NURS 524 Week 2 Discussion Board Forum 1 on Delegation Example

Discussion Board Forum 1: Delegation, Accountability and Trust on a Busy Unit

NURS 524 Systems Management and Leadership for Nurse Leaders, Discussion Board Forum 1

Thread by [Student Name]

The unit example and the classmates replied to are composites written for a model discussion.

Last month, I asked a nursing assistant on our medical unit to recheck vital signs on a patient who had just received a dose of IV hydralazine. I said, "Can you get vitals on 12 when you have a minute?" Forty minutes later, the patient's pressure had dropped to 84/50, and the vitals had not been taken because the assistant had three other patients' fingersticks due. Nobody was harmed, but it could easily have gone the other way. My first reaction was frustration with the assistant. My second, after this week's reading, was that I had delegated badly.

Kelly and Tazbir (2014) frame good delegation as five questions to get right: whether this task may be handed off, whether the situation allows it, whether this person is able to do it, whether the instructions are clear, and whether someone will supervise and check the result. Measured against them, my request failed on at least three. Rechecking vital signs is an appropriate task for an assistant, and the assistant was competent, so the task and person were right. But my directions gave no time frame, no reason and no values that should be reported immediately, and "when you have a minute" told the assistant it was low priority. I also did not follow up. The registered nurse who delegates keeps accountability for the outcome, so a vague request is not delegation at all; it is a hope.

Recent research describes what effective delegation looks like when managers do it well. Gilvari et al. (2026) interviewed eleven nursing managers about how they delegate and identified three main elements: a formal framework that clarifies the task, its purpose and its limits, including what cannot be delegated; continuous mentoring and support, with training that builds the other person's skill gradually; and supervision and evaluation, monitoring performance so that accountability is maintained. Although the study involved managers delegating to staff rather than nurses delegating to assistants, the same three elements were missing from my request: clarity, support and follow-up.

Delegation also changes under pressure. In a simulation study of 30 critical care teams, Poitrin et al. (2026) found that leaders delegated less as scenarios became more difficult, while delegation started by other team members became more frequent when unexpected events increased. Delegation was moderately associated with the team's satisfaction, engagement and cohesion, though not with the simulated patient's survival. On a busy medical unit, that pattern sounds familiar: the busier we are, the less carefully we delegate, just when clear delegation matters most.

What would I do differently? I would say, "Please recheck the blood pressure on 12 at 1415, twenty minutes after the hydralazine, and come find me right away if the top number is under 100." I would also set a reminder to check that it was done. Porter-O'Grady and Malloch (2016) describe effective teams as relying on shared understanding rather than control, and a clear delegation is a small act of building that understanding. Paul encouraged believers to "let all things be done decently and in order" (English Standard Version Bible, 2001/2016, 1 Corinthians 14:40), and clear delegation is part of good order on a nursing unit.

Reply to Lauren

Lauren, your story about avoiding a conflict with a night-shift colleague who repeatedly left tasks undone made me think about how closely conflict and delegation are connected. When a handoff goes wrong more than once, it is tempting to stop handing off and simply do the work ourselves, which avoids an awkward conversation but slowly burns us out. Kelly and Tazbir (2014) describe avoidance as a common conflict response that may be useful for minor issues but leaves recurring problems unresolved and often makes them worse. I wonder whether the repeated undone tasks are partly a delegation problem as well. The three elements Gilvari et al. (2026) found in nurse managers' delegation, clear expectations, continued support and monitoring, could apply to peer handoffs too. A conversation framed around clarity rather than blame, such as "Can we agree on which tasks will be finished before report and which will be handed over?", might address both the conflict and the handoff. Matthew 18:15 describes going to a brother or sister privately first when there is a problem (English Standard Version Bible, 2001/2016), which suggests a direct, private conversation before involving the manager. Have you had a chance to talk with your colleague one-on-one, and if so, did the conversation focus on the specific tasks or on the pattern? I suspect the specific tasks are an easier and less defensive place to start, and agreeing on them once may settle the pattern without a larger confrontation. If it does not, at least you will have a clear, shared expectation to point to when you raise it again.

Reply to Andre

Andre, I agree with your view that new graduates are often under-delegated to, because experienced nurses do not trust them yet and find it faster to do the work themselves. The irony is that new nurses only gain the skills that earn trust by being given tasks to do. The managers in the study by Gilvari et al. (2026) described gradual training and active guidance as part of how they delegated, starting with smaller responsibilities and expanding them as competence grew. That approach could work for preceptors as well: a preceptor might hand a new graduate the full care of one stable patient on the first day, then two patients with a check-in each hour, and so on. The Poitrin et al. (2026) simulation study also found that delegation was associated with team cohesion and engagement, which suggests that being trusted with tasks may help newer team members feel part of the team rather than spectators. Kelly and Tazbir (2014) remind us that the delegating nurse remains accountable, so this kind of graduated delegation must include supervision, but supervision is very different from doing the task oneself. On your unit, do preceptors have a structured plan for increasing a new graduate's responsibilities, or is it left to each preceptor's judgment? A simple week-by-week guide might make the process more consistent across preceptors, and it would give new graduates a clear picture of what they are working toward. It could also give preceptors permission to step back, which many find harder than stepping in.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gilvari, T., Fallahi-Khoshknab, M., Khankeh, H., Ebadi, A., & Hosseini, M. (2026). Nursing managers' experiences of delegation strategies and practices: A qualitative content analysis in Tehran, Iran. BMJ Open, 16(7), Article e114529. https://doi.org/10.1136/bmjopen-2025-114529

Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd ed.). Delmar Cengage Learning.

Poitrin, L., Le Bris, S., Rineau, E., Savary, D., Martin, L., Jourdain, M., Alcouffe, T., Riou, J., Martin, D., & Lerolle, N. (2026). Leadership delegation, team efficacy and resilience in critical care: A simulation-based study. BMJ Open, 16(3), Article e109624. https://doi.org/10.1136/bmjopen-2025-109624

Porter-O'Grady, T., & Malloch, K. (2016). Leadership in nursing practice (2nd ed.). Jones & Bartlett Learning.