DON Success: Delegation of Duties

As the acuity and complexity of long-term care residents has increased, the responsibilities of the Director of Nursing (DON) have also escalated significantly. The duties of the DON are not just clinical in nature, they also involve regulatory, reimbursement, and legal aspects of facility operations as well. It is virtually impossible for the DON to accomplish all of the tasks that must be performed on a day-to-day basis; therefore, proper delegation of duties is essential to DON success.

1. A critical component of successful delegation of duties is understanding and applying the concept of “autonomy with accountability”. When tasks are divided among members of the nursing team, the DON must make every effort to assign specific tasks based on the strengths and competencies of the team members. When tasks are allocated to the nursing team member who has established competency in the area assigned, they are much more likely to feel comfortable and be successful with the task. The DON must ensure that all of the necessary education and tools are provided to the team member to enhance their success, and then should allow them the autonomy to take over the responsibility. Micro-management will not instill confidence; however, there must be opportunities to meet to discuss outcomes to ensure accountability, identify gaps in performance, and provide any necessary follow up education or resources. There must also be clear direction that questions are welcome and encouraged to ensure understanding and process effectiveness. Proactive resources for competency development include the Nursing Skills Competency Toolkit and SNF Staff Department Competency Checklist and Standards of Care webinar package.
2. The next critical component of successful delegation of duties is to make certain that all duties assigned to the nursing team members have assigned “back-up” for that team member. Cross training of the nursing team members gives them opportunity for growth, as well as ensures that tasks can be completed even when the team member with the primary assignment for the duty is not available. It also reduces the risk of incomplete tasks for extended periods of time when team members leave employment at the facility.
3. Having a task list to review with the nursing team members can be an invaluable resource for the delegation process. Each team member can voice their areas of strength and preference, as well as what they will need in the way of training and tools. The back-up assignments can be established, along with a schedule and process for cross-training. The assignments can be documented on the list, and a copy provided to each team member for reference. It would also be beneficial to have each team member sign a copy of the assignment list for the DON to keep on file to support the acknowledgement of the nursing team members in accepting their assignments.

Access a complimentary sample Delegation of Duties list, and for more information and strategies for DON success, make plans to join Proactive for the Dynamic DON virtual workshops on March 26th and 28th. This workshop focuses on skill building for serving effectively as DON, with emphasis on leadership, staff engagement, nursing operations and systems of care.