The art of delegation

Within our profession we regularly talk about delegation, but there can often be confusion about what this means. Delegation is an important way of increasing our teams feeling of value, morale and boosting how well a team works together. But do we really understand what delegation means for our teams, and are we all confident about delegating tasks?

This blog explores explore delegation to Registered Veterinary Nurses (RVNs), as being one and employing them I feel this is definitely an area I can offer advice in. But many of the principles will apply to other vet-led team relationships too.

The principles of delegation

It has become really evident to me over the last 12 months that one of the biggest barriers within the vet-led team, particularly with veterinary surgeons and RVNs, is the art of delegation and the subsequent accountability. We need a better understanding of what delegation is, what we can and can’t do, and how we can effectively delegate properly and responsibly to our teams, confident that we have delegated to the right level and the right person.

To delegate effectively, we need an understanding of our team members’ levels of competency. This requires clear and open communication and regular review.

I used to think of delegation as quite a linear process – choose a task, pass it on to someone you think will carry it out better than you and get it done; or take the risk that you should have just done it yourself anyway (we all have those days!). But, I recently attended a course[1] which opened up the principles of delegation to me.

There are five parts to the delegation process:

• Analysis of the task
• Appointment of the task
• Defining the task
• Control – Monitoring and encouraging
• Appraisal – reviewing and revising

These five areas ensure that you fully understand the task you are delegating, that you select the right person dependant on their skill set, competency level and whether they can carry it out as well as whether they truly understand what has been asked of them. This is so significant for our day to day working life, and in the long run will make our lives easier by sharing workload as well as allowing out teams to grow and develop.

Understanding the levels of delegation

I had without thinking about it understood most of these areas. But I think the area that is key for Schedule 3, and probably the one most often missed, is ‘Control’. This is the realisation that when delegating a task, you have a choice of eight different levels of ‘authority’:

Level 1: Get the facts, I’ll decide

Level 2: Suggest alternatives, I’ll decide

Level 3: Recommend an alternative, I’ll decide

Level 4: Decide, wait for my approval

Level 5: Decide, act unless I say no

Level 6: Act, report results

Level 7: Act, report if unsuccessful

Level 8: Act, reporting not needed

I would say that delegation to an RVN can fall up to level 6 depending on the task, and up to a level 3 for a Student Veterinary Nurse (SVN), as the decision still remains with a more senior member of staff. Having an understanding of the different levels of delegation makes it less daunting. It also clarifies ‘Direction & Supervision’ within the code of conduct.

We know that an RVN cannot make a formal diagnosis and then act upon that diagnosis without consulting a veterinary surgeon, and that an RVN cannot prescribe medication. But some teams fail to recognise that an RVN can work within a Care Bundle that has been prescribed by a veterinary surgeon; within that Care Bundle the veterinary surgeon can place their expected responses to a treatment, and if they are not achieved, the RVN can report back for a new action to be taken. The veterinary surgeon does not need to be present and supervising their RVN’s care of an inpatient for example. The veterinary surgeon would delegate that care to them by way of a treatment and care plan, expecting the RVN to alert them to any worsening of condition or unexpected response to treatment.

Regulatory jurisdiction

The RCVS Code of conduct states that veterinary surgeons may direct registered or student (enrolled with the RCVS) veterinary nurses to carry out limited veterinary surgery. This is ambiguous, but it remains open to interpretation for good reason. Providing a closed list would limit some of the work that suitably qualified, competent RVNs can do – especially in specialist veterinary surroundings.

It's also important to remember that RVNs are subject to ‘similar regulatory jurisdiction as Veterinary Surgeons’. An RVN will be accountable for actions carried out outside the scope of the delegation and their competency level.

The RCVS SUPERB Poster and case studies for effective delegation are really useful resources for both veterinary surgeons and veterinary nurses to understand the provisions of Schedule 3.

Delegation used correctly is the key to enhancing the feeling of value, job satisfaction and progression in a role. But it does need to be understood and used appropriately so it doesn’t knock confidence or pressure a staff member into carrying out a task they are not competent to do. Communication is again so important here; so is the adoption of a no-blame culture – teams should learn from ‘mistakes’ together. We all need to also accept responsibility for our own actions; a no blame culture promotes this honesty and allows the team to grow with confidence rather than fear.

[1] Leadership and Management course by https://www.carolcarpenter.co.uk/