Nurses storied experiences of direction and delegation
Thesis DisciplineHealth Sciences
Degree GrantorUniversity of Canterbury
Degree NameDoctor of Philosophy
Direction and delegation is a professional competency required of all New Zealand nurses and all nurses must attest to understanding direction and delegation on their annual practicing certificate application. However, the literature on how New Zealand nurses managed their direction and delegation interactions was silent. This thesis offers a New Zealand perspective and contributes to the discussion found in the overseas nursing literature about delegation.
The purpose of the study was to explore nurses’ perceptions about their everyday direction and delegation experiences using a narrative approach. The role of story in narrative research reflected my own views about the importance of story in nursing. Nurses are responsible for informing others in handovers, progress notes, health information education sessions and inter-disciplinary meetings. This is carried out through a series of different stories depending on the audience which includes patients, nursing and medical colleagues, support staff or whānau and family. The narrative plots made possible by the methodology and methods of narrative research uncovered how nurses made sense of direction and delegation in their workplace.
As the Enrolled and Registered Nurse Agents shared their own storied experiences it was revealed that working in a team differs to working as a team, and that both are needed; that communicating well and professionally were vital to the success or not of the delegation interaction; and that nurses needed to form a delegation relationship rather than provide a set of instructions. The ability to meet this professional obligation requires skill and knowledge, and more workplace relevant information from nurses in leadership roles to support ‘good’ direction and delegation interactions.
Taken together the eight major patterns that came into focus, and presented as eight narratives, showed that the main concern for all nurses was to keep the patient safe, and ensure they worked to their Scope of Practice. This narrative research study has provided the unique and individual perspectives related to direction, delegation and accountability relevant to nurses in clinical workplaces, education, leadership and management settings. Significant implications for nursing practice, research, policy design, the theory taught in nursing education programmes, and access to in-service information sessions were identified.