Nurses’ Perception of Their Nurse Managers’ Delegation of Responsibilities in Four Tertiary Hospitals
CHAPTER ONE
Objectives of the study
Specifically, the study objectives are set to:
- Determine nurses’ perception of their nurse managers’ adherence to stipulated guidelines/criteria in delegating
- Assess nurses’ perception of their nurse managers’ use of job description in delegating responsibilities.
- Assess nurses’ perception of their managers’ practice the transfer of authority when delegating
- Determine how nurse managers use accountability in the process of delegating responsibilities.
- Ascertain nurses’ perception of their nurse managers’ supervision of delegated responsibilities.
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This chapter discuses related literature materials reviewed from text books and journals, unpublished and published articles from libraries internet materials.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 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.
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).
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 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 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.
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,
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.
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
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 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.
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 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 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
- 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.
- 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
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