Health Science Journal

Keywords

Effective delegation; Attitude; Preparedness; Nurse manager; Hospital

Introduction

Perhaps nothing is more basic to work managers do than the process of delegation. Indeed, if one can embrace a common definition of management as being " the accomplishment of work through others," it is delegation that primarily differentiates managers from those who are not considered managers [1]. Delegation of additional responsibilities, of decision – making power, and of control over critical management functions builds both competence and confidence in three managerial levels of Nurse manages (first, middle and upper levels managers). Insufficient delegation stifles creativity, initiative, and professional development. Failure to delegate effectively can and frequently does, because high- potential employees to seek other positions where they talents are better used. In the end, this loss of high- potential employees is a cost no organization – and managers – can afford [2].

Delegation legitimatizes lower – level managers, not only in the way they are viewed themselves, but also in the way subordinates view them. Little respect is accorded to those who are managers in a title only. If these managers lack the authority to make decisions and do not have the support of their superiors, their abilities to manage and control subordinates is significantly diminished. Delegation is an inescapable fact of organizational life. Responsibilities are often so numerous and demanding that failure to delegate would guarantee failure on the job. In such cases, delegation is essential [3]. Consequently, for the manager, delegation is not an option but a necessity. The ability to delegate tasks to others is an essential skill for the nurse manager, process of delegation requires the nurse manager to remain accountable for the delegated task.

Attitude toward delegation

Some nurse managers may not realize that they have difficulty delegating; they may consider themselves hardworking and be unaware that they are restricting the effective functioning of the nurses, and some refuse to shear leadership role with delegates because of their strong need to maintain control [4]. Nurse Managers as Delegators should begin by sharing small amounts of responsibility and power with nurses, meanwhile, can help by taking on more responsibilities. In that way, it can decrease their dependency on the delegators, Yukl [5] stated that delegates may refuse to accept delegation because they feel that they are incompetent of completing the tasks. Further study, opined that if delegators feel that delegates are competent, yet the delegates themselves do not believe they are, the delegators should enhance delegate's self-confidence [6].

Preparedness to delegate

The American Nurses Association developed elements essential for effective preparation of delegator and delegation process include: definition of delegation, based on the nurse practice act and regulations; review of laws and regulations regarding delegation; identification of disciplinary actions related to inappropriate delegation; emphasis on tasks/ functions that cannot be delegated nor routinely delegated; determination of the degree of supervision required for delegation; identification of guidelines for lowering risk related to delegation; development of feedback mechanisms to ensure that task is completed and to receive updated data to evaluate the outcome [7].

Furthermore, the following key guidelines are essential to the delegator to ensure effective delegation consistency such as: starting with a positive attitude, clarify availability; carefully consider how directions are given during delegation; directions need to be clear; be fair about undesirable activities; indicate priorities, give and receive feedback. However, Effective delegation requires knowledge and skills in matching the task with abilities, capabilities, and delegate's interest. Effective delegation can enhance job satisfaction, responsibility and productivity of the nurse managers, since it gives them more time to focus on what is most important. Concomitantly, delegation will enrich personal and professional growth of staff [8].

Studies on delegation are few and the growing demands on professional nurses, effective delegation has become more pressing in order for nurse managers to be able to concentrate on their management activities. Effective delegation is not a recent concern within nursing and health care management and also to the quality of the health care provided and patient outcomes. When delegation is ineffectively performed, there could be a potential for compromised quality of patient care [9-12].

Though much has been written about delegation, [13-18] there have been no studies investigating the attitude of nurse managers toward delegation and preparedness to delegate effectively in Saudi health care settings. Therefore, this study aimed to assess nurse managers’ attitudes toward, their preparedness for effective delegation in Saudi hospitals. To fulfill the aim of the study, the following questions are to be answered by the study results:

The research questions include the following:

1. What are the attitudes of Nurse Managers toward delegation?

2. To what extent are the Nurse Managers prepared to effectively delegate?

3. What is the relationship between the Nurse Managers' attitudes toward delegation and their preparedness to delegate effectively?

4. Are there associations among the Nurse Managers’ attitudes toward delegation, and their readiness to delegate when grouped according to selected profile characteristics?

Research Methodology

Study design: A quantitative, Cross-sectional descriptive correlational design with a self-reporting questionnaire was used in this study.

Study settings: this study was conducted in two large hospitals in Riyadh city. The study was conducted in all inpatient general medical, surgical and specialist's wards, as well as critical care units. One of them is the biggest and oldest hospitals in Riyadh city and affiliated to Ministry of Health (MOH). The other hospital affiliated to Ministry of Higher education. These two hospitals were selected to be the setting for this study because they include the highest bed-capacity representing the non- academic and academic sectors respectively; both hospitals are government hospitals where most of health care services are provided thus, they are expected to reflect representative data of these sectors in Riyadh city.

Sample size and subjects: The target population for this study was Nurse Managers working in Saudi Hospitals affiliated to Ministry of Health, and Ministry of Higher education.

The subjects: For this study composed of the nursing manager personnel (nursing supervisors, head nurses, charge nurses) working in all in-patient, out-patient and critical care units in the selected hospitals. Quota sampling technique was decided to be used to structure the sampling plan for this study [19]. To determine the sample size, the researcher consulted an expert statistician who recommended taking 30-40% from the entire population to gain enough representative samples in the study, considering 5% as error level and 95% as confidence level. For greater precision the researcher decided to take 40% from overall population as a sample. The total number of the study sample were (397) from both hospitals.

Tool of the study: In this study, a self-administered questionnaire for Nurse Managers’ Attitudes and their Preparedness toward Effective delegation, which developed by Karnested, and Haghighi was used in this study [20,21]. The questionnaire divided into three parts Part I: included the demographic profile of the Nurse Managers which includes age, gender, nationality, educational background, overall nursing experience, and years of experience in present unit / department, and marital status. In addition to work related information including working unit. Part II: which is geared toward assessing the Nurse Managers’ attitude towards delegation on a five-point Likert scale Ranging from (5) "disagree," (4), moderately disagree (3), unsure (2), moderately agree to (1) "agree

Part III: pertains to the Nurse Managers’ preparedness to delegate effectively. It consists of 20 statements with two subscales: Subscale 1 geared toward principles and rights of delegation, contains 12 statements scoring as (5) always, to 1 (never). Subscale 2, reflects Nurse Managers’ preparedness to delegation, it contains 8 statements, scoring as (5) agree, to (1). Disagree.

Ethical considerations: Before using questionnaire, the researcher obtained permission from the authors. The Research and Ethics committee approved the study protocol. All principles of ethics in research were followed. The data collection tool had a cover page that explained the aim of the study and the participant's rights to withdraw from the study at any stage without any penalty, participation was voluntary, and there were no apparent risks for the participants, confidentiality, anonymity, and the use of their information solely for research. Each participant was then asked to sign the form as consent to participate.

Results

Regarding personal related characteristics of the subjects, the results revealed that the sample consists of (93.7%) female and (5.5%) male. In addition (36.3%) of total sample where in the age group (26-35). The marital status of sample where (74.8%) are married, and (21.7%) are single, and with respect of the nationality of the nurses, (83.6%) of the nurses were non-Saudi, and (13.9%) were Saudi. Moreover, (49.6%) of the nurses has Bachelor of Science in nursing. With respect to nurses experience it was measured with either the nurse’s total experience are in the same hospital or in the current position; (38%) of nurses had 1 – 10 years of total experience in nursing and number of experience years in the same hospital, there are (62.3%) had 1-10 years of experience. Moreover, number of experience years in the same position where examined and it found that (47.7%) of the sample had 1-5 years’ experience in the same position regarding the working place (75.1%) of the sampled nurses works in patient unit. For works in administration position, (62.7%) works as charged nurse.

Regarding research Question of What are the attitudes of Nurse Managers toward delegation? Table 1 shows the overall mean of agreement for Nurse Managers perception and attitude towards delegation is (3.1 ± 0.99) which mean that Nurse Managers are unsure about their attitude towards delegation. This finding is consistent with Haghighi, Mohammadi' findings [22], they found that 74.1% of Nurse Managers had a neutral attitude about delegation. On the other hand, these findings are inconsistent with Karnested and Bragadottir, they found that participants’ attitude towards delegation was positive [21]. The findings of the current study could be attributed to that; the Nurse Managers lack selfconfidence in their delegation. In this respect, Hudson, announced that, successful delegation starts with the nurse manager’s completion of an introspective personal character assessment, positive attitude toward delegation assist Nurse Manager especially in first level management position to develop self-confidence [8].

Table 1: Mean, standard deviation and rank of attitudes of nurse managers toward delegation.

Statements	Mean	Standard Deviation	Rank
I would delegate more, but the jobs I delegate never seem to get done the way I want them to be done	3.02	1.52	3
I don’t feel I have time to delegate properly	3.6	1.54	11
When I give clear instructions and the job isn’t done right, I get upset	2.44	1.5	1
I feel staff lack the commitment that I have. So any job I delegate won’t get done as well as I’d do it	3.15	1.5	7
I would delegate more, but if the individual I delegate the task to does an incompetent job, I’ll be severely criticized	3.14	1.52	6
When I delegate a job, I often find that the outcome is such that I end up redoing the job myself	3.08	1.53	5
I have not really found that delegation saves any time	3.6	1.47	10
I can’t delegate as much as I would like because my subordinates lack the necessary experience	3.41	1.5	9
I would delegate more but I’m pretty much a perfectionist	3.23	1.46	8
I can give subordinates the routine tasks, but I feel I must keep the non-routine tasks myself	3.03	1.5	4
I would delegate more if I were more confident in delegating	2.69	1.62	2
Overall mean	3.13	0.99

Moreover, the results of the current study showed, the majority of Nurse Managers agreed to rank "statements of “When I give clear instructions and the job isn’t done right, I get upset "as the number one for their attitude toward delegation, followed by the statement of “I would delegate more, but the jobs I delegate never seem to get done the way I want them to be done. " Additionally, they ranked the statement of "I would delegate more if I were more confident in delegating" as number three. The agreement in these statements may be due to that Nurse Managers do not know themselves what they want. In this respect, Brett and Kate McKay, claimed that, managers who complain that their subordinates don’t have the ability to tackle responsibilities competently are sometimes to blame themselves. They have not given their people clear guidance on what is expected of them. These managers do not know themselves what they want and yet are angry when the result of a subordinate’s work is not up to par. They know what they don’t like, but can’t articulate what they want [23].

Additionally, in studies conducted by Karnested and Bragadottir [21], and Quallich [24] stated that lack of self confidence in leader, trust in subordinates, lacks to commitment and experience back ground of delegate to complete tasks in a satisfactory method are barriers to delegation and have impact on manager attitude toward delegation [21,24]. Conversely, Cymerman, [25] stated that, the improvement of delegation skills can increase delegates' commitment to effective tasks performance and reduce unsuccessful outcomes. In the same concern, Wheeler added that, delegation can be used as a powerful tool to train and empower others, handing over a little responsibility to a staff member can increase their motivation and job satisfaction, enable an assessment of their strengths, and identify areas for future development [26].

The current study results showed that, the Nurse Managers aware that, the effective delegation save their time, this reflected on statements with respect of disagreement were “I don’t feel I have time to delegate properly” and “I have not really found that delegation saves any time.” This result was expected because delegation is one of time management tool and can save more time to nurse manager to concentrate on other managerial management tasks that cannot be delegated. Curtis, and Nicholl, claimed that, dealing with narrowing time constraints needs delegation skills and time management, effective delegation saves time [4]. Also, in this respect, Hansten, and Washburn added, with more time available, the manager can develop new skills and abilities, facilitating the opportunity for career advancement.

In relation to research Question 2, to what extent are the Nurse Managers 'prepared to effectively delegate? The result in Table 2 highlight that, the overall mean of agreement for nurse manager preparedness towards effective delegation in sub-scale 1which geared toward following principles and rights of delegation was (4.00 ± 0.46) which demonstrates that Nurse Managers are often follow the statements in sub-scale 1 in their delegation. In relation to subscale 2 of nurse managers 'preparedness to delegate, Table 3 shows the overall mean is (4.5 ± 0.48) which indicate that, there almost full agreement on the sub-scale statements. These findings indicated that, Nurse Managers' preparedness towards delegation is positive, and to some extent prepared for effective delegation, but they in need of strengthening their delegation skills. The current result is congruent with Karnested, and Bragadottir, study that showed highest agreement from nurse's manager in applying principles and using the five right of delegation. Moreover, in Egypt, the results of a study conducted by Eid, Salem, and Zakari, revealed that the majority of participants understood and properly used delegation [27,28].

Table 2: Mean, standard deviation and rank of nurse managers' preparedness to delegate sub-scale 1.

Statements	Mean	Standard Deviation	Rank
I take into account staff ’s individual skills prior to delegation	4.47	0.84	6
I give staff feedback following delegation (e.g. praise)	4.38	0.89	7
I seek feedback from staff on whether you have explained the task sufficiently	4.3	0.89	8
I seek feedback from staff to improve your delegation skills	4.06	1	9
I find you spend a lot of time on jobs others could do	3.36	1.14	10
I think you give up power or lose respect because of delegation	2.21	1.27	12
I concerned that staff finds me lazy for delegating tasks	2.29	1.32	11
In delegation, I make clear who is to do the task	4.5	0.83	5
In delegation, I make clear when to do the task	4.6	0.66	1
In delegation, I make clear where to do the task	4.56	0.75	4
In delegation, I make clear why to do the task	4.58	0.74	3
In delegation, I make clear how to do the task	4.6	0.7	2
Overall mean	4	0.46

Table 3: Mean standard deviation and rank of nurse manager preparedness to delegate sub-scale 2.

Statements	Mean	Standard Deviation	Rank
Nursing staff’ skills could be better utilized with more effective delegation.	4.51	0.87	6
Delegated duties are documented.	4.54	0.86	4
Documentation of delegated duty helps employee to know exactly what is expected and how the task will be evaluated.	4.69	0.68	3
I think I have received sufficient preparation to delegate through my education or at work.	4.44	0.85	7
Effective delegation improves staff development and satisfaction, which results in better patient care and patient satisfaction.	4.77	0.62	1
I find it clear which tasks can be delegated to nursing staff.	4.52	0.8	5
I think I have sufficient skills to face staff’s negative reaction when delegating tasks.	4.44	0.85	8
I am familiar with my legal responsibilities when delegating.	4.75	0.6	2
Overall mean	4.5	0.48

In relation to the statements of "I think I give up power or lose respect because of delegation" this is valid since the majority of Nurse Managers ranked it as the least agreement. In this respect, Tourigny and Pulich, define delegation as a key component of empowerment, the process that involves the manager sharing power with a subordinate, the nurse manager also can use delegation to develop the potentialities of staff nurses. In this respect, Foster [9], stated that, the manager cannot have a narrow view of delegation that fails to recognize the opportunities for nurses’ professional development as a result of delegation. Moreover, Walker stated that, the benefits of effective, efficient delegation include added innovation, improved job satisfaction, more flexible and responsive adaptation to change, better leadership mentoring, improved quality, and quickness of decisions and increase commitment to the profession, and then the professionalization of nursing [29]. Shaw, and Fairhurst, added that, delegation motivates young nurses to take on more responsibility, authority, whereas the act of delegation is an incentive in of itself for both delegator and delegates [30].

Furthermore, the current study findings showed that, Nurse Managers were familiar with legal responsibilities when delegating tasks but the lowest agreement was for the statement “I think I have sufficient skills to face staff’s negative reaction when delegating task”. This result may be attributed to lack of self confidence, skills in delegation and they need developing their skills in practice of delegation. This result goes in parallel with a study of more than 40 emergency departments in the United States, 78% of participants indicated that their delegation skills were good or excellent, yet 22% scored poorly on an accompanying test that evaluated their knowledge of basic principles of delegation. However, Whitehead, stated, to enhance nurse manager's skills and confidence in delegation, it is important for Nurse Managers to be aware of staff’s legal job definitions and job descriptions, as well as their skills and willingness to accept the delegation of the task in question [31]

Concerning research question of What is the relationship between the Nurse Manager’s attitudes toward delegation and their preparedness to delegate effectively?

The results in Table 4 revealed no significant correlation between nurse’s manager’s attitude towards delegation and their effectiveness of delegation in both sub-scales and for the whole scale. This finding could be attributed to that, some Nurse Managers may not realize that they have difficulty delegating; they may consider themselves hardworking and be unaware that they are restricting the effective functioning of nurses, and some refuse to shearing leadership role with delegates because of their strong need to maintain control. others are afraid that other employees, will learn what they know and later they will use this ability against the managers.

Table 4: Correlation between nurse managers' attitude towards delegation and they effectively to delegate.

Correlations	(1)	(2)	(3)	(4)
(1)   Nurse ManagerAttitude toward delegation.	1
(2)   Nurse ManagerPreparedness to delegate sub-scale1.	-0.03	1
(3)   Nurse ManagerPreparedness to delegate sub-scale2.	0.072	.369**	1
(4) Nurse manager preparedness to delegate.	0.017	.889**	.753**	1

** Correlation is significant at the 0.01 level (2-tailed).

In this concern, Brett and Kate McKay, Khosravi, et al. said that; a manager who insists on maintaining all control and authority is insecure and actually fails to even meet the definition of a Manager [23,32]. On the same line, Corazzini et al., emphasized that , a Manger is an executive who manages time, resources, and people. A Manger does not do everything himself; rather he marshals all of these elements on the pathway to success [33].

Although attitudes are cited as a barrier to delegation throughout much of the literature [8,15,34] which is contradicted with the current study results . On the contrary side, Anderson, and Pulich claimed that delegation plays a very important role in health care workplace and it is one of the tools and skills for successful Nurse Managers [35]. Furthermore, effective delegation requires managers with high level of positive attitude toward delegation because poor and weak delegation could demotivate and confuse the person with new responsibility delegated to him. As a result, he will fail to deliver the job in due time and according to standards.

Also the current study result inconsistent with Gazda, who assured that, when Nurse Managers have positive attitude toward delegation, can delegate task to nursing staff, with more confidence and passion, and they are able to get the job done with minimal supervision, Nurse Managers will get more free times for handling most critical management problems [36]. Additionally, according to Foster, managers with constructive attitudes toward delegation are able to identify talents among employees, decentralize the management process, then delegate tasks to staff, so the employees themselves will find this great opportunity to exploit and discover their talents. Consequently, positive attitudes to delegation plays key role, contributing to effective delegation in organizations [11].

Looking at the research question of; Are there associations among the Nurse Manager’s attitudes toward delegation, and their readiness to delegate when grouped according to selected profile characteristics?

The result in Tables 5 and 6 show the correlation test to confirm whether there are an association between nurse’s manager attitudes and preparedness towards delegation and personal, work related characteristics. Table 7 show linear regression was done using all the personal and work related characteristics variables as independent variables and nurse’s attitude towards delegation as the dependent variable.

Table 5: Test of association between the personal and work related characteristics and nurse’s attitude towards delegation.

Correlation	Gender	Age	marital status	Nationality	Educational Background	Total number of years of nursing experience	Total number of years in this hospital	Total number of years in this current position	Current position	Current position as	Nurse Manager Attitude Toward Delegation
Gender	1
Age	0.053	1
marital status	0.028	-.237**	1
Nationality	0.034	.318**	-.122*	1
Educational Background	-0.082	-0.032	0.006	-.115*	1
Total number of years of nursing experience	0.047	.874**	-.230**	.315**	-0.08	1
Total number of years in this hospital	0.03	.732**	-.163**	.185**	-0.016	.738**	1
Total number of years in this current position	-0.002	.514**	-.129*	.212**	-.129*	.496**	.536**	1
Current position	0.091	.124*	-0.019	0	.103*	.109*	.100*	-0.057	1
Current position as	-0.066	.242**	-.113*	-0.058	0.067	.249**	.203**	-0.008	.414**	1
Nurse Manager Attitude Toward Delegation	-0.019	-0.002	-0.036	-0.019	-0.05	-0.031	0.017	0.02	0.017	0.042	1

** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).

Table 6: Test of association between the personal and work related characteristics and nurse manager's preparedness to delegate

Correlations	Gender	Age	Marital status	Nationality	Educational background	Total number of years of nursing experience	Total number of years in this hospital	Total number of years in this current position	Current position	Current position as	Nurse manager preparedness to delegate
Gender	1
Age	0.053	1
Marital status	0.028	-.237**	1
Nationality	0.034	.318**	-.122*	1
Educational background	-0.082	-0.032	0.006	-.115*	1
Total number of years of nursing experience	0.047	.874**	-.230**	.315**	-0.08	1
Total number of years in this hospital	0.03	.732**	-.163**	.185**	-0.016	.738**	1
Total number of years in this current position	-0.002	.514**	-.129*	.212**	-.129*	.496**	.536**	1
Current position	0.091	.124*	-0.019	0	.103*	.109*	.100*	-0.057	1
Current position as	-0.066	.242**	-.113*	-0.058	0.067	.249**	.203**	-0.008	.414**	1
Nurse manager preparedness to delegate	0.04	0.091	0	.162**	-0.088	.117*	0.06	0.018	0.034	0.09	1

** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).

Table 7: Linear regression of nurse’s attitude towards delegation and personal and work related characteristics.

Model	Unstandardized Coefficients		Standardized Coefficients	t	Sig.
	B	Std. Error	Beta
(Constant)	35.15	6.422		5.474	0
Gender	-1.56	2.45	-0.035	-0.637	0.524
Age	0.092	0.111	0.095	0.829	0.408
marital status	-0.61	0.821	-0.041	-0.747	0.456
Nationality	-0.69	1.734	-0.023	-0.4	0.69
Educational Background	-0.41	0.313	-0.073	-1.309	0.191
Total number of years of nursing experience	-0.23	0.121	-0.217	-1.902	0.058
Total number of years in this hospital	0.076	0.099	0.064	0.764	0.445
Total number of years in this current position	0.207	0.909	0.014	0.227	0.82

A. Dependent variable: nurse manager attitude toward delegation

It is revealed that all the personal and work related characteristics variables were not a significantly predictor on nurse’s attitude towards delegation, as presented in the last column of the table. The study results showed no correlation, therefore, demographical variables are not a good predictor for nurse’s attitude towards delegation. This result could be attributed to that, the Nurse Manager’s attitude represents how they feel or their state of mind about delegation, where attitude is concerned with perceptions, awareness, values, beliefs, concepts, and judgments. Nurse Managers' attitude toward delegation is affected by their values and judgments regarding what, when, how, to whom they will delegate which is not affected by demographic characteristics that stated in this study. In this concern, the ANA Code of Ethics [37] notes that delegation is based on the delegator judgment concerning delegated task, the competence of all members of the nursing team, and the degree of supervision required. This statement coincides with the Five Rights of Delegation developed by the NCSBN [38]. These Rights of Delegation include: (a) the right task, (b) the right circumstance, (c) the right person, (d) the right direction/communication, and (e) the right supervision. On the other hand, this result is in contrast with many studies [22,39,8,40].

In Table 8 present the result of the Linear regression to test the effect of the personal and work related characteristics variables on nurse managers' preparedness to delegate, it shows that, the variables that had a significant effect are nationality and current position have a positive effect on nurse’s preparedness to delegate. The results revealed only significant correlation between nationality, total number of years of nursing experience and Nurse Manager's preparedness to delegate which means that with more years of experience, the Nurse Managers are prepared effectively to delegate. This result could be due to experiences that give them more chance to acquire management skills, and learn more about job description, policies, and procedures that clarify the role and function of delegation. In addition, they recognized the strengths and capabilities of the staff and use those talents to maintain the benefit for quality of patient care [6]. This finding is consistent with Morsy, who showed relation between years of experience in the current position of the professional head nurses and their skills in delegation [39].

Table 8: Linear regression of nurse manager’s preparedness to delegate and personal and work related characteristics.

Model	Unstandardized Coefficients		Standardized Coefficients	T	Sig.
	B	Std. Error	Beta
(Constant)	72.829	4.893		14.884	0
Gender	1.993	1.867	0.057	1.068	0.286
Age	-0.051	0.085	-0.069	-0.609	0.543
marital status	0.516	0.626	0.045	0.825	0.41
Nationality	3.566	1.321	0.153	2.699	0.007
Educational Background	-0.281	0.239	-0.064	-1.176	0.241
Total number of years of nursing experience	0.104	0.092	0.126	1.124	0.262
Total number of years in this hospital	-0.038	0.075	-0.041	-0.502	0.616
Total number of years in this current position	1.548	0.692	0.137	2.235	0.026

a. Dependent variable: nurse manager readiness to delegate

Also, regarding nationality, non-Saudi were more prepared to delegate than Saudi nurses. In this concern, Karnested and Bragadottir mentioned that previous experience and education on delegation are significantly related to attitude and preparedness issues regarding confidence in delegating, mutual trust, collaboration, and communication [21].

Conclusion and Recommendations

The results of this study showed that nursing managers had a neutral (unsure) attitude about delegation and need learning opportunities that can allow them to develop confidence and competency in the skills of delegation to acquire an expert level of competency in this management skill. Based on the findings of the present study, firstly, Nurse Managers require access to education specifically designed to develop knowledge, skills and attitudes in the practice of delegation, so leadership and management should include delegation as a core component of Nurse Managers continuing education activities. Secondly, the Health Education department at the hospital develops a standard examination for leadership used to evaluate clinical and content effectiveness of the process of delegation. Thirdly, in academic educational institutions, incorporating the use of simulation-based learning into course curriculum would promote student confidence and increase assessment skills of delegation. Fourthly, Nurse manager Following the essential guidelines to ensure effective delegation such as: starting with a positive attitude, clarify availability; carefully consider how directions are given during delegation; directions need to be clear; be fair about undesirable activities; indicate priorities, give and receive feedback.

9498

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