findings of the study on table 4 revealed that majority of respondents perceived that their nurse
managers practice transfer of authority in delegating responsibilities.Most of them strongly
agreed that nurse managers allow delegates freedom to use their discretion and creativity to
accomplish their task. Greater number of the respondents has positive perception of their nurse
managers’ practice of ensuring that each person working on a project/task gets to understand the
individual roles and responsibilities involved. Majority of the nurses also agreed that their nurse
managers delegate with trust, allow the subordinate to indicate if authority given to him/her is
enough to produce desired results, and make provisions for negotiating for more authority if
necessary.The findings are in agreement with those of Hasson et al (2012), who found out that
nurse managers practice transfer of authority in delegating responsibilities. The findings also
agreed with those of Corazzini et al (2010) who also stated that nurse managers practice transfer
of authority in delegating responsibilities and that this practice builds confidence and trust
among team members through enhanced communication, teamwork and leadership skills.
lxxxix
Research question 4
What are the nurses’ perceptions of their nurse managers’ use of accountability in
delegating responsibilities?
Findings from this study as recorded on table 5 revealed that the majority of the nurse
respondents held the opinion that their nurse managers practice accountability in delegating
responsibilities. This is evidenced by the fact that most of the respondents agreed that their nurse
managers always ensure that subordinates know what is expected of them and they also develop
accurate methods of measuring results in delegated jobs .Majority of the respondents also
believed that their nurse managers take ultimate accountability for the process and outcome of
care in delegated task.
Assessment of whether the nurse managers ensure the required follow-up while the task is being
completed, and whether they evaluate and give feedback on the effectiveness of delegation to
staff showed that the respondents had positive opinions. The above results correlate with the
results of Standing et al (2010), who revealed that nurse managers categorize delegated tasks as
lower or higher activities and they accept responsibilities for the outcome of such delegated
tasks. Also Gravlin and Bittner (2010), in support stated that nurses must have a clear
understanding of their accountability for actions or inactions of others in delegating process. The
reasons for the above findings could be the nurse managers in the institution under study must
learned from the years of experience that they are accountable and responsible to the hospital
authority and their professional bodies. They are therefore more through in assessing what to
delegate.
xc
Research question 5
What are the nurses’ perception of their nurse managers’ practice of supervision of
delegated responsibilities?
Findings from the study as recorded on table 6 revealed that nurses perceived that their nurse
managers practice supervision of delegated responsibilities. This supervision involves stating and
communicating the objectives clearly to the subordinates. Most of the respondents agreed to this.
Majority of the respondents equally agreed that their nurse managers evaluate if the task has
been performed according to established standards of practice and they also observe if the
delegate remains competent to perform the delegated task so that necessary steps should be taken
to discontinue the delegation when a delegate is observed to be incompetent.
Carin et al (2014) in support, revealed that nurses agreed that their nurse managers supervise
delegated responsibilities. They stated that supervision of delegated responsibilities as well as
reflection of conversation relating to organization are perceived as important by the nurses.Abedi
et al (2007) in agreement revealed that nurse managers practice supervision of delegated
responsibilities and that supervision is a category of delegation. The findings of this study were
expected in a tertiary health institution, especially teaching hospitals where senior professionals
teach, supervise and mentor their junior colleagues.
Hypotheses one: There is no significant difference in nurses’ perception of their nurse managers’
delegation of responsibilities based on their ages.
The study revealed that nurses’ perception of nurse managers delegation of responsibilities did not vary
according to the ages of the nurses. This is evidence by the fact that all the items tested in this factor (age)
xci
scored above criterion mean of 2.5. This was expected because all the nurse in tertiary institutions studied
were/are always participating in workshops. Seminars and continuing education programmes irrespective
of age. Corazzini et al (2010), however, identified age among other factors as a barrier to delegation of
responsibilities by nurse managers but the ages of nurses did not affect their perception of their nurse
managers delegation of responsibilities. This finding supports the saying that “age is no barrier to
learning;
Hypothesis Two: There is no significant difference in the nurse perception of their nurse managers’
delegation of responsibility based on their ranks.
No significant different was found in nurses’ perception of their nurse managers’ delegation of
responsibilities based on the rank of the nurses. The result was expected since knowledge and experience
are always shared among rank and file in nursing profession especially in a tertiary hospital. Leaders and
managers in nursing profession make it a point of duty to disseminate useful information across the ranks
of nurses.This finding is in agreement with the findings of Standing et al (2010) which revealed no
difference in nurses’ perception of their nurse managers’ delegation of responsibilities based on ranks.
Hypothesis three: There is no significant difference in the nurses’ perception of their nurse mangers’
delegation of responsibility based on their years of experience.
This result showed that years of experience did not influence the way nurses perceive their nurse
mangers’ delegation of responsibilities. The finding was expected in a world that has become a global
village in which information and communication technology makes information sharing simple and fast.
A young nurse quickly taps from the experience of her senior colleague, or from the world of technology.
xcii
The result agreed with that of Hasson et al (2012) which showed no significant difference based on years
of experience.
Hypothesis Four: There is no significant difference in the nurse perception of their nurse managers’
delegation of responsibilities based on their institutions.
This result demonstrated that there was a significant difference in the nurses’ perception of their nurse
managers’ delegation of responsibilities based on their institution.This finding showed that protocols and
their observances vary from institution to institution. The four (4) tertiary health institutions studied
showed significant adherence to international best practices in nursing profession. However, there was
variation in their system of rules about the correct way to act in formal situations. This is in agreement
with the findings of Standing et al (2010) which showed that institutional protocols affected nurse
perception of their nurse mangers’ delegation of responsibilities
Implication for nursing
The result of the study shows that a greater population of the respondents perceived the nurse
managers adherence to stipulated guidelines/criteria, use of nursing job description, practice of
delegation of authority, practice of accountability and supervision as positive. Therefore it
becomes necessary that the nurse managers should mentor the subordinates and student nurses to
help them develop delegation skills. Its benefit will help in developing quality nurses that will
give quality care, which will in turn lead to better caring outcome for the patients. The
organization at large will also benefit because patients need where they will get better care and
this will lead to increase patient flow.Hence, regular update, seminar and workshop are needed to
enhance delegation skills.
xciii
Limitation
There is paucity of literature for the study.
Nurses find it difficult to fill questionnaire by giving excuses that there is no time. Delegation
activity in tertiary hospitals where supervision and inter-professional communication is available
is different from health centre setting and so findings from this study cannot be extended to
them. This study was conducted in one province and. thus may limit its generalizability
Suggestion for further research
Similar study should be carried out to compare tertiary, state and private facilities.
Same study should be carried out on managers’ perspective
Nurses’ perception of their nurse managers’ delegation of responsibilities in health institutions
should be carried out in other geopolitical zones.
Studies identifying other factors which may relate to delegation perception may be investigation.
Summary
The main purpose of the study was to determine nurses’ perception of their nurse managers’
delegation of responsibilities in tertiary hospitals in Enugu State. To achieve the purpose of this
study, five objectives were set: to determine nurses’ perception of their nurse managers’
adherence to stipulated guidelines/criteria in delegating responsibilities, assess nurses’ perception
of their nurse managers’ use of nursing job description in delegating responsibilities, assess
nurses’ perception of their nurse managers’ practice of the transfer of authority when delegating
responsibilities, determine how nurse managers use accountability in the process of delegating
xciv
responsibilities, and ascertain nurses’ perception of their nurse managers’ supervision of
delegated responsibilities. This helped to elicit information regarding nurses’ perception of their
nurse managers’ delegation of responsibilities. Four hypotheses were used to test significant
difference in nurses’ age, rank, years of experience, institutional variation and nurses’ perception
of their nurse managers’ delegation of responsibilities. Literature review was carried out on the
related topics.
A descriptive survey design was adopted for the study. The areas of study were four tertiary
health institutions in Enugu State: UNTH, ESUTH, NPHE and NOHE. The population of the
study comprised 943 Nursing sisters and Senior Nursing Sisters in the four tertiary health
institutions. A sample size of 300 nurses was calculated using Krejcie and Morgan power
formula and a 10% attrition rate. Inclusion criteria were observed. A purposive sampling
technique was used to select the samples from each of the institutions for the study.
Questionnaire was used for data collection. Split half method was used to test for reliability
which yielded 0.895 and 0.959 respectively. Descriptive statistics data analysis was done with
the aid of SPSS (Statistical Package for Social Sciences) version 20. T-test and ANOVA were
used to test for hypotheses.
The findings from the study have shown that the nurses perceived that their nurse manager’s
adhere to stipulated guidelines/criteria in delegating responsibilities, use nursing job description
in delegating responsibilities, practice transfer of authority in delegating responsibilities, use
accountability in the process of delegating responsibilities and supervise delegated
responsibilities. No significant difference was found `between nurses’ age, rank, years of
experience and their perception of their managers’ delegation of responsibilities. However, there
xcv
is significant difference found in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their institutions.
Conclusion
Based on the findings of this study, it can be concluded that:
- The nurses perceived that their nurse manager’s adhere to stipulated guideline/criteria in delegating
responsibilities.
- The nurses perceived that their nurse manager’s use nursing job description in delegating
responsibilities.
- The nurses perceived that their nurse manager’s practice transfer of authority in delegating
responsibilities.
- The nurses perceived that their nurse manager’s use accountability in the process of delegating
responsibilities.
- The nurses perceived that their nurse manager’s supervise delegated responsibilities.
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their ages
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their rank.
There is no significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their years of experience.
xcvi
There is a significant difference in the nurses’ perception of their nurse managers’ delegation of
responsibility based on their institutions. This is because four out of the items tested in this factor scored
less than 0.5 level of significance which shows that there is institutional variation of the nurses
perception of nurse managers delegation of responsibility.
Recommendations
Based on the findings from the study, the following recommendations were made:
� The nurse managers should mentor the student nurses and subordinates on delegation
skills so that they would be able to render quality care
� Seminars and workshop should be done regularly to enhance already learnt skill
xcvii
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cii
APPENDIX: I
Nursing Science Department
Faculty of Health Sciences and Technology
University of Nigeria
Enugu, Campus.
Dear Respondent,
QUESTIONNAIRE
I am an MSc Student in the Nursing Sciences Department, University of Nigeria Enugu
Campus. This questionnaire is designed to assess the nurse’s perception of their nurse manager’s
delegation of responsibilities in tertiary hospital in Enugu state. Kindly assist me in completing
the questionnaire by selecting from answers provided
The information obtained is purely for academic purposes and confidentiality will be
maintained. Therefore, you are not required to disclose your name. Please, the success of this
study depends on your honest response to this questionnaire.
Yours faithfully
Nze Edith C.
ciii
General Instruction
Please tick [√] in the most appropriate box that reflects your honest response.
Section A
Demographic Data
1. What is your age {last birthday}?
2. What is your gender?
Male Female
3. What is your Religion?
Christianity
Muslim
Paganism/Traditional Religion
4. Marital Status
Married
Single
Divorce/Separated
Widowed
5. Educational Qualification
Registered Nurse
Registered Midwife
Bsc Nursing/BNSC
Master’s Degree
PHD
6. Which of these hospitals do you work in?
University of Nigeria Teaching Hospital Ituku Ozalla
Enugu State Teaching Hospital
Federal Neuro Psychiatric Hospital Enugu
civ
National Orthopedic Hospital Enugu
7. In which unit do you presently work?
Surgical Pediatrics
Medical Psychiatric
Acc & Emerg Ophthalmic
Maternity GOPD
Theatre Others specify
8. What is your Designation?
Nursing Officer
Senior Nursing Officer
9. Years of Experience
cv
Section B Tick (√ ) the appropriate option in the box provided
Strongly agreed-4
Agreed - 3
D-Disagreed -2
SD-Strongly disagreed-1
Use of stipulated guidelines/criteria in delegating responsibilities.
10
The Nurse Managers: SA A D DS
Consider the specific needs of the patients in deciding what tasks should be
delegated
11
Consider the nature of the task before delegating it to a particular nurse.
12
Consider if a staff needs extra training/counseling before undertaking a task
13
Discuss the responsibilities associated with the task with their subordinates.
14
Provide needed guidance/support in delegating a job
15
Shares with the rest of the team, the success or the shortcomings of the
completed task/ project
16 Enquire from delegates how the work is progressing
17 Pair experienced and inexperienced staff in delegating jobs
cvi
Use of job description in delegating responsibility
The Nurse Managers: SA A D SD
18 Give required/ appropriate information on the task being delegated
19 Define specific expectation of the jobs to be accomplished
20 Match subordinate experience with skill needed to carry out task
delegated
21 Match subordinate competence with skill needed to carry out task
delegated.
22 Considering the institution (hospital) policies in taking the decision to
delegate a task.
23 Considering the professional policies /standard in taking the decision to
delegate a task.
24 Take into consideration the level of education before delegating a job to
their subordinate
25 Take into consideration the training attained before delegating a job to
their subordinate
26 Utilize other relevant information such as delegate shift, position and
location before delegating task
27 Match staff skill/expertise to patients’ needs before delegating a task
Practice of Transfer of Responsibilities in Delegating Responsibility
The Nurse Managers; SA A D SD
28 Allow delegates freedom to use their discretion and creativity to
accomplish their task
29 Ensure that each person working on a project/task gets to understand the
individual roles and responsibilities involved.
30 Delegate with trust/confidence on the delegates.
31 Allow the subordinate to indicate if responsibilities given to him/her is
enough to produce desired results.
cvii
32 Make provision for negotiating for more responsibilities if the
subordinate considers it necessary.
33 Ensure that a blaming culture does not exist in the workplace i.e. to
remove fear of failure among subordinate.
34 Encourage employee to come up with their own solutions to problems
identified (i.e. not to dump problems upwards).
35 Outline clearly the level of authority associated with the delegated job
36 Inform other members of the team the level of authority that has been
ascribed to the delegates while they undertake the task
37 Give required/appropriate information on the task being delegated
38 Delegate responsibility as an invitation for participation
Nurse Managers ’Practice of Accountability in Delegating Responsibility
The Nurse Managers: SA A D SD
39 Ensure subordinate know what is expected of them.
40 Develop accurate methods of measuring results in delegated job.
41 Select the appropriate job to delegate to a subordinate.
42 Select appropriate staff based on skill/experience to carry out the task.
43 Communicate early the expectation of the task to be accomplished.
44 Ensure the required follow-up while the task is being completed.
45 Take ultimate accountability for the process and outcome of the care in
delegated task.
46 Evaluate and give feedback on the effectiveness of delegation to staff.
cviii
Practice of supervision in delegating responsibility
The Nurse Managers; SA A D AD
47 Involve stating and communicating the objectives clearly to the
subordinate
48 Evaluate if the task has been performed according to established
standards of practice.
49 Oversee/observe performance of delegates in their activities to ensure
achievement of objective already set
50 Decide/discuss the supervision that is necessary during the process of
delegation.
51 Supervise during and after each procedure to ensure that the subordinate
does the right thing at the right time
52 Determine/vary the degree of supervision required depending on the
training/skill/experience of the delegate.
53 Observe if the delegate remains competent to perform the delegated task
when client condition deteriorates
54 Takes necessary steps to discontinue the delegation of the task when a
delegate is observed to be incompetent
cix
