Delegation skills can be strengthened when:
• RNs understand the nurse state practice act
• Nursing education and nursing service support students and RNs as they continually expand their knowledge about delegation
• Simulation exercises using scenarios found in daily practice are used to teach and demonstrate delegation competency
• Pairing and/or partnering is utilized and supported by the staff schedule and method of patient assignment
• Delegation is viewed as competency that is based on a skill set and that requires ongoing development
Developing delegation skills is indeed a multifaceted activity. Developing delegation skills begins during pre-licensure nursing education. It is important that educators and organizations provide clinical experiences for students to see delegation as a skill set that has to be practiced in order for it to be perfected. Developing practice environments that foster students' learning of delegation skills reinforces the authority of all RNs to delegate to LPNs and nursing assistants who may see the student as inexperienced. As new RNs enter professional practice, they need ongoing support and education to perfect this skill.
Delegation skills can also be developed using simulation to create practice scenarios reflecting daily practice. Both clinical aspects of care and delegation skills can be evaluated during the simulation. Simulation creates the opportunity for feedback and analysis of how pre-licensure students and/or RNs directed the work of others during the simulation, with an emphasis on the effect that the simulated delegation would have had on clinical and financial outcomes. RNs can evaluate their interpersonal skills used during the simulation, as well as review the work performed, asking how the work could have been done differently and considering who else might have been in a position to do this work.
Simulation might be used, for example to improve both the skill of delegation and that of administering blood for a post-operative patient. In the simulation scenario, the required technical skills of blood administration could be evaluated as well as the RN's ability to appropriately delegate, during the procedure, some responsibilities for patient care to either the LPN or nursing assistant. The post-simulation discussion (debriefing) could include an evaluation of both the blood-administration procedure and also the quality of the delegation with a focus on the RN's communication skills. The LPN and nursing assistant could provide feedback as to their perception of the RN's delegating skills.