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Critical Thinking, Delegation, and Missed Care in Nursing Practice

Bittner, Nancy Phoenix PhD, RN, CCRN; Gravlin, Gayle EdD, RN, NEAA-BC

Journal of Nursing Administration: March 2009 - Volume 39 - Issue 3 - p 142-146
doi: 10.1097/NNA.0b013e31819894b7

Objective: The aim of this study was to understand how nurses use critical thinking to delegate nursing care.

Background: Nurses must synthesize large amounts of information and think through complex and often emergent clinical situations when making critical decisions about patient care, including delegation.

Method: A qualitative, descriptive study was used in this article.

Findings: Before delegating, nurses reported considering patient condition, competency, experience, and workload of unlicensed assistive personnel (UAP). Nurses expected UAP to report significant findings and have higher level knowledge, including assessment and prioritizing skills. Successful delegation was dependent on the relationship between the RN and the UAP, communication, system support, and nursing leadership. Nurses reported frequent instances of missed or omitted routine care.

Conclusion: Findings from this project provide insight into factors that influence delegation effectiveness. These can guide CNOs and frontline nurse leaders to focus on implementing strategies to mitigate the consequence of missed care. Ineffective delegation of basic nursing care can result in poor patient outcomes, potentially impacting quality measures, satisfaction, and reimbursement for the institution.

Authors' Affiliations: Assistant Dean and Associate Professor(Dr Phoenix Bittner), School of Nursing and Health Professions, Regis College, Weston; and Associate Chief Nurse (Dr Gravlin), Nursing Education, Research, and Professional Development, Lahey Clinic, Burlington, Massachusetts.

Corresponding author: Dr Phoenix Bittner, Regis College, 235 Wellesley St, Weston, MA 02493 (

© 2009 Lippincott Williams & Wilkins, Inc.