Confidence in delegation and leadership of registered nurses in long-term-care hospitals
JUNGMIN YOON R N , M S N 1, MIYOUNG KIM R N , P h D , M B A , G N P 2 and JUHHYUN SHIN R N , P h D 3
1Master Graduate, 2Associate Professor, 3Assistant Professor, Division of Nursing, College of Nursing, Ewha Womans University, Seoul, Korea
Correspondence
Miyoung Kim
Division of Nursing,
College of Nursing,
Ewha Womans University,
52 Ewhayeodae-gil,
Seodaemun-gu,
Seoul 03760,
Korea
E-mail: mykim0808@ewha.ac.kr
YOON J., KIM M. & SHIN J. (2016) Journal of Nursing Management Confidence in delegation and leadership of registered nurses in
long-term-care hospitals
Background and aims Effective delegation improves job satisfaction, responsibility, productivity and development. The ageing population demands more nurses in long-term-care hospitals. Delegation and leadership promote
cooperation among nursing staff. However, little research describes nursing
delegation and leadership style. We investigated the relationship between registered nurses’ delegation confidence and leadership in Korean long-term-care
hospitals.
Methods Our descriptive correlational design sampled 199 registered nurses from 13 long-term-care hospitals in Korea. Instruments were the Confidence and Intent
to Delegate Scale and Multifactor Leadership Questionnaire.
Results Confidence in delegation significantly aligned with current-unit clinical experience, length of total clinical-nursing experience, delegation-training
experience and leadership. Transformational leadership was the most statistically
significant factor influencing delegation confidence. Implications for Nursing Management When effective delegation integrates with efficient leadership, staff can deliver optimal care to long-term-care patients.
Keywords: delegation, leadership, long-term-care hospital, registered nurses
Accepted for publication: 28 January 2016
Introduction
Health-care providers must furnish safe, efficient,
patient-tailored care (Institute of Medicine, as cited in
Kohn et al. 2000). Successful, efficient delegation is
essential to optimal health care (Standing & Anthony
2008), intensifying the limited resources under pressure
from rising health-care costs (Gillen & Graffin 2010).
Effective delegation contributes to job satisfaction,
empowerment, responsibility, productivity, profes-
sional growth, and effective patient care (Kærnested &
Bragad�ottir 2012), whereas inappropriate delegation
relates to poor core caring, repetition of caring or
unbalanced workload (Anthony & Vidal 2010).
Leaders delegate to unlicensed nursing personnel
(UAP, also nursing assistants, nursing auxiliaries, care
assistants, care aides, health aides and support work-
ers; Johnson et al. 2015) to use their skills and compe-
tencies (Bystedt et al. 2011). Through successful
delegation, registered nurses (RNs) concentrate on
complicated nursing tasks (Stonehouse 2015) and
focus on reviewing charts, monitoring significant med-
ical changes, and teaching patients (Standing &
Anthony 2008). Registered nurses identify nursing
diagnoses, organise care plans, communicate with
patients and evaluate patients’ overall outcomes: skills
requiring critical thinking and professional knowledge
(Paquay et al. 2007, Kim & Jeong 2014). Unlicensed
DOI: 10.1111/jonm.12372
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Journal of Nursing Management, 2016
nursing personnel mostly assist in direct nursing care,
such as vital signs, range of mobility, feeding and
bathing (Kleinman & Saccomano 2006). However,
inadequate supervision can engender health-care
errors, which has an impact on patients’ outcomes
(Anthony et al. 2000). Failure to delegate is an error
in nursing-task planning and execution (Standing &
Anthony 2008), generating staffing complications and
omissions (Standing & Anthony 2008, Bittner &
Gravlin 2009, Thompson 2012). Many RNs are
unsure which tasks are right for different roles and are
unaware they are responsible for their patients’ nurs-
ing care, even when they delegate to others (Hansten
2011).
The proportion of elders in Korea has rapidly
increased (7.2% in 2000 and 11.8% in 2012; Statistics
Korea 2014). Long-term-care hospitals, with the high-
est growth rate of health-care organisations (111.6%,
2005–2015; Statistics Korea 2015), are using a nursing-
staff skill mix, including UAPs, to meet elders’ diverse
needs (Kim & Lee 2014). The number of certified nurs-
ing assistants (CNAs) in long-term-care hospitals has
burgeoned (from 1436 in 2006 to 8921 in 2011),
whereas the percentage of nursing assistants in total
nursing staff was increased from 31.0% in 2006 to
49.0% in 2011, while that of Registered nurses
decreased from 69.0% to 51.0% of total nursing staff
during the same period(Ministry of Health and Welfare,
2013). The RN shortages in long-term-care settings
has increased the need to maintain RNs in leadership
positions (Fleming & Kayser-Jones 2008). Unlicensed
nursing personnel perform nursing tasks in Korean
long-term-care hospitals, but there is a lack of clear
legal standards (Kim & Jeong 2014).
Efficient leadership includes successful delegation
(Bittner & Gravlin 2009). Relationship-oriented lead-
ership emphasises people and relationships, whereas
task-oriented leadership focuses on structures and
tasks (Cummings et al. 2010). Relationship-oriented
transformational leaders encourage members to
accomplish more (Northouse 2010) by inspiring self-
esteem through positive feedback (Riahi 2011). Task-
oriented transactional leaders highlight the economic
exchange between leaders and members to achieve
work (Bass & Avolio 1993). Leaders are aware of
members’ needs and supervise their task performance
(Bono & Judge 2004).
Hutchinson and Jackson (2013) proposed a new
vision of nursing leadership emphasising realistic,
moral, shared governance, energetic involvement in
the organisation and self-determination (Hannah et al.
2014, Wong 2015). Despite the growing significance
of leadership and delegation in long-term-care hospi-
tals’ quality, little research exists on the delegation–
leadership relationship (Corazzini et al. 2010). This
study examined correlations between delegation confi-
dence and RN leadership in Korean long-term-care
hospitals.
Literature review
Leadership
To maintain the reciprocal process of mobilising peo-
ple with various economic, political, and other
resources to realise goals independently or mutually
(Burns 1978), leadership is vital for RNs to effectively
supervise UAPs and delegate successfully (Saccomano
& Pinto-Zipp 2011). A RN’s leadership style affects
successful relationships among nursing staff (Corazzini
et al. 2010, Saccomano & Pinto-Zipp 2011) because
intellectual leadership traits include delegation, knowl-
edge and skills (Denehy 2008).
Whereas transactional leaders are task-oriented,
advocating for the current situation (Burke 2008),
transformational leaders focus on higher ideals
(Doody & Doody 2012), acknowledging members’
contributions and enhancing empowerment (Kim et al.
2012). Transformational leaders effectively resolve
challenges in long-term-care hospitals such as staff
turnover (Utley et al. 2011), vacancy rates, growing
demands for care (Grove et al. 2010), and improved
quality of care (Wong et al. 2010). In studies explor-
ing nursing leadership practices and patient outcomes,
transformational leadership aligned significantly with
fewer medication errors, patient falls and hospital
infections (Houser 2003, Capuano et al. 2005). Trans-
actional leaders contributed to enhanced patient satis-
faction by effectively managing patient care through
clear direction and work expectations (Doran et al.
2004). However, little research exists relating leader-
ship and patient outcomes (Wong 2015).
Delegation
Accelerating changes in health care, an ageing popula-
tion, rising health-care costs and worldwide nursing
shortages have increased attention on delegation in
nursing (Gillen & Graffin 2010). Delegation is ‘the
transfer of responsibility for the performance of (but
not the accountability for) an activity from one indi-
vidual to another’ (American Nurses Association
1992). The American Nurses Association (ANA)
(2005) defined terms related to delegation, principles,
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J. Yoon et al.
and roles of RNs and certified nursing assistants
(CNAs). However, most US states make their own
definitions of delegation, which are different from the
