NURSES’ PERCEPTION OF THEIR NURSE MANAGERS’ DELEGATION OF RESPONSIBILITIES IN FOUR TERTIARY HOSPITALS IN ENUGU STATE

CHAPTER ONE

INTRODUCTION

1.1 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).

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. 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.

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). Thus, despite the advantages of effective delegation, most nurse managers do not use established pattern and process of delegation to delegate duties. 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.

1.2       Statement of the 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.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. 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 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.

1.3       Objective of the 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. Specifically, the study is 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.

1.4       Research 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.

1.5       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 authority, practice of accountability, and supervision.  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.

1.6       Scope of the 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.

1.7       Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher will simultaneously engage in this study with other academic work. As a result, the amount of time spent on research will be reduced.

1.8       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.

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.

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