NR 529 Week 2 Delegation Analysis of a Standing Job Example

Delegation Analysis: The Weekly Supply Order I Handed to a Charge Nurse in March, the Empty Dressing Bin in June, and the Parts of the Job That Never Left My Desk

Student Name

College of Nursing, Chamberlain University

NR 529: Leadership and Management within the Clinical Healthcare Environment

Instructor Name

Month Day, Year

Delegation Analysis: The Weekly Supply Order I Handed to a Charge Nurse in March, the Empty Dressing Bin in June, and the Parts of the Job That Never Left My Desk

The Job and Why It Moved

For my first four months as manager of our thirty-bed renal and urology floor, I placed the weekly supply order myself. Every Tuesday I walked the clean utility room with the par sheet, counted what was below par and submitted the order to materials management by 1400. It took about ninety minutes a week, often at the end of a day spent on staffing. In March I delegated the job to Tomás, a day charge nurse with nine years on the unit who had asked for work that would prepare him for a leadership role. I showed him the par sheet, walked the room with him twice and gave him the ordering login. For eleven weeks nothing went wrong.

On a Sunday in June, a night nurse needed a dressing kit for a tunneled hemodialysis catheter and found the bin empty. She borrowed two kits from the intensive care unit, and the patient's dressing was changed on time. On Monday morning the director of nursing called me, not Tomás, to ask why my unit was borrowing supplies every weekend. That call is the start of this analysis. It was the right call to make to me, and working out why it came to me explains most of what went wrong.

What I Actually Handed Over

I handed over a task: count the bins, compare them with the par sheet and order the difference. That task was done correctly every week. Tomás's orders matched the sheet exactly. The problem was that the sheet was wrong for June, and the sheet was not part of what I delegated.

The five rights set out in the national delegation guidelines cover five points: which task, under what conditions, handed to whom, with what instructions and with what follow-up (National Council of State Boards of Nursing [NCSBN], 2016). Those guidelines were written for clinical tasks handed to other care providers, but the same questions apply to a management task, and asking them in order shows where my handover was thin. The task was appropriate. The person was well chosen. The directions covered counting and ordering but said nothing about when the par levels themselves should change. The supervision was absent: after the second week I stopped looking at the orders.

What Never Left My Desk

Three pieces of the job stayed with me without either of us noticing. The first was the knowledge that par levels follow census and case mix. In spring the unit typically has four or five patients on hemodialysis. In June we had nine for most of the month because a nearby unit closed beds for renovation and sent us its renal overflow. I knew about the overflow from a directors' meeting; Tomás did not. A par level set for five dialysis patients runs out for nine, and it runs out on the weekend, when no order goes in.

The second was authority. Even if Tomás had noticed the bin emptying, he did not know he was allowed to change a par level, which requires a form to materials management signed by the manager. I had never told him he could raise the par temporarily and tell me afterward, so the safe course for him was to keep ordering to the sheet.

The third was the relationship with the materials coordinator, who used to phone me when an order looked unusual. She kept phoning me. I passed the messages on when I remembered, which was not always. In short, I delegated the counting and kept the judgment, the authority and the information that the judgment needed.

Why the Director Called Me

The director's call reflects where accountability sits. When a manager delegates, the person who accepts the task is responsible for doing it well, but the manager still answers for how things turn out and for having chosen to hand the work over (NCSBN, 2016; Weydt, 2010). Tomás did the task well. The outcome was a unit borrowing supplies, and the decision that made that likely, handing over a task stripped of its judgment, was mine. I told the director so, and I did not name Tomás in that conversation. He learned about the call from me the same day, together with what I intended to change.

The Cost of the Gap

No patient was harmed, because the night nurse found kits elsewhere. The cost was quieter. Searching for supplies is time taken from patients, and studies of how nurses spend their time find that a meaningful share goes to hunting, fetching and waiting for things rather than to care (Storfjell et al., 2008). Over the weekend of the stockout, night staff estimated they spent close to an hour between them locating kits and gauze. The unit's standing with the intensive care unit, which lent the kits twice that month, also took a small hit. A task that saved me ninety minutes a week had started costing other people more than that.

What I Changed

I did not take the job back. Taking it back would have taught Tomás that delegation ends at the first failure and would have returned ninety minutes a week to my desk. Instead I handed over the missing pieces, in writing.

Judgment. Tomás now receives the weekly census forecast I get from the bed management office, including the count of dialysis patients expected. A one-page guide lists which supplies follow dialysis census, which follow urology procedures and which barely move.

Authority. He may raise any par level by up to 50% for up to two weeks on his own signature and must tell me by email the same day. Larger or longer changes still come to me.

Information. The materials coordinator now calls Tomás directly, with me copied on a monthly summary.

Supervision. For the next quarter we review the order together for ten minutes each Tuesday before it goes in, then monthly. Weydt (2010) describes supervision as the part of delegation most often dropped once a task appears to be running smoothly, which is exactly where mine went.

What This Taught Me About Delegating

The task I delegated was the visible part of a job whose real content was invisible to the person I handed it to. The next time I delegate a standing job, I will list three things before I hand it over: the decisions the job contains, the authority those decisions need and the information they depend on. If I am keeping any of the three, I will say so, so that the person doing the task knows where its edges are. I will also set a date for the first review before I hand anything over, not after the first problem. A delegated job should fail loudly to the person doing it, not quietly to the manager three months later.

References

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3

Storfjell, J. L., Omoike, O., & Ohlson, S. (2008). The balancing act: Patient care time versus cost. Journal of Nursing Administration, 38(5), 244-249. https://doi.org/10.1097/01.NNA.0000312771.96610.df

Weydt, A. (2010). Developing delegation skills. OJIN: The Online Journal of Issues in Nursing, 15(2). https://doi.org/10.3912/OJIN.Vol15No02Man01