Delegation: perception and practice in community nursing

Abstract

The changing demands on primary health care have focused attention on workforce diversification. Although skill mix has been researched for some time, exploration of delegation decision-making is an underresearched topic. This limits the sharing, teaching and monitoring of the inherent skills. Utilizing focus groups, this exploratory research was therefore designed to map delegation perceptions, experiences and decision-making processes of health visitors and districts nurses in a primary care trust in the north of England. The focus group discussions revealed a diversity of delegation practices. Decisions were driven by both pragmatic and needs assessment factors. Issues around the delegatee, the delegator, patient need and structural factors were strongly influential. Delegation of aspects of ‘established’ care was at times in conflict with the philosophy of holistic care. The research suggests that it is important to recognize the community context of practice increases the complexity of delegation decision-making.