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Journal of Health Policy and Management

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Mehdi Hayat Khan1*, Amna Bibi2, Umar Hayat1, Johnny Gill1 and Mehtabel Muncie1
1 Department of Nursing, University of Health Sciences Lahore, Lahore, Pakistan, Email: [email protected]
2 Department of Nursing, King Edward Medical University, Lahore, Pakistan
*Correspondence: Mehdi Hayat Khan, Department of Nursing, University of Health Sciences Lahore, Lahore, Pakistan, Email: [email protected]

Received Date: Dec 14, 2020 / Accepted Date: Dec 29, 2020 / Published Date: Jan 05, 2021

Citation: Khan MH, Bibi A, Hayat U, et al. Attitude and preparedness of nurse manager towards effective delegation in public sector hospital, Lahore. J Health Pol Manag. 2021;4(1):1-5.

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact [email protected]


Delegation is not first-born concept of nursing professions but also important as speedy changes occurring in the profession. It has been expected from nurse managers to deliver effective supervision and leadership to influence the other healthcare professionals. The competency of nursing leader is crucial for effective delegation, routinely.


Nurse manager; Attitude; Delegation; Preparedness; Public sector hospital


Nursing professionals are accountable to distribute and transfer the main responsibility of health care facilities and resources effect i vely to work. Delegation helps junior nurses to develop and enhance their skills, promote teamwork and improve productivity, so that an effective nursing care should be provided to admit patient in the hospital. The first managers are accountable to ensure the delegated task has been completed efficiently and effectively. Moreover, delegation is transfer of responsibility to junior staff nurses to carry out specific job-related activities.

The role of caregiver of the nurses is ignored and remained still a myth [1]. The healthcare system is becoming more complex and complicated in 21st century and delegation is difficult leadership skill for nurses to learn. Nurses and nurse managers may be reluctant to delegate. However, delegation has been a critical skill for healthcare providers to perfect as it is today [2].

Delegation is an effective process, when responsibility and accountability is shared by competent delegators. The American nurses Association proposed five effective fundamentals of delegation and these basic elements included as:

• Nurse practice act is based on delegation

• Revision and recommendation of delegation regulations and laws

• Identification of poor delegation and appropriate disciplinary action

• Effectiveness of difficult or impossible task, that not be delegated routinely

• Determination of supervisory level for effective delegation, identification the risk of delegation and development of guidelines for nurses towards effective delegation [3].

Literature Review

A study conducted on the attitude of nurse managers toward effective delegation among nurses and overall means score was found (3.1 ± 0.99). The result predicted that the nurses were unsure about their opinion about effective delegation [4]. Moreover, a similar result was identified that nurse manager 74.1% possess neutral attitude towards delegation among nursing leaders. It is concluded that attitude of nurse manager was not positive regarding delegation [5]. The previous research indicated that nurse managers have lack of self-confidence regarding effective delegation while on duty. Nurse managers can perform effective and successful delegation, if they assess their personal character and develop positive attitude with selfconfidence, that will lead to high performance in managing the healthcare organization [6].

Another study, among nurse manager concluded that majority of them 66.7% reported that they are not sure of their good or bad attitude towards effectiveness of delegation and negate the declaration that they are busy at duty time and cannot be able to delegate effectively. On one more query 37.8% disagreed that “they would like to delegate more if they were having more confident in delegating”. However, 64.4% study participants are agreed and declared that “when they give instruction but still the job remains pending, they got upset [7].

Preparedness among nursing professionals is of great importance for their clinical judgment and self-efficacy in delivering the task. It concludes that nurse managers should adopt some strategies for effective delegation. Nurse manager should accept the deficiency and learnt for competency to help and support the junior nurse professionals. Moreover, a research finding revealed that nurse managers are familiar with their responsibilities and are accountable while delegating the task. Some facts were identified of low preparedness because majority responded that they have lack of skill to react the negative feedback of delegate during delegation. This is due to lack of confidence; therefore, it is highly recommended to improve their skills and competency with confidence among nurse managers [6].

Another study of nurse manager that was held in emergency department of US revealed that 78% of emergency nurse manager were well prepared and has effective skill of delegation. 22% nurse manager were not well prepared and graded as low score on delegation scale and basic principle of delegation. Moreover, there was need to enhance their delegation skill. Nurse manager confidence and self-efficacy should be improved regarding legal nursing job regulation. The job description of the manager should be comprehended and have sufficient skill to identify the preparedness and willingness of the delegate to receive the task being delegated [8]. Nursing professions are unaware of effective delegation that’s why they need clear guidelines and understanding of delegation, and registered nurses expect from the graduates of this era. They assured that recent nursing graduates possess extraordinary knowledge and skill about effective delegation. When the nurses encounter with chronic diseased patient having no life expectancy, then they seek improvement about well preparation of delegation [1]. A quasi experimental study evaluated the attitude and preparedness of registered nurses toward delegation and also assesses the supervisory skill and professional communication. ANOVA test showed the effectiveness of intervention and significant improvement was found as p=018 the nurse manager describe facilitation toward clear communication [9].


• To assess the nurse manager’s attitude towards effective delegation in public sector hospital Lahore.

• To assess the nurse manager’s preparedness towards effective delegation in public sector hospital Lahore.


This study will improve behavioral changes and competency of skills for effective delegation, which is critical requirement for nurse manager to able them to contemplate nursing profession activities. Profession knowledge is important for effective delegation and if the manager nursing doesn’t know their role, will lead to failure [10]. This research might improve competency skill among nurse manager towards understanding of effective nursing delegation.


Study setting

The current study was conducted in one of the Punjab advance public sector hospital (King Edward Medical University, Mayo Hospital Lahore). The study has enrolled all inpatient areas as medical and surgical tower as well as specialty and critical area of the hospital.

Study design

A cross sectional descriptive, quantitative design was used to assess the attitude and preparedness of nurse managers towards effective delegation at one of the advance public sector hospitals. The research study measures the findings at one point in time simultaneously, that’s why known as, cross sectional [11].

Study population: The population of study was included the nurse manager, nursing supervisors, head nurses and senior charge nurses working in all concern department of KEMU hospital.


Convenient sampling method was used to recruit the required sample from the healthcare setting. A sample of n=150 was inducted from the targeted study population.

Research instrument

A self-administered adopted questionnaire was utilized and adopted from “Nurse Manager’s Attitude and Preparedness towards Effective Delegation in Saudi Hospitals” [6]. The questionnaire was divided into three sections. First section contains demographic information of the participants, such as age, gender, educational status and clinical experience. Second section consists of the attitude of nurse manager towards effective delegation. There are 11 question related to attitude with five-point Likert scale Ranging from (5) “Strongly disagree,” (4), disagree (3), unsure (2), agree to (1) “ strongly agree. Third section included 20 declarations where 12 statements are about the principles and rights of delegation, while remaining highlights the preparedness of nurse manager toward effective delegation.

Data collection method

The questionnaire was distributed among the nurse managers (Nursing supervisors, Head Nurses, Senior Staff nurses) in hard copy. They were given 30 minutes to fill the questionnaire according to their own perception and understanding of delegation and then filled questionnaire were collected for analysis.

Analysis of data

The collected data was analyzed on software SPSS version 21. The findings are presented in the form of tables and graphs and descriptive are discussed in averages and percentages. The correlation was assessed through Pearson correlation test between attitude and preparedness towards effective delegation.

Study time frame

The data was gathered from August, 2019 to October, 2019.

Ethical consideration

First of all, permission was granted from the research supervisor and principal of Lahore School of Nursing, The University of Lahore. After that a written permission was taken from the head of KEMU hospital for the study. A written consent was taken from study participants before distributing the questionnaire. The purpose, significance and relevant knowledge of study was explained and willingness of participation was encouraged. No study participants were enrolled forcefully and permitted to quit the research anytime. This research was non maleficent to the healthcare setting as well as for the participants.


Profile of participants

The participants were enrolled in study from KEMU hospital, Lahore (Table 1)

Variables Number (n) %
Male 0 0
Female 150 100
Less than 25 years 7 4.7
26-30 years 45 30
31-35 years 40 26.7
Above 35 years 58 38.7
Marital Status
Single 41 27.3
Married 109 72.7
Nursing Diploma 12 8
Diploma Plus Specialization 37 24.7
BSN/PRN BSN 94 62.7
MSN/MPH 7 4.7
5-10 years 54 36
11-15 years 50 33.3
16-20 years 19 12.7
Above 20 years 27 18

Table 1: Demographic Data

Table 1 represents that 100% females were enrolled and no male participant was included in the study. Furthermore, 4.7% study respondents were less than the age of 25 years, 30% were between 26-30 years of age, 26.7% were in 31-35 years age group and 38.7% of study participants were above the age of 35 years. 27.3% of respondents were unmarried and remaining 72.7% were married. Moreover, 8% of respondents were nursing diploma holder, 24.7% were with specialization, 62.7% holds BSN or post RNBSN and only 4.7% has advance degree of MSN or MPH. Table 1 also concludes that 36% participants possess working experience of 5-10 years, 33.3% were 11-15 years of working, while 12.7% of respondents were having 15-20 years and 18% had working experience of more than 20 years of age (Table 2).

  S.No. Statement Strongly Disagree Disagree Neutral Agree Strongly Agree
N % N % N % N % N %
1 I would delegate more, but the jobs I delegate never seem to get done the way I want them to be done 9 6 19 12.67 14 9.33 94 62.67 14 9.33
2 Nurse managers feel they have less time to delegate effectively 3 2 29 19.33 31 20.67 58 38.67 29 19.33
3 Nurse Managers get upset when the job is not done according to their instructions 12 8 11 7.33 15 10 54 36 58 38.67
4 Managers feel that staffs are not committed and the tasks delegated would not be completed 1 0.67 5 3.33 41 27.33 79 52.67 24 16
5 I would delegate more, but if the individual I delegate the task to does an incompetent job, I’ll be severely criticized 5 3.33 24 16 27 18 62 41.33 32 21.33
6 When Nurse managers delegate, the managers usually find that often the outcome is not good enough and need to re do it 7 4.67 11 7.33 24 16 85 56.67 23 15.33
7 Nurse managers mainly find that delegation is not saving their time 8 5.33 49 32.67 29 19.33 38 25.33 26 17.33
8 Due to lack of necessary experience, the Nurse managers cannot delegate as much they want 3 2 25 16.67 39 26 60 40 23 15.33
9 Nurse Manager delegate less because of they want perfection 0 0 9 6 17 11.33 92 61.33 32 21.33
10 Nurse Managers can give the routine tasks, but they feel they must keep the non-routine out 5 3.33 14 9.33 15 10 75 50 41 27.33
11 Nurse manager would delegate more if they were more confident in delegation 0 0 3 2 12 8 91 60.67 44 29.33

Table 2: Overall Score of Attitude

Table 2 presents the attitude of nurse manager towards effective delegation and mixed responses of agreements and disagreement were noted on diverse declarations. The study respondents 6% were strongly disagree on the statement that they would delegate more when the job is not done their way they want to be done, 12.67% were disagree, 9.33% responded as neutral, 62.67 remained agree with the statement and 9.33% were strongly agree. 2% strongly disagree with the statement that they have less time to delegate, 19.3% disagree, 20.67% remained neutral, 19.33% strongly agree but 38.67% agree with the statement. On the declaration, that when the nurse manager delegate the task and job not done rightly, they get frustrated, 8% of respondent were strongly disagree, 7.33% were disagree, 10% remained neutral,36% showed agreement, while 38.67% were strongly agreed with the statement. On the query that, any task, they delegate, will not be completed because the of staff commitment, 16% of participants were strongly agree, 52.67% were agree, 27.33% remained neutral, 3.33% were disagree and less than 1% were strongly disagree because the feel less committed with subordinate nurses. on question of delegation to incompetent nurses leads to more criticism, the responses were as fellows, 3.33% were strongly disagree, 16% were disagree, 18% remained neutral, 41.33% were agree and 21.33% showed strongly agreement. When I delegate the task, I usually find that often the outcome is not good and need to re do it again by myself, 4.67% were strongly disagree, 7.33% showed disagreement, while 16% remained neutral, 56.67% were agree and 15.33% were strongly agree with the statement. On query that the delegate saves less time 17.33% of respondents were strongly agree, 25.33% were agree, while 19.33% remained neutral, 32.67% were disagree and 5.33% showed strongly disagreement. To another statement that nurse managers cannot delegate effectively due to lack of experience, 2% were strongly disagree, 16.67% were disagree, while 26% remained neutral, 40% were agree and 15.33% were strongly agree. To one more query that the Nurse manager would delegate not more because they need pretty perfectionist and responses were as followed, 6% were disagree, while 11.33% remained neutral, 61.33% showed agreement and 21.33% showed strongly agreement. When they were asked if they can give subordinates the routine tasks, where 3.33% participants strongly disagreed, 9.33% disagreed, 10% remained neutral, 50% agreed to the statement and 27.33% strongly agreed. Another statement was asked I (Nurse managers) would delegate more if I (Nurse managers) were more confident in delegating 0% Strongly disagreed, 2% disagreed, 8% neutral, 60.67% agreed and 29.33% strongly agreed with this statement (Table 3).

Attitude Level        
  Frequency Percent Valid Percent Cumulative Percent
Negative attitude (Less than 35 score/55) 18 12 12 12
Positive Attitude (35 or above score/55) 132 88 88 100
Total 150 100 100  

Table 3: Overall Score of Attitude

Table 3 concluded that 88% of participants have positive attitude towards effective delegation, who scored 35 or above on 55 total score scale, while only 12% had revealed negative attitude and had scored less than 35 on attitude scale of 55.


The evidences of my research article are that nursing manager have no time for delegation, the overall 2% of respondents were strongly disagree with this, while 38.67% agreed that they have less time and 19.33% showed strong agreement. Furthermore, another query elaborated that nurse manager uses delegation process more often if they were more confident, only 2% participants were disagreed while 60% were agree and 29.33% responded as strong agreement.

One of the earlier researches explored a high percentage 66.7% of the respondents that were disagree to statement, “Nurse manager don’t feel, they have sufficient time to delegate effectively”. Furthermore 37.8% disagree with the statement that they would get more encouragement and appreciation if they would delegate more. Moreover 64.4% of study respondent agree with the statement that they get upset, if the delegated task is not accomplished through proper delegated instruction [7].

The result of this research project revealed that most of the respondents 88% having positive attitude towards effective delegation who scored 35 or more on a total score scale of 55, while remaining 12% had possessed negative attitude who scored below 35 on attitude scale of 55.

Findings of previous research explored overall mean score 3.1 ± 0.99 which predicted that nurses were unsure about their opinion of delegation [4]. Moreover, another study showed similar results 74.1% of nurse manager having neutral attitude towards effective delegation. This shows that the attitude of nursing manager was negative towards effective delegation [5].

This study result indicated that 82.67% respondents had good preparedness, who scored 75 or above in a total score of 100, while 17.3% had poor preparedness because they score less than 75 on total score of100.

The study showed that majority of nurse managers possess very less often feedback from the subordinate nurses on whether the delegation job is explained in correct manner or not, moreover 45% of nurse managers have much concerned that the nurses and subordinates may regards them lazy because they are delegating tasks and not doing themselves [5].


• The sample size n=150 in not sufficient to generalize the results to greater population.

• The study duration was short; therefore, no prospective event could be interpreted.

• The sampling method was convenient, which may have some business.


The finding of current study predicted a positive attitude of nurse manager and senior staff nurses towards effective delegation. It is mandatory to achieve a patient satisfaction and successful quality care outcome, there is need to advance staff development and satisfaction with delegation. Nurse managers are advised to boost the skill and knowledge of junior nurses for more effective and satisfactory delegation. They should organize learning session to improve their confidence and competency with minimum guidance. As result of current study, it is essential that the nurse manager requires to have access to education based on knowledge, attitude and practices of nursing delegation.

It is mandatory for the top nursing management and policy maker to include nursing delegation process and continuous nursing education programs among nurse managers. Furthermore, the nurse managers are supposed to follow the recommended training session to ensure quality delegation among subordinates and junior staff nurses following essential guidelines to ensure effectiveness.