International Journal of Nursing Education Scholarship

Volume 3, Issue 1 2006 Article 15

Nursing EDGE: Evaluating Delegation Guidelines in Education

Deborah Henderson* Pa ela !ealover !and$ &ones (i )la#e "ic#i !harrer !all$ %usner** !tacie !'eet

*hio +niversit$ , -anesville, hendersd.ohio/edu *hio +niversit$ , -anesville, iller03.ohio/edu *hio +niversit$ , -anesville, sharrer.ohio/edu ***hio +niversit$ , -anesville, 1usner.ohio/edu *hio +niversit$ , -anesville, 2oness3.ohio/edu *hio +niversit$ , -anesville, s'eets.ohio/edu *hio +niversit$ , -anesville, bla#et.ohio/edu
*

3o0$right c 2006 (he )er#ele$ Electronic Press/ 4ll rights reserved/

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Nursing EDGE: Evaluating Delegation Guidelines in Education

Deborah Henderson, Pa ela !ealover, "ic#i !harrer, !all$ %usner, !and$ &ones, !tacie !'eet, and (i )la#e

Abstract
Delegation, an i 0ortant conce0t 1or nursing students to learn and 0ractice, is central to registered nurse 56N7 0er1or ance, and i 0ortant on the N38E9,6N e:a ination/ Nursing 1acult$ e bers 1ro an 4DN 0rogra designed a descri0tive stud$ to evaluate 0lanned versus actual delegation in the curriculu , and a second stud$ to evaluate an intervention on delegation/ !tud$ *ne assessed the 0resence o1 delegation in each nursing course/ !tatistical anal$sis co 0ared the 0lanned i 0le entation 'ith the results 1or student de1initions o1 delegation, and identi1ication o1 the 1ive rights o1 delegation based on the National 3ouncil o1 !tate )oards o1 Nursing 5N3!)N7 de1inition and 1ive rights/ !tud$ one results are shared/ !tud$ ('o utili;ed a co 0arison o1 0re,to,0ost intervention easures/ !tudents 'ere as#ed to co 0lete eight ste0s o1 a delegation e:ercise and deter ine 'hat could be delegated to an unlicensed assistant, and 'hat should be co 0leted b$ the 6N/ 4ns'ers 'ere coded and entered into !P!!/ !tatistical anal$sis co 0ared each student<s abilit$ to correctl$ identi1$ the 1ive rights o1 delegation 0rior to the e:ercise, against the abilit$ to correctl$ ans'er 1ive =uestions t'o 'ee#s 0ost e:ercise/ !igni1icant i 0rove ent 50 < 0/057 occurred on each easure/ 6eco endations are discussed/ KEYWORDS: delegation, nursing curriculu , nursing 1acult$, nursing education

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(oda$<s nurses 1ace nu erous challenges in 0roviding =ualit$ care/ 3urrent changes and trends in health care include high 0atient acuit$, registered nurse shortages, an increased need 1or registered nursing services and increased use o1 unlicensed 0ersonnel/ 3onse=uentl$, nursing 1acult$ are being called u0on to 0re0are nursing graduates in the art and s#ill o1 delegation/ Delegation is not a ne' conce0t but one dating bac# to %lorence Nightingale/ (he National 3ouncil o1 !tate )oards o1 Nursing 5N3!)N7 de1ines delegation as ?trans1erring to a co 0etent individual authorit$ to 0er1or a selected nursing tas# in a selected situation@ 5N3!)N, 1AA5, 0/ 17/ (he a2orit$ o1 !tate nurse 0ractice acts s0eci1icall$ address delegation 1or the registered nurse 56N7/ Delegation is considered b$ N3!)N 51AA57 to be an entr$,level nursing 0ractice s#ill 1or 6Ns/ %urther ore, according to the 4 erican Nurses< 4ssociation Position !tate ent *n 6egistered Nurse Education 6elating (o (he +tili;ation o1 +nlicensed 4ssistive Personnel 54N4, 1AA27, ?curricula 1or all 6N 0rogra s should include content on su0ervision, delegation, assign ent and legal as0ects regarding nursing<s utili;ation o1 assistive 0ersonal@ 50/ 17/ Delegation has beco e i 0ortant enough that the conce0t is included on the national licensure e:a 1or 6Ns 5N3!)N7/ Even though delegation is considered an entr$,level activit$, an$ ne' graduates cite a lac# o1 acade ic 0re0aration 1or this role 53onger, 1AAA7/ Bn a stud$ o1 CD 6Ns, Parsons 51AAC7 1ound that onl$ >1E had been taught delegation s#ills in nursing school/ (his suggests a need 1or nurse educators to evaluate current curricular content to ensure that delegation is taught and 0ractised b$ nursing students/ (he 0ur0ose o1 this stud$, there1ore, 'as to underta#e an evaluation o1 delegation in an undergraduate nursing curriculu / !ince it 'as deter ined that delegation 'as not eeting the learning outco es o1 the curriculu , an intervention 'as i 0le ented to 1urther evaluate student #no'ledge and abilit$ to use delegation in clinical 0ractice/ LITERATURE REVIEW (he N3!)N 51AA57 0ublished 1ive rights o1 delegation 'hich include the right: F F F tas#: one that is delegable 1or a s0eci1ic 0atient circu stances: 'here the a00ro0riate 0atient setting, available resources, and other relevant 1actors are considered 0erson: 'hich eans delegating the right tas# to the right 0erson to be 0er1or ed on the right 0atient

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direction and co unication: that includes clear, concise descri0tion o1 the tas#, including its ob2ective, li its, and e:0ectations, and su0ervision and evaluation: 'hich includes a00ro0riate onitoring, evaluation, intervention, as needed, and 1eedbac#/

Nu erous authors have utili;ed the N3!)N 1ive rights o1 delegation 5Gell$, Heidenthal H Iarthaler, 2005J 8e one H )ur#e, 200>J N3!)NJ (a00an, Keiss, H Khitehead, 200>7/ Bn the Position !tate ent on +nlicensed 4ssistive Personnel 5+4P7 54N4 1AA27, delegation is de1ined as trans1erring res0onsibilit$ 1or the 0er1or ance o1 an activit$ 'hile retaining accountabilit$ 1or the outco e/ (his de1inition has also been used b$ nu erous authors 5Gell$,Heidenthal H Iarthaler, 2005J 3urtis H Nicholl, 200>J 8e one H )ur#e, 200>J (a00en, Keiss, H Khitehead, 200>7/ %urther outlined in the 0osition state ent is that the 6N ust use 0ro1essional 2udg ent to deter ine the a00ro0riate activities to delegate/ (his deter ination is based on the conce0t o1 0rotection o1 the 0ublic and includes consideration o1 the needs o1 0atients, the education and training o1 nurses and assistive sta11, the level o1 su0ervision re=uired, and sta11 'or#load/ (he 4N4 state ent also identi1ies 'hich tas#s should not be delegated, i/e/, health counseling, teaching or inde0endent, s0eciali;ed nursing #no'ledge, s#ill or 2udg ent that re=uires anal$sis o1 evidence or data/ *ther sources that a$ i 0act the 6N<s delegation authorit$ include: 0ro1essional organi;ations and the &oint 3o ission on the 4ccreditation o1 Healthcare *rgani;ations 5%isher, 1AAA7/ Eason 520007 has identi1ied ?1our 4<s@ o1 delegation: assess ent, assign ent, authorit$, and accountabilit$/ Killia s and 3oo#se$ 5200>7 added that tas#s 'hich are re0etitive and su00ortive can be delegated to unlicensed assistive 0ersonnel 5+4P7/ 3urtis and Nicholl 5200>7 have a00lied 3ul0 and ! ith<s 51AAD7 si: stages o1 delegation 1or sel1 anage ent: 5a7 'hat to delegate, 5b7 selecting delegates, 5c7 assigning tas#s, 5d7 assessing and discussing, 5e7 e:ecuting the tas#, and 517 co 0letion o1 the tas#, 'hile Hansten and &ac#son 5200>7 de1ined delegation as ?trans1erring to a co 0etent individual authorit$ to 0er1or a selected nursing tas# in a selected situation@ 50/ 17/ Parsons 51AAC7 described results o1 a 2ob satis1action surve$ involving CD 6Ns, 30 da$s 1ollo'ing a structured teaching intervention on delegation and decision a#ing/ 6egistered nurses 'ith higher delegation scores on the Nursing 4ssess ent Decision Grid re0orted high levels o1 2ob satis1action relative to decision a#ing and abilit$ to 0ro ote 'ithin the organi;ation/

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International Journal of Nursing Education Scholarship

"ol/ 3 L2006M, No/ 1, 4rticle 15

%actors that hinder e11ective delegation have been described b$ 3urtis and Nicholl 5200>7, notabl$ 'or#ing in a hierarch$, doubting delegatee<s abilities, di11iculties delegating, inade=uate sta11ing, dustbin 5un0leasant tas#s7 delegation, under,delegating, over,delegating 5du 0ing7, and resistance to delegation/ (he$ re0orted that e11ective delegation, on the other hand, re=uires ?s#ills such as sensitivit$ to the ca0abilities o1 tea e bers/// abilit$ to co unicate clearl$ and directl$J #no'ledge o1 the stages involved in e11ective delegationJ and a vision o1 ho' delegation can bene1it delegators, delegatees, and 'ards or organi;ations@ 50/ >,67/ BRIEF OVERVIEW OF UNDERGRADUATE NURSING PROGRAM (he nursing curriculu is divided into a three,level, si: =uarter, associate degree 54D7 nursing 0rogra / !tudents stud$ incre entall$, 1unda entals o1 nursing, assess ent, co unication, edical and surgical alterations that a11ect nursing care, ental health, aternit$ and 0ediatric nursing, e ergenc$ nursing, leadershi0 and anage ent, and role transition 1ro student nurse to 6N/ 8icensed 0ractical nurses 58PNs7 have the o0tion to enter the 0rogra at level t'o 1ollo'ing success1ul co 0letion o1 8PN transitions courses, 'hich include to0ics such as nursing 0rocess, co unication s#ills, delegation, edical,surgical content, and legalNethical conce0ts/ Bn level one, there is an absence o1 reading assign ents, o1 ob2ectives dealing 'ith delegation or evidence o1 delegation on the clinical evaluation tool/ (he conce0t o1 delegation is not covered in class, clinical, or included in the curriculu content a0/ Bn all level t'o courses, there is also no evidence o1 assigned reading on delegation, 'hile a descri0tion o1 delegation is in the re=uired edical surgical te:t/ *utco e ob2ectives do not include delegation/ !tudents are evaluated as to 'hether or not the$ de onstrate accountabilit$ 1or their o'n care and care delegated/ (he conce0t o1 delegation is not evaluated on 'ritten e:a s in level t'o/ Ho'ever, level three covers the 1ive rights o1 delegation as described b$ N3!)N, and delegation is included in the curriculu content a0/ *utco e ob2ectives are included in assigned readings and are assessed on course e:a s/ Bt is also a to0ic 1or class discussion, in 'hich students co 0lete s all grou0 0ro2ects based on oc# scenarios, and read the !tate )oard o1 Nursing rules and regulations on delegation/ %urther ore, delegation is included as a clinical course ob2ective re=uired 1or success1ul course co 0letion/ Research Questions (he 1ollo'ing research =uestions guided stud$ one/

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4re level one students able to de1ine delegation incor0orating a ini u o1 t'o o1 the 1ive rights o1 delegationO 4re level t'o students able to de1ine delegation incor0orating a ini u o1 three o1 the 1ive rights o1 delegationO 4re level three students able to de1ine delegation incor0orating a ini u o1 1ive o1 the 1ive rights o1 delegationO (he 1ollo'ing research =uestion 'as 0osed 1or stud$ t'o/ Bs there a change in students< abilit$ to identi1$ the 1ive rights o1 delegation 0retest to 0ost testO METHODOLOGY

Study One (he N3!)N de1inition 51AA57 o1 delegation is used to evaluate student #no'ledge o1 the delegation 0rocess/ Nursing 1acult$ e:a ined 'hen delegation 'as introduced and ho' it 'as integrated throughout the curriculu / 4 descri0tive stud$ 'as conducted in 2005 'hich included 210 associate degree nursing students in southeastern *hio, 11 o1 'ho 'ere advanced 0lace ent 8PNs/ Bn the 1irst stud$, 210 student surve$s 'ere collected: >0E 5n P C37 1ro level oneJ 50 E 5n P 1067 1ro level t'oJ and A E 5nP 1A7 1ro level three 5see (able 17/ 4ssessed 'as the 0resence o1 delegation in each nursing course/ Data 'ere coded and loaded into !P!!/ !tatistical anal$sis co 0ared the 0lanned i 0le entation 'ith the results 1or student de1initions o1 delegation, and 1or identi1ication o1 the 1ive rights o1 delegation based on the N3!)N de1inition// !tatistical anal$ses included 1re=uencies and chi,s=uares/ %or the de1inition o1 delegation to be correct, level one students 'ere to identi1$ t'o o1 the 1ive rights o1 delegationJ level t'o, three o1 the 1ive rightsJ and level three, 1ive o1 the 1ive rights/ Each de1inition 'as e:a ined using 0redeter ined criteria, and coded as right or 'rong/ 4ll surve$s 'ere coded b$ a second researcher and results co 0ared/ Discre0ancies 'ere discussed b$ the research grou0 to 1inali;e coding as right or 'rong/ (he 1ive rights o1 delegation 'ere also coded as right or 'rong, and validated b$ the sa e 0rocess as 1or the de1inition o1 delegation/

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(able 1 Results of Study One 8evel 1 NPC3 52 ite s7

6ight

De1inition Delegation right tas# right 0erson circu stance right directionN co unication right su0ervision Nevaluation

3C >5/C E 26 31/3 E 26 31/6 E A/ 6 15/D E 15 1C/1 E

Kron g >5

8evel 2 NP1 0D 6ight

5 >/DE 33 30/CE >2 3A/3E 6/ 5 3/DE E 16 15E

8evel 3 NP20 55 ite s7

Kro ng 102 6ig ht 0 Kro ng 20

(ota l NP 210 6ight

>3 20/5 E D5 35/D E C5 >0/5 E 11/ AE 13/C 2A >> 21E

Krong

5>/2E 5D 6C/DE 5D 6C/DE A0/> D0 C>/3E

A5/3 E D> 6A/2 E 65 60/D E A>/3 E 103 A6/3

0E 16 C0 E 1D C5 E 50 E 12 60

100 E > 20E 3 15E 5 0 >0E E D >/2 E

16D DA/5E 135 6>/3E 125 5A/5E CC/1E 1C1 C6/3E

6C C1/AE

A1 C5E

13 65 E

166 DAE

Study Two 4 descri0tive stud$ conducted during %all =uarter 2005 included level three students, and so e level t'o students 1ro !tud$ *ne 5nP2>7/ 4 co 0arison o1 0re,0ost intervention easures 'as e 0lo$ed/ (he 0retest, in 'hich students 'ere as#ed to 'rite the 1ive rights o1 delegation, 'as ad inistered 1our 'ee#s a1ter class content on delegation 'as discussed/ 4dditionall$, students co 0leted an intervention that included eight ste0s o1 a delegation si ulation, 'hereb$ the$ deter ined 'hat could be delegated to an unlicensed assistant and 'hat should be co 0leted b$ an 6N/ 4 coding 0rocedure to =uanti1$ each ans'er into right or 'rong had been deter ined according to 'hether students delegated a00ro0riatel$ and i1 the$ under, delegated/ %acult$ assess ent o1 the coding o1 each student<s res0onse ensured agree ent/ 3oded data 'ere loaded into !P!! and 1re=uencies 'ere calculated/

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Henderson et al/: Nursing Education Delegation Guidelines

(he 0osttest 'as ad inistered 2 'ee#s 1ollo'ing the clinical si ulation/ !tudents ans'ered 1ive =uestions on their 1inal e:a ination, 'hich 1ocused on a s0eci1ic right 1ro the 1ive rights o1 delegation/ Each 0retest right 'as atched 'ith the sa e 0osttest right 1or data anal$sis/ RESULTS Study One: Delegation Definition Khen as#ed to de1ine delegation in nursing, 20E o1 all students de1ined delegation correctl$ according to 1acult$,deter ined criteria 5see (able 17/ %ort$,si: 0ercent 53C o1 C37 o1 level one students correctl$ de1ined delegation, co 0ared to 5E 55 o1 10D7 o1 level t'o, and 0E 50 o1 207 o1 level three/ 8evel three students had the highest 0ercentage o1 the co 0onents o1 the delegation de1inition 5i/e/, right tas# C0E, right 0erson C5E, right circu stance 50E, right directionNco unication 60E, right su0ervisionNevaluation 65E7/ 8evel one students had the second highest 0ercentage on 1our o1 the delegation de1inition co 0onents 5right tas# 31EJ right circu stance 10EJ right directionN co unication 16EJ right su0ervisionNevaluation 1CE7/ 8evel t'o had the lo'est 0ercentages o1 correct ans'ers 1or 1our o1 the 1ive rights 5right tas# 31EJ right circu stance DEJ right directionNco unication >EJ and right su0ervisionNevaluation 15E7/ 8evel t'o had the second highest 0ercentage onl$ 1or the right 0erson 53AE7 in the delegation de1inition/ Five Rights of Delegation !igni1icant results 'ere obtained on chi s=uare tests 1or each o1 the 1ive rights o1 delegation 50Q/057/ Khen incor0orating the 1ive rights, level three students had the highest 0ercentage o1 correct ans'ers 5n P 207: right tas# 5C0E7, right 0erson 5C5E7, right circu stance 550E7, right directionNco unication 560E7 and right su0ervisionNevaluation 565E7/ 8evel one students had the ne:t highest 0ercentage o1 correct ans'ers on 1our o1 the 1ive rights 5n P C37: right tas# 531/3E7, right circu stance 5A/6E7, right directionNco unication 515/DE7 and right su0ervisionNevaluation 51C/1E7/ 8evel t'o students had the lo'est 0ercentage o1 correct ans'ers 5n P 10D7 on right tas# 530/CE7, right circu stance 56/5E7, right directionNco unication 53/DE7 and right su0ervisionNevaluation 515E7 but the second highest 0ercentage o1 correct ans'ers 1or right 0erson 53A/3E7/

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Study Two Results ('o cases that had issing data 'ere eli inated/ *ne student did not co 0lete the course and 'as also eli inated/ (his resulted in a sa 0le si;e o1 21/ 6esults indicated that all students o itted identi1$ing at least one o1 the 1ive rights in the de1inition o1 delegation/ Ho'ever, there 'as a signi1icant increase 1ro 0re to 0ost intervention 1or each o1 the 1ive rights 5see (able 27/ (able 2 Five Rights of Delegation %ive 6ights N P 21 6ight tas# 6ight 0erson 6ight circu stance 6ight direction 6ight su0ervision Pre, Bnterventi 1> 56DE7 1> 56DE7 A 5>3E7 Post, interventi 20 5A5E7 20 5A5E7 1A 5A1E7 !igni1icance 0/03 0/03 0/000

5 52>E7 A 5>3E7

1C 5C6E7 20 5A5E7

0/000 0/001

(he 1ollo' u0 chi,s=uare test results de onstrated a decline in students< abilit$ to de1ine delegation 1ro level one to level t'o, and 1ro level one to level three/ Khile the e:0ectation o1 de1ining delegation increased across levels, correct ans'ers decreased signi1icantl$ 50 Q /057/ %or right tas#, right 0erson, and right su0ervision, the direction o1 signi1icant results 'ere une:0ected/ Bnstead o1 i 0roving as students 0rogressed through the curriculu , their correct ans'ers declined/ (he 1ollo',u0 chi,s=uare indicated i 0rove ent in correct ans'ers 1or right circu stance 1ro level one to level three, and level t'o to level three/ Ho'ever, the di11erence in grou0 si;e a$ have con1ounded the statistical anal$sis, since levels one and t'o 'ere uch larger than level three/ %urther ore, the content on delegation had not been covered nor assessed 1or level three students/

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DISCUSSION %ro the results o1 stud$ one it 'as a00arent that the conce0t o1 delegation 'as not i 0le ented as 0lanned in level t'o o1 the 0rogra / Ho'ever, delegation 'as covered as 0lanned during level three/ %or level one students, the criteria 1or the correct delegation de1inition 'as set at t'o o1 the 1ive rights o1 delegation/ Khen students 'ere as#ed to list the 1ive rights o1 delegation, several listed the 1ive rights o1 edication ad inistration instead/ (his 'as a concern as there a$ have been a coding error since the right ti e o1 edication ad inistration 'as coded as being the correct res0onse 1or right circu stance o1 delegation/ 3redit had also been given 1or right 0erson, even though it 'as obvious students 'ere listing the 1ive rights o1 edication ad inistration/ (his is an obvious li itation o1 the stud$/ %urther ore, it 'as 1ound that integration o1 the conce0t o1 delegation 'as not being i 0le ented across curricular levels as 0er the curriculu 0lan/ (he criteria 1or level three students 'ere set at a higher e:0ectation, 'ith 1ive o1 the 1ive co 0onents o1 delegation necessar$ in order to be coded correctl$/ Bn stud$ t'o, a signi1icant i 0rove ent occurred 'ith level three students being able to identi1$ each o1 the 1ive rights o1 delegation 50ost intervention7/ (he a2orit$ o1 students 520 o1 217 stated delegation e:ercises should be introduced earlier in the 0rogra 5beginning at level t'o7/ (he$ also ac#no'ledged that the delegation e:ercise 'ould have been ore di11icult to co 0lete 'ithout classroo discussion andNor a 0rece0ted learning e:0erience/ RECOMMENDATIONS Khile a li itation o1 this stud$ is the s all sa 0le si;e and onl$ one setting, thereb$ li iting generali;abilit$ o1 1indings, several reco endation are 'orth$ o1 ention/ 6e0lication o1 this stud$ using a larger sa 0le si;e, and several nursing education institutions 'ould be 'orth'hile/ 4dditionall$, re1ine ent, as 'ell as reliabilit$ and validit$ testing o1 the surve$ tools, are necessar$/ (he N3!)N de1inition o1 the 1ive rights should be ado0ted b$ educators in nursing education 0rogra s since the assess ent o1 entr$ level nurses< #no'ledge o1 delegation 'ill be deter ined b$ N3!)N/ Bt is also reco ended that because o1 1e' resources available 1or teaching delegation s#ills, 0ublished reliable interventions and si ulations 1or nurse educators 'ould be valuable/

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Delegation as a conce0t and 0rocess should be introduced earl$ in nursing curricula through assigned readings and 1ollo'ed b$ a00lication in classroo and clinical settings/ Nurse educators should a#e a conscious e11ort to incor0orate delegation throughout the curriculu , and easurable, si 0le to co 0le: learning o00ortunities i 0le ented in all nursing courses/ 4dditionall$, since the 0rocess used to evaluate delegation, 0articularl$ in !tud$ *ne, 'as 1ound to be an e11ective tool 1or 1acult$ evaluation o1 an$ curricular conce0t, this 0rocess could be e:0anded 1or content coverage, curricular threads, and educational outco es/ %inall$, =uarterl$ or se ester 0re,0ost tests ight 0rovide ore de1initive statistical anal$ses 'hen used 'ith grou0s o1 var$ing si;es/ (his could also 0rovide ore s0eci1ic in1or ation on students< #no'ledge and 0rogress at 0articular stages in the nursing 0rogra , and decisions could be ade 1or i 0roving content deliver$/ SUMMARY Nurse educators need to 0resent in1or ation about delegation earl$ in the curriculu , increase e 0hasis on a00lication o1 delegation as students 0rogress, and ado0t easurable ethods to trac# success in using delegation/ 3urrentl$, there is a 0aucit$ o1 resources 1or teaching delegation, hence these should be develo0ed and disse inated/ Delegation is a conce0t that has beco e ore i 0ortant in the role o1 6Ns/ (here1ore, nurse educators should res0ond b$ incor0orating this #no'ledge and s#ill a00lication in nursing curricula/

REFERENCES 4 erican Nurses 4ssociation 54N47 51AA27/ 6egistered nurse utili;ation o1 unlicensed assistive 0ersonnel/ American Nurses Association osition Statement! 4 erican Nurses 4ssociation 54N47 51AA27/ 6egistered nurse education relating to the utili;ation o1 unlicensed assistive 0ersonnel/ American Nurses Association osition Statement! 3onger, I/ 51AAA7/ Evaluation o1 an educational strateg$ 1or teaching delegation decision a#ing to nursing students/ Journal of Nursing Education" #$, >1A,>23/ 3urtis, E/ H Nicholl, H/ 5200>7/ Delegation: 4 #e$ 1unction to nursing/ Nursing %anagement" &&5>7, 26/

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3ul0, G/ H ! ith, 4/ 51AAD7/ !i: ste0s to e11ective delegation/ Journal of %anagement in Engineering" &#517, 30,31/ De8aune, !/ 3/ H 8adner, P/ G/ 520027/ Fundamentals of Nursing' Standards ( ractice 52nd ed/7/ Ne' Ror#: Del ar (ho son 8earning/ Eason %/6/ 520007/ (he 1our S4Ts o1 delegation/ Advance for Nurses )arolina*+eorgia" ,5237, 11,13/ %isher, I/ 51AAA7/ Do $our nurses delegate e11ectivel$O Nursing %anagement"#-557, 53/ Hansten, 6/ B/ H &ac#son, I/ 5200>7/ )linical Delegation S.ills/ A 0and1oo. For rofessional ractice! Iassachusetts: &ones and )artlett/ Harrington, N/ H (err$, 3/ 520037/ 2 N to RN 3ransitions/ Achieving Success in 4our Ne5 Role 52nd ed/7! Philadel0hia: 8i00incott Killia s H Kil#ins/ Gell$,Heidenthal, P/ H Iarthaler, I/ (/ 520057/ Delegation of Nursing )are/ Ne' Ror#: (ho son Del ar 8earning/ 8e one, P/ H )ur#e, G/ 5200>7/ %edical Surgical Nursing/ )ritical 3hin.ing in )lient )are! Ne' &erse$: Prentice Hall/ National 3ouncil o1 !tate )oards o1 Nursing 51AA57/ Delegation: 3once0ts and decision U a#ing 0rocess/ National )ouncil osition aper! *hio +niversit$ 3urriculu *utco e *b2ectives 51AAA7/ Ohio 6niversity 7 8anesville*)hillicothe Associate Degree Nursing rogram N2N Accrediting )ommission Site Visit Self Study! &9537/ Parsons, 8/ 51AAC7/ Delegation s#ills and nurse 2ob satis1action/ Nursing Economics "&:517, 1C,2D/ (a00en, 6/I/, Keiss, !/4/ H Khitehead, D/G/, 5200>7/ Essentials of Nursing 2eadership and %anagement! 53rd ed/7/ Philadel0hia: %/ 4/ Davis/ Killia s, &/G/ H 3oo#se$, I/I/ 5200>7/ Navigating the di11iculties o1 delegationJ 8earn to i 0rove tea 'or# in the unit b$ delegating duties a00ro0riatel$/ Nursing ,--;" #;5A7, 32/

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