Empowerment and Delegation: Two Vital Skills Every Nurse Leader Needs

By Kelly Hancock, DNP, RN, NE-BC

In the last decade, Cleveland Clinic’s executive nurse leaders have become some of the health system’s most significant decision-making representatives. Among many notable accomplishments, they have helped create an environment at Cleveland Clinic that empowers nurses to practice collaboratively with physicians to improve patient outcomes.

Empowerment along with the ability to delegate are considered highly vital to success. In fact, these skills are considered so imperative that in 2015, Cleveland Clinic’s Office of Nursing Education and Professional Development began offering a class focused solely on these two skills for the health system’s nurse managers and assistant nurse managers.

Why empowerment and delegation

Empowerment and delegation are crucial in nursing leadership for many reasons.

For starters, numerous reports demonstrate that empowerment is an important predictor of organizational commitment in staff nurses. It is also associated with less nurse burnout, nurses working to the fullest extent of their education and training, and improved job and patient satisfaction. Hospitals with high levels of empowerment often have strong Shared Governance structures in place and have attained Magnet Program Recognition® from the American Nurses Credentialing Center (ANCC) – both of which typically result in higher patient satisfaction scores, and thus, improved patient outcomes.

Similarly, delegation is one of the most necessary and complex nursing skills – both in a clinical and leadership sense. Delegation in the clinical environment includes an understanding of responsibility, authority and accountability. For example, nurses have to understand the needs of their patient and/or family member(s) and engage the appropriate caregivers to assist in meeting those needs.

In nursing leadership, delegation is required to effectively manage a leader’s vast number of responsibilities. With today’s ever-changing healthcare environment, it is virtually impossible for any single leader to do, or know, everything. Additionally, delegation helps further engage caregivers in shared decision-making.

The concepts of empowerment and delegation are often considered on the same continuum – allowing leaders to be more efficient and effective in their roles, while also encouraging them to engage and further develop their teams.

The path to ‘Building an Empowered Team’

Cleveland Clinic’s executive nurse leaders and members of the Office of Nursing Education and Professional Development team first recognized the immense value of empowerment and delegation in nursing leadership in 2014. A group of nurse leaders had recently completed the Manager Ready behavioral assessment by Development Dimensions International (DDI).

Using real-world simulation, the assessment provides critical information used to make decisions in an effort to identify whom within an organization is ready for a front-line leadership role. It also helps identify how people can develop within these roles for more effective leadership.

Recognizing that patient outcomes and caregiver success were linked to leadership strength, Cleveland Clinic’s goal was to use this assessment to create individualized development plans for nurse managers. Assessment results showed that while Cleveland Clinic nurse managers demonstrated an average proficiency greater than the national benchmark, they were not where the organization was hoping they would be.

Shortly after, the ‘Building an Empowered Team’ class was formed. Speaking to the assessment results, it was designed to build competency and capacity in delegation and empowerment. Today, the one-time class is offered three or four times per year, and focuses on:

• The current state of delegation and empowerment competencies in the nurse leader role
• Identifying the key differences between the two skills
• The advantages and barriers to performing both skills
• When to use both skills and how to incorporate them into daily roles and key behaviors

The class begins with an exercise that demonstrates poor delegation. Participants discuss how the scenario impacted them and what they would have done differently. In an interactive fashion, the class then considers each participant’s current situation to help personally identify opportunities for delegation and empowering caregivers to take ownership of their practice.

Nurse leaders can do anything, just not everything

As Cleveland Clinic’s ‘Building an Empowered Team’ class facilitator will say: “nurse leaders can do anything, they just can’t do everything.” With this in mind, it’s important for nurse leaders to understand and use delegation and empowerment as effectively as possible to further enhance team development, care delivery and patient outcomes.

Kelly Hancock is the Executive Chief Nursing Officer of the Cleveland Clinic Health System, and Chief Nursing Officer of Cleveland Clinic Main Campus.

Follow Kelly on Twitter at @kkellyhancock.