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Confidence in delegation and leadership of

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DOI: 10.1111/jonm.12372

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Journal of Nursing Management, 2016, 24, 676–685

Confidence in delegation and leadership of registered nurses in

long-term-care hospitals
1 2 3
JUNGMIN YOON RN, MSN , MIYOUNG KIM RN, PhD, MBA, GNP and JUHHYUN SHIN RN, PhD

1
Master Graduate, 2Associate Professor, 3Assistant Professor, Division of Nursing, College of Nursing, Ewha
Womans University, Seoul, Korea

Correspondence YOON J., KIM M. & SHIN J. (2016) Journal of Nursing Management 24, 676–685.
Miyoung Kim Confidence in delegation and leadership of registered nurses in
Division of Nursing, long-term-care hospitals
College of Nursing,
Ewha Womans University, Background and aims Effective delegation improves job satisfaction,
52 Ewhayeodae-gil, responsibility, productivity and development. The ageing population demands
Seodaemun-gu, more nurses in long-term-care hospitals. Delegation and leadership promote
Seoul 03760, cooperation among nursing staff. However, little research describes nursing
Korea
delegation and leadership style. We investigated the relationship between
E-mail: mykim0808@ewha.ac.kr
registered nurses’ delegation confidence and leadership in Korean long-term-care
hospitals.
Methods Our descriptive correlational design sampled 199 registered nurses from
13 long-term-care hospitals in Korea. Instruments were the Confidence and Intent
to Delegate Scale and Multifactor Leadership Questionnaire.
Results Confidence in delegation significantly aligned with current-unit clinical
experience, length of total clinical-nursing experience, delegation-training
experience and leadership. Transformational leadership was the most statistically
significant factor influencing delegation confidence.
Implications for Nursing Management When effective delegation integrates with
efficient leadership, staff can deliver optimal care to long-term-care patients.
Keywords: delegation, leadership, long-term-care hospital, registered nurses

Accepted for publication: 28 January 2016

Leaders delegate to unlicensed nursing personnel

Introduction
Health-care providers must furnish safe, efficient,
patient-tailored care (Institute of Medicine, as cited in
Kohn et al. 2000). Successful, efficient delegation is
essential to optimal health care (Standing & Anthony
2008), intensifying the limited resources under pressure
from rising health-care costs (Gillen & Graffin 2010).
Effective delegation contributes to job satisfaction,
empowerment, responsibility, productivity, profes-
sional growth, and effective patient care (Kærnested &
Bragad ottir 2012), whereas inappropriate delegation
relates to poor core caring, repetition of caring or
unbalanced workload (Anthony & Vidal 2010).
(UAP, also nursing assistants, nursing auxiliaries, care
assistants, care aides, health aides and support work-
ers; Johnson et al. 2015) to use their skills and compe-
tencies (Bystedt et al. 2011). Through successful
delegation, registered nurses (RNs) concentrate on
complicated nursing tasks (Stonehouse 2015) and
focus on reviewing charts, monitoring significant med-
ical changes, and teaching patients (Standing &
Anthony 2008). Registered nurses identify nursing
diagnoses, organise care plans, communicate with
patients and evaluate patients’ overall outcomes: skills
requiring critical thinking and professional knowledge
(Paquay et al. 2007, Kim & Jeong 2014). Unlicensed

DOI: 10.1111/jonm.12372
676 ª 2016 John Wiley & Sons Ltd

nursing personnel mostly assist in direct nursing care,
such as vital signs, range of mobility, feeding and
bathing (Kleinman & Saccomano 2006). However,
inadequate supervision can engender health-care
errors, which has an impact on patients’ outcomes
(Anthony et al. 2000). Failure to delegate is an error
in nursing-task planning and execution (Standing &
Anthony 2008), generating staffing complications and
omissions (Standing & Anthony 2008, Bittner &
Gravlin 2009, Thompson 2012). Many RNs are
unsure which tasks are right for different roles and are
unaware they are responsible for their patients’ nurs-
ing care, even when they delegate to others (Hansten
2011).
The proportion of elders in Korea has rapidly
increased (7.2% in 2000 and 11.8% in 2012; Statistics
Korea 2014). Long-term-care hospitals, with the high-
est growth rate of health-care organisations (111.6%,
2005–2015; Statistics Korea 2015), are using a nursing-
staff skill mix, including UAPs, to meet elders’ diverse
needs (Kim & Lee 2014). The number of certified nurs-
ing assistants (CNAs) in long-term-care hospitals has
burgeoned (from 1436 in 2006 to 8921 in 2011),
whereas the percentage of nursing assistants in total
nursing staff was increased from 31.0% in 2006 to
49.0% in 2011, while that of Registered nurses
decreased from 69.0% to 51.0% of total nursing staff
during the same period(Ministry of Health and Welfare,
2013). The RN shortages in long-term-care settings
has increased the need to maintain RNs in leadership
positions (Fleming & Kayser-Jones 2008). Unlicensed
nursing personnel perform nursing tasks in Korean
long-term-care hospitals, but there is a lack of clear
legal standards (Kim & Jeong 2014).
Efficient leadership includes successful delegation
(Bittner & Gravlin 2009). Relationship-oriented lead-
ership emphasises people and relationships, whereas
task-oriented leadership focuses on structures and
tasks (Cummings et al. 2010). Relationship-oriented
transformational leaders encourage members to
accomplish more (Northouse 2010) by inspiring self-
esteem through positive feedback (Riahi 2011). Task-
oriented transactional leaders highlight the economic
exchange between leaders and members to achieve
work (Bass & Avolio 1993). Leaders are aware of
members’ needs and supervise their task performance
(Bono & Judge 2004).
Hutchinson and Jackson (2013) proposed a new
vision of nursing leadership emphasising realistic,
moral, shared governance, energetic involvement in
the organisation and self-determination (Hannah et al.
2014, Wong 2015). Despite the growing significance
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 676–685
Nursing leadership and delegation
of leadership and delegation in long-term-care hospi-
tals’ quality, little research exists on the delegation–
leadership relationship (Corazzini et al. 2010). This
study examined correlations between delegation confi-
dence and RN leadership in Korean long-term-care
hospitals.
Literature review
Leadership
To maintain the reciprocal process of mobilising peo-
ple with various economic, political, and other
resources to realise goals independently or mutually
(Burns 1978), leadership is vital for RNs to effectively
supervise UAPs and delegate successfully (Saccomano
& Pinto-Zipp 2011). A RN’s leadership style affects
successful relationships among nursing staff (Corazzini
et al. 2010, Saccomano & Pinto-Zipp 2011) because
intellectual leadership traits include delegation, knowl-
edge and skills (Denehy 2008).
Whereas transactional leaders are task-oriented,
advocating for the current situation (Burke 2008),
transformational leaders focus on higher ideals
(Doody & Doody 2012), acknowledging members’
contributions and enhancing empowerment (Kim et al.
2012). Transformational leaders effectively resolve
challenges in long-term-care hospitals such as staff
turnover (Utley et al. 2011), vacancy rates, growing
demands for care (Grove et al. 2010), and improved
quality of care (Wong et al. 2010). In studies explor-
ing nursing leadership practices and patient outcomes,
transformational leadership aligned significantly with
fewer medication errors, patient falls and hospital
infections (Houser 2003, Capuano et al. 2005). Trans-
actional leaders contributed to enhanced patient satis-
faction by effectively managing patient care through
clear direction and work expectations (Doran et al.
2004). However, little research exists relating leader-
ship and patient outcomes (Wong 2015).
Delegation
Accelerating changes in health care, an ageing popula-
tion, rising health-care costs and worldwide nursing
shortages have increased attention on delegation in
nursing (Gillen & Graffin 2010). Delegation is ‘the
transfer of responsibility for the performance of (but
not the accountability for) an activity from one indi-
vidual to another’ (American Nurses Association
1992). The American Nurses Association (ANA)
(2005) defined terms related to delegation, principles,
677
J. Yoon et al.
and roles of RNs and certified nursing assistants
(CNAs). However, most US states make their own
definitions of delegation, which are different from the
ANA in various situations (Thomas et al. 2000). No
clear legal instructions or documents describe delega-
tion for complex, unpredictable patient-health condi-
tions (Gravlin & Bittner 2010); many RNs consider
delegation to be time consuming (Kærnested & Bra-
gadottir 2012), feel they have insufficient authority
over CNAs and lack conflict-management skills
(Kalisch 2006). New graduate RNs are unsure of
CNAs’ roles (Potter et al. 2010), and what tasks can
be delegated (Berkow et al. 2008).
Delegation allows RNs to use more advanced nursing
skills and facilitate more frequent observation of
patients (Corazzini et al. 2010). Moreover, delegation
enhances supervised UAPs’ confidence and self-esteem
(Gillen & Graffin 2010). Thus, delegation, based on
mutual trust, can proactively improve safety (Anthony
& Vidal 2010). Trust is a key component of delegation
(Standing & Anthony 2008) when interdependent rela-
tionships help perform tasks in uncertain environments
(Rousseau et al. 1998, Anthony & Vidal 2010). As
trust builds, the amount and richness of shared infor-
mation increase (McNeish & Mann 2010), allowing
the sharing of timely, meaningful patient information
and clarifying nursing planning (Anthony & Vidal
2010). Ineffective delegation has a negative impact on
safety and quality of care (Bittner & Gravlin 2009) and
hinders RNs’ concentration on critical nursing activities
(Kærnested & Bragad ottir 2012). Registered nurses
lacking professional experience are less likely to dele-
gate, owing to weak motivational skills and supervisory
inexperience (Kærnested & Bragad ottir 2012). Novice
nurses remain unsure of UAP roles, job descriptions and
training (Potter et al. 2010).
Health-care leaders must develop innovative delega-
tion strategies. Improved delegation and communica-
tion skills require a basic understanding of the
concepts of delegation. Nurses should practice these
skills with experiential learning such as role-playing
scenarios and case studies (Standing & Anthony 2008,
Hansten 2011).
Korean studies have merely discussed which nursing
activities were delegated frequently to CNAs in gen-
eral hospitals (Sim & Kim 2010), rather than princi-
ples for delegation, scope of duties and legal
responsibilities (Yang & Kim 2013). In addition, dele-
gation is not included in nursing curricula. Leaders
should understand staff capabilities and training
requirements, communicating task details clearly and
accurately (Quallich 2005). Exploring the delegation–
678
leadership relationship may offer strategies to build
effective RN–CNA relationships.
Methods
Study sample
Using a descriptive correlational design, 180 direct-
care RNs employed in 13 Seoul long-term-care hospi-
tals submitted 230 questionnaires. To achieve a power
of 0.80 with an effect size of 0.25 and a significance
of 0.05 using G-power 3.1.9.2 (Heinrich Hein Univer-
sity, Dusseldorf, Germany), 180 participants were
required. We excluded CNAs, administrative RNs and
RNs with no practical experience.
Instrument
We measured confidence in delegation using the Con-
fidence and Intent to Delegate Scale (CIDS; Parsons
1999) with 11 dichotomous items and 10-point Lik-
ert-type scales ranging from 1 (never) to 10 (always);
higher scores indicated greater confidence in delega-
tion. The original scale’s Cronbach’s alpha was 0.95
(Parsons 1999). The modified scale’s Cronbach’s alpha
was 0.83 in this study.
We measured leadership using the Multifactor Lead-
ership Questionnaire (MLQ; Bass & Avolio 1993)
translated by Lee (1996) and modified by Kim (2003).
The scale addresses contingent reward, management of
exception, charisma, intellectual stimulation and indi-
vidual consideration, with 25 questions on a five-point
Likert-type scale ranging from 1 (never) to 5 (always).
Kim (2003) reported an internal reliability of 0.82; the
Cronbach’s alpha for the present study was 0.92.
Procedure
From 1331 long-term-care hospitals listed in the
National Health Insurance Service in (2014), we ran-
domly telephoned 50 in Seoul; 13 agreed to partici-
pate. We visited selected settings to introduce the
study and obtain consent and asked participants to
place individually completed forms in a collection
envelope we retrieved 1 week later.
Data analysis
Owing to the parametric–non-parametric controversy
when analysing different Likert-scale responses (Sulli-
van & Artino 2013), we conducted both to confirm
results. No large differences emerged. Kolmogorov–
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 676–685
 Nursing leadership and delegation

Smirnov and Shapiro–Wilk tests provided normal dis- Respondents returned a total of 199 questionnaires
tribution. We then examined delegation-confidence (86.5%). Participants’ average age was 47.12 years
differences using t-tests and analysis of variances (SD = 10.65), current-unit clinical nursing experience
(ANOVAS), on participants’ general characteristics and was 3.05 years (SD = 2.73); participants’ CNAs were
leadership styles. A Spearman’s rho correlation test 48.17  6.11 years and their clinical experience per-
examined relationships among participants’ delegation iod was 6.55  4.46 years. Reporting an average of
confidence, general characteristics, and leadership style 13.03 years’ (SD = 8.83) total clinical nursing experi-
and multiple linear regression analysis identified pre- ence, most participants (73.4%) had delegated, 60.8%
dictors of delegation confidence. were unfamiliar with CNAs’ job description and
67.3% reported that CNAs’ roles and responsibilities
were inconsistent with their current unit’s scopes of
Results practice. Only half were aware of their legal supervi-
sion responsibility for CNAs. Median participant
Participants’ general characteristics
scores for delegation confidence was 37 and for trans-
The average bed count was 169.88 (SD = 38.17) formational leadership and transactional leadership,
(Table 1). All participating settings were for-profit pri- scores were 53 and 34, respectively.
vate long-term hospitals operating in Seoul an average
of 52.73 months (SD = 42.56). Among these, three
Confidence in delegation
were church-based settings.
Confidence in delegation was statistically significantly
Table 1
affected by current-unit clinical experience, total clini-
General characteristics cal nursing experience, training or educational pro-
grammes, experience in delegation, familiarity with
Median
Characteristics n % Mean  SD (range) CNA job description, legal understanding and leader-
ship style (Table 2). Participants with more than
Number of beds 169.88  38.17
Period of operation 52.73  42.56
5 years of current-unit clinical nursing experience had
(months) more confidence to delegate than others (U = 6.137,
Age (years) P = 0.018). The confidence in delegation of participants
20–29 16 8.0 47.12  10.65
30–39 31 15.6 who had worked <5 years was significantly less than
40–49 54 27.1 those with more than 5 years (v2 = 6.137, P = 0.001).
≥50 98 49.2
Participants with on-the-job training or career-devel-
Period of clinical nursing experience in the current unit (years)
<5 156 78.4 3.05  2.73 opment programmes were more confident in delega-
≥5 43 21.6 tion than those with no training (v2 = 15.491,
Period of total clinical nursing experience (years)
<5 33 16.6 13.03  8.83
P = 0.001). Participants with experience delegating
≤5 ~ < 10 44 22.1 (U = 2787.500, P = 0.003) and familiar with the job
≥10 122 61.3 description of CNAs (U = 3550.000, P = 0.003) had
Educational background
Three-year diploma 126 63.3 greater confidence in delegating. Participants who
Bachelor 62 31.2 thought a job description for CNAs was consistent
Graduate school 11 5.5 with the scope of their actual practice had a higher
Age of UAPs (years)
30–39 19 9.5 48.17  6.11 level of confidence in delegating (U = 3172.000,
40–49 106 53.2 P = 0.005) and knew their legal responsibilities in
≥50 74 37.2
Period of UAPs’ clinical experience (years)
supervising CNAs (U = 3818.000, P = 0.014). Partici-
≥5 78 39.2 6.55  4.46 pants using transformational leadership were signifi-
≤5 ~ <10 85 42.7 cantly more confident delegating than those with a
≥10 36 18.1
Total leadership scores
transactional leadership style or equal scores for both
Transformational 53 (15–75) styles (v2 = 16.702, P = 0.000).
leadership
Transactional 34 (10–50)
leadership Correlations between confidence to delegate and
Total score of 37 (6–60)
confidence in leadership
delegation
Years of current-unit clinical nursing experience
UAP, unlicensed nursing personnel. (r = 0.169, P < 0.017), transformational leadership

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Journal of Nursing Management, 2016, 24, 676–685 679
J. Yoon et al.

Table 2
Differences in confidence in delegation according to participants’ general characteristics and delegation-related characteristics

Mean Mann–Whitney U
Characteristics n rank or chi-Square P Scheffe

Age (years)
20–29 16 73.06 6.008 0.111
30–39 31 103.05
40–49 54 93.17
≥50 98 107.49
Period of clinical nursing experience in the current unit (years)
<5 156 95.22 2354.500 0.018*
≥5 43 119.63
Period of total clinical nursing experience (years)
<5 a
33 69.53 14.056 0.001** a < b, c
≤5 ~ <10b 44 118.29
≥10c 122 102.82
Educational background
Three-year diploma 126 93.96 4.405 0.111
Bachelor 62 105.85
Graduate school 11 126.64
Age of UAPs (years)
30–39 19 89.46 1.200 0.549
40–49 106 103.36
≥50 74 99.03
Period of UAPs’ clinical experience (years)
<5 78 102.50 .913 0.633
≤5 ~ <10 85 101.13
≥10 36 91.95
Experience of delegation
Yes 146 107.41 2787.500 0.003**
No 53 79.59
Resource for education on delegation
Nursing curricula a
38 93.68 15.491 0.001** d < b, c
On-the-job trainingb 47 112.66
Career development programmec 50 118.38
Noned 64 80.09
Familiarity with a job description for UAPs
Yes 78 114.99 3550.000 0.003**
No 121 90.34
Consistency of a job description with the scope of actual practice
Yes 65 115.65 3172.000 0.005**
No 134 91.17
Awareness of legal responsibility
Yes 117 108.37 3818.000 0.014*
No 82 88.06
Leadership style
Transformational leadershipa 91 117.95
Transactional leadershipb 86 85.26 16.702 0.000*** a > b, c
Samec 22 81.76

a-c
’s test for all possible comparison
Scheffe
UAP, unlicensed nursing personnel.
*P < 0.05, **P < 0.01, ***P < 0.001.

(r = 0.420, P < 0.001) and transactional leadership

(r = 0.307, P < 0.001) had significantly positive corre-
lations with confidence in delegation (Table 3). Partic-
ipants’ age significantly correlated with total clinical
experience (r = 0.344, P < 0.001), transformational
leadership (r = 0.220, P = 0.002) and transactional
leadership (r = 0.230, P = 0.001). No significant cor-
relation emerged between total clinical experience and
transformational leadership. Transactional and trans-
formation leadership styles positively intercorrelated
(r = 0.721, P < 0.001).
Factors predicting confidence to delegate
To predict confidence to delegate, we used multiple
regression analysis (Table 4). The analysis, including
participants’ ages, current-unit clinical nursing experi-
ence, period of total nursing experience, ages of
CNAs, and periods of CNAs’ clinical experience
accounted for 14.7% of the variance in confidence in
delegation (F = 5.197, P < 0.001). Transformational
leadership was the most significant predictor of confi-
dence in delegating (b = 0.473, P < 0.001).

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680 Journal of Nursing Management, 2016, 24, 676–685
 Nursing leadership and delegation

Table 3
Correlations between confidence in delegation, general characteristics and leadership

Clinical nursing
Confidence in experience in the Total clinical Transformational Transactional
Variables delegation, r (P) Age, r (P) current unit, r (P) experience, r (P) leadership, r (P) leadership, r (P)

Confidence in delegation 0.130 (0.066) 0.169* (0.017) 0.121 (0.088) 0.420*** (<0.001) 0.307*** (<0.001)
Age 0.072 (0.315) 0.344*** (<0.001) 0.220** (0.002) 0.230** (0.001)
Clinical nursing experience 0.286*** (<0.001) 0.104 (0.144) 0.098 (0.170)
in the current unit
Total clinical experience 0.059 (0.409) 0.241** (.001)
Transformational leadership 0.721*** (<0.001)

*P < 0.05, **P < 0.01, ***P < 0.001.

egating may align with an insufficient level of confi-

Table 4
Results of multiple regression analysis for variables predicting dence in delegating (Saccomano & Pinto-Zipp 2011).
confidence in delegation Older RNs and those with more clinical experience
Variables B SE b t P
had better competency and confidence in delegating
and providing clear instructions as leaders or role mod-
(Intercept) 15.198 8.014 1.896 0.060
els, compared with younger, newly employed RNs.
Age 0.003 0.071 0.004 0.049 0.961
Period of clinical 0.009 0.017 0.040 0.547 0.585 Some experienced RNs did not understand they must
nursing experience provide CNAs with initial direction, intermittent super-
Period of total 0.005 0.007 0.068 0.796 0.427
nursing experience
vision, and evaluation (Hansten 2011). If RNs are una-
Age of nursing 0.048 0.104 0.035 0.467 0.641 ware of their full accountability for the outcomes of
assistant delegated tasks, they will be unsuccessful in providing
Period of nursing 0.020 0.013 –0.118 1.619 0.107
assistant’ clinical appropriate supervision to CNAs who carry out direct
experience patient-care activities (Standing & Anthony 2008). In
Transformational 0.557 0.137 0.473 4.074 <0.001*** this study, the confidence in delegation of participants
leadership
Transactional 0.260 0.252 0.120 1.032 0.304 who had worked less than 5 years was significantly
leadership lower than those with 5 to 10 years and those with
R2 = 0.182, Adj R2 = 0.147, F = 5.197
more than 10 years of total clinical nursing experience.
***P < 0.001. It may be interpreted that the confidence of delegation
was proportional to the nursing experience. However,
further research is necessary to confirm this.
As expected, leaders with interpersonal communica-
Discussion
tion skills, advocates for sound environments and
This study examined confidence in delegation of RNs involvement in leadership behaviours of members
in long-term-care hospitals, investigating correlations achieved better patient outcomes (Wong 2015). Trans-
between RNs’ confidence in delegation and leadership formational and transactional leadership correlated
style. Meaningful work experience was an essential with confidence in delegation in this study. Transac-
factor in developing leadership (Doh 2003). Total tional leaders clearly identify each member’s duties and
length of nursing experience was a statistically signifi- accountability in an established standard or job descrip-
cant factor (Standing & Anthony 2008, Corazzini tion (Laohavichien et al. 2009). Under clear goals,
et al. 2010, Kærnested & Bragad ottir 2012). Those transactional leaders control members’ performance by
with more than 5 years of total clinical nursing expe- offering rewards for desirable fulfilment and withhold-
rience had higher levels of confidence in delegating ing incentives for poor outcomes (Boldy et al. 2013).
than those with <5 years. However, more research is Transformational leaders form integrated mutual
necessary to confirm the relationship, as some studies awareness, fortifying motivation by promoting sup-
reported that confidence in delegation did not statisti- porters’ self-related outlook, worth, and belief in a
cally correlate with clinical experience (White et al. self-sacrificing culture (Starratt 1999). Mutual trust
2011, Saccomano & Pinto-Zipp 2014). Kærnested and effective communication serve as critical compo-
and Bragad ottir (2012) reported that age and experi- nents of confidence in delegating (Kærnested & Bra-
ence were critical factors in determining an RN’s level gadottir 2012). Transformational leaders were more
of confidence in delegating. Lacking experience in del- confident in delegating, allowing RNs to perform at
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 676–685 681
J. Yoon et al.
their optimal potential competency through autonomy
(Roberts-Turner et al. 2014) while being sensitive to
CNAs’ potential, aware of CNAs’ training require-
ments, and providing clear and accurate communica-
tion (Quallich 2005). Transformational leaders
developed a collaborative culture.
Health-care organisations, legislative bodies and
countries such as Korea should develop organisational
cultures that promote effective teamwork, supporting
efficient delegation by developing legal standards, poli-
cies and regulations on the scope of practices for RNs
and UAPs. In Korea, medical laws are under consider-
ation to mandate that UAPs should practice under the
supervision of RNs, and UAPs’ scope and limitation
of tasks should be determined by the Korean Ministry
of Health and Welfare (2012). Based on legal guideli-
nes, creating a collaborative ward culture that pro-
motes effective delegation among nurse staff is
required. Both RNs and UAPs should know their cor-
responding roles, based on the different characteristics
of nursing tasks (Johnson et al. 2015).
National leaders should define which nursing tasks
RNs can delegate to UAPs, based on setting character-
istics, available staff patterns and financial status.
Organisational culture, individual working style, com-
munication effectiveness and different nursing tasks
have an impact on successful delegation (Johnson
et al. 2015). Inconsistencies between expected nursing
tasks and required nursing tasks may diminish patient
outcomes (McNeese-Smith 2000). Uncertainty about
roles of nursing staff can negatively influence RNs’
confidence in delegating (Bittner & Gravlin 2009).
Unlicensed nursing personnel should receive education
on documentation and the importance of reporting
significant changes in patients (Johnson et al. 2015).
Nationally standardized delegation regulations for
nursing tasks would maintain the safety of patients.
Policies and regulations that reinforce continuing edu-
cation programmes will optimise RNs’ confidence in
delegation and leadership. When effective delegation
integrates with efficient leadership, health-care staff
deliver optimal quality care to patients.
Finally, nursing education curricula should include
leadership courses. Management leadership experts
insist that leadership is a core requirement, especially
for organisational research, education and nursing prac-
tice, despite the debate on teaching methods of leader-
ship (Doh 2003). Leadership teaching should include
knowledge, skills, and attitudes. Although the mandate
to delegate is essential to competent nursing, few under-
graduates experience such education (Hasson et al.
2013, Saccomano & Pinto-Zipp 2014) and have little
682
practical experience (Johnson et al. 2015). Registered
nurses require formal education on delegation and
transformational leadership in nursing practice.
In the present study, educated participants had
greater confidence in delegating. Workplace education
programmes could improve participants’ skills and con-
fidence in delegation (Potter et al. 2010). Education
and training on delegation needs to reflect clinical prac-
tice and highlight how to build trust between RNs and
CNAs. A RN’s educational preparation should align
with recent significant changes in health-care systems,
providing nurses with clinical experiences to help them
acquire the necessary delegation skills.
Limitations
The results from the small sample size in Seoul may
not be generalizable. Moreover, the model for multi-
ple regression analysis only accounted for 14.7% of
the variance, although transformational leadership
was the most influential variable to predict confidence
in delegating. Additional research with a larger sample
across broader areas, nurse staffing-ratio units, and
different types of organizations would help to discern
more comprehensive understanding of RNs’ confi-
dence in delegating.
Conclusion
Registered nurses’ length of total clinical nursing expe-
rience, delegation training or educational programmes
and leadership significantly affected confidence in dele-
gating. This initial study identified determinant factors
for confidence in delegating and explored relationships
with leadership styles for nurses in Korea. The results
will help in formulating planning strategies to yield
effective and efficient nurses, and achieve ideal nursing
performance in long-term-care hospitals.
Implications for nursing management
Stable, effective, efficient nursing-staff delegation is
fundamental to optimal quality of care. Hospitals
expect the costs in long-term-care settings to require
more UAPs (Standing & Anthony 2008). At present,
RNs need leadership through delegation, cooperation,
partnerships and trust to successfully manage patient
care. In long-term-care settings, RN leadership is para-
mount for directors of nursing (Fleming & Kayser-
Jones 2008). Transformational leadership was most
influential in measuring delegation confidence. The
generational characteristics of nursing staff should be
ª 2016 John Wiley & Sons Ltd
Journal of Nursing Management, 2016, 24, 676–685

considered in promoting leadership; in this study, RNs
and UAPs were of similar ages, and such similarities
cause newly employed RNs difficulty in delegating
(Potter et al. 2010). Improved communication and
relationships engender successful RN–UAP partner-
ships (Standing & Anthony 2008).
Delegation-training programmes should include job
descriptions, scope of nursing practice, and legal
responsibilities. Education in universities and socializa-
tion training in clinical settings should optimise RNs’
clinical delegation competence (Thompson 2012).
Nurse managers should develop continuing education
programmes on delegation that reflect clinical settings
and educational preparation to improve RNs’ leader-
ship competence, particularly transformational leader-
ship.
Ethical approval
The Institutional Review Board at a Korean university
granted ethical approval. We informed participants of
their anonymity, distributing questionnaires only to
those who understood these explanations, voluntarily
consented to participate, and signed the written con-
sent form.
Source of funding
The authors did not receive any funding for this
paper.
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