The basic element of the universe is a time; time only goes through one way, and only comes once, the most effective way to be spent. The manager use the time management tools effectively will achieve their personal and professional goals, and allow one to spend time on important matter nurse managers are predicting to control and oversee the performance of other healthcare. The ability to delegate routinely is effectively to the success of this function. Aim of this study: To examine the effect of time management training program on delegation skills regarding nurse manager working at Kafrelsheikh General Hospital. Research design: A quasi-experimental intervention research design with pre-post assessment was used in the study. Study sample: A sample of nurse managers including all nurse managers available (39) at the time of data collection, working in all inpatient departments of the Kafrelsheikh General Hospital. Tools: Three tools were used for data collection in this study, these were: 1) The delegation questionnaire tool, 2) Time management tool, and 3) Time wasters’ tool. Results: There were statistically significant improvements in nurse managers’ knowledge related to time management, delegation, and time wasters between pre and posttest (p value < 0.001). Statistically significant positive correlations were detected between age and experience on all time management domains, total time management, delegation, and time wasters (internal & external). Recommendations: Educational program should be focused on the preparation of new graduates to undertake responsibilities of delegation and time management skills as theoretical components, and identify the time wasters during their work setting and what are the strategies to deal with them.
The nurse managers have a lot of pressures on their time, and achieve a high rate of productivity; they must use the effective key of delegation to success. There are some of activities need to do by the managers, but their first task is to make sure that everyone accomplish the assigned task to achieve the organizational goals and mission. Efficient managers define which responsibilities to delegate to achieve her/him plan as timeline, to cooperate with others in the organization, and to appraise the nurses performance, the managers must give the delegate adequate feedback and actualization chance. 1.
There are many meaning for delegation subsists in nursing literature. The most common one established by the American Nurses Association and the National Council of State Boards of Nursing. These institutions express delegation as the process used by nurses to achieve nursing Tasks and activities through direct another person. It has two ways: the delegator, and the delegate. The delegator who assign part of tasks of care to should be registered nurse. 2
In addition, Marriner 3 delegating has reasons: is a time saver, and can help others to develop. Delegation provide staff to use their maximize talent. It can enhance trust and increase self-esteem, appreciation, and satisfaction. It helps the personnel uses their potentials growth and development. Increase the personnel management skills by participation, motivation, and engagement to achieve goals during group unity. It helps to identify the future leaders and management, it also cost effectiveness for managerial.
Barishansky 4 suggests that the purpose of delegation is to have someone else get the job done efficiently and effectively. Frequently, there are work to much be accomplished. In this case, delegation becomes synonymous with productivity, and there a lot of reasons for delegation for this it is not an option but it is essentials. Occasionally, nurse managers must delegate routine activities to be free to handle those complex problems that require a higher level of expertise. The managers select person is prepared well or more expertise or has problem solving skills. When managers wants provide learning or "expansion" opportunities can use delegation. Subordinates may become bored because are not delegated enough responsibility, unproductive, and incompetent. So, the manager participate their subordinates personal and professional improvement by delegation.
The practice of delegation has many benefits for nurses. Effective delegation allows the nurse time to perform more complex activities that are specific to the registered nurse role 5, 6, autonomy increased nursing satisfaction 5, 6, 7, and enhanced time management 7, 8.
Moreover, to ensure the effective delegation consistency the following basic key guideline to the delegator like: a positive attitude is started, provide clarification, during delegation carefully consider how directions are given; need the clear directions; fair enough about unfavorable tasks; determine priorities, provide and receive feedback. Further, managers should match the task with person who has knowledge, skills, abilities, capabilities, and delegates' interest to get effective delegation. Effective delegation gives the nurse managers more time to concentrate on what is urgent and important and can improve job satisfaction, responsibility and productivity 9.
Marquis and Huston 10 mentioned the managers make recurrent mistakes in delegation, these include under delegating, over delegating, and improper delegating. Manager has a false guessing that delegation may be explained as lack of ability to do job correctly or completely that means under delegation. Delegation can expand the manager’s power and capability by increasing what can be accomplished not needs to limit the manager’s control, prestige, and authority. In fact, delegation can be empowering, both to the person delegating and to the person being delegated to.
Swinton 11 suggests that the most frequent causes of under delegation the manager’s willingness to achieve the whole job personally due to a lack of trust in anyone; because he or she require more experience or the manager can do it better and faster than anyone else. It is important to remember that time spent in learning another to do a job can be return10-fold in the future. Furthermore, it is the opportunity for subordinates to improve productivity, and express feelings of enrichment and accomplishment.
While, Bai 12 clarified that some managers over delegate as they are poor monitors of time and spend most of their time just trying to get organized and added that others over delegate because they feel insecure in their ability to perform a task. Moreover, Marquis and Huston 13 spotlighted that inappropriate delegation contains delegating at the false time, false person for a false reason. It may include assigning the task and responsibility that are beyond the capability of the person to whom they are being delegated or that should be done by someone with greater expertise, training, or authority. However, with delegation, responsibility can be transferred from the registered staff member to the nursing assistive personnel (NAP) but accountability is shared by both 14.
In delegation as a function of professional nursing with the restructuring of care delivery models, registered nurses at all levels are increasingly being expected to make assignments for, and supervise the work of different levels of employees. To increase the likelihood that the increased delegation required in today’s restructured health care organizations does not result in an unsafe work environment, organizations should have: a) a clearly defined structure where register nurses are recognized as leaders of the health care team, b) job descriptions that clearly define the roles and responsibilities of all workers, c) education programs that help personnel learn the roles and responsibilities of coworkers, and d) training programs that foster the development of leadership and delegation skills 15.
Organizing and using time efficiently, is the biggest challenges one may face in his/her first position, and is a time management process. Employees haven't time to accomplish their technical job efficiently, because time is limited, it's become essential to learn time management skills 16.
The issue of “not enough time” have an answer is time management. In addition, time management has around the tools, skills, activities and mentality needed to work every day in a more efficient way. One must recognize that wasting time is a preferable pastime for most nurse managers, and it is important for nurse managers to acquire knowledge on time management so that productivity could be improved 17.
Olejniczak 18 says: Time management is about the harmonious and oriented how to apply the goal in practice of certain mechanism of work that managing individuals and workplace environment becomes easy in which, the available one's time is used up in the most way possible” planning of one minute of supply saves ten minutes of doing that. By implementing several work mechanism in organizations gradually; that lead to the nurses are increase their efficiency and effectiveness of work. According to Olejniczak 18 lists ten benefits from planning and using up individuals time well: presents the activities with a smaller amount of power, organizing of individuals to work better, decrease chaos and stress, increase work satisfaction, increase motivation, engage in tasks in time, decrease stress at work and focus efficiently, less mistakes, achievement faster to goals.
On the hand, it is important and vital issues require leadership and management in all areas of activity. Effective leadership lead to human and non-human resources move quickly toward higher productivity. In the meanwhile, time management is an essential in the nursing managers’ profession. 19.
In addition, two final attitudes that help managers to avoid time wasters and procrastination: 1) social groups that is the common time wasters includes telephone, unexpected visitors, inappropriate delegation, disorganization personal, miscommunication, and bad self-discipline. 2) Person who spends too much time uses a telephone, while another only manages by crisis. When he/she completes his/her personal analysis suggested earlier, looks at ways in which he/she spends his/her time and decides which of those actions act as time wasters. Once specified, he/she design plans for remove or lessening the time spent in such activity 16.
Determining the time of day when he/she is most productive. When he/she has determined what works best for him/her, using this time to initiate projects. This will make the task seem less overwhelming 20. Because most individuals are inundated with requests for their time and energy, the next step in time management is prioritizing, which may well be the key to good time management. Prioritizing simply means what needs to be accomplished? Is all requests divided into three categories: a) don’t do, b) do later, and c) do now. The “don’t do” items probably reflect problems that will take care of themselves, are already outdated, or are better accomplished by someone else 13. The do later means “procrastinated” it reflects to put off something until a future time, to postpone, or delay needlessly. According to Berkman 21, the procrastination is what happens when the value of doing something else outweighs the value of doing it now. Although procrastination may be appropriate in some cases, the reality is that more often than not, it is a barrier to effective time management and is rarely appropriate when it is done to avoid a task because it is overwhelming or unpleasant.
Finally, the do now requests most commonly reflect a unit’s day-to-day operational needs. These requests may include daily staffing needs, dealing with equipment shortages, meeting schedules, conducting hiring interviews, and giving performance appraisals 13.
Personal time management: It refers in part to self-knowledge, self-awareness is a leadership skill. There are Brans’ 12 rules to master for personal time management mentioned by Brans 22:
1. Struggle to be real as you can be a truthful with yourself about what you need and why you work what you work.
2. Build trusting relationship. Depend on persons you can exchange trust with them.
3. To keep a good lifestyle: practice exercise weekly, eating health food and sleep enough.
4. Organize your day according to biological status and rearrangement your tasks.
5. Priorities plan. Determine the most of two things that are with urgent and important priority to work on them.
6. Ability to say No, refuse things that are opposite with your plan.
7. Schedule time every day to work on just one thing.
8. Doing things better, faster and looking for creative ways to implement it.
9. Set standard process that requires a little supervises.
10. Predict the problem in the future, immediately solve problems, and determine time to think in a future visionary.
11. Division of work and think on one part at a time and then objective by another to achieve your goals.
12. Finish your work who you are started
1.1. Significance of the StudyThus, the essential of examine time management and delegation because the nurse managers are the most crucial role in hospital and that time management is the most important point of success effectiveness, and consider that factors affecting of it. That factors like doing tasks according to priority, and work planning that factors effect on using success time and delegation. 23.
1.2. Aim of the StudyTo examine the effect of time management training program on delegation skills regarding nurse manager working at Kafrelsheikh General Hospital through:
Ÿ Measuring time management skills by nurse managers pre implementation of the training program
Ÿ Extension of delegation process uses pre and post implementation of training program.
Ÿ Planning and implementing of delegation training program
Ÿ Measuring time management skills after implementation of training program.
1.3. Research HypothesisNurse Managers who receive training program about time management on delegation have higher knowledge and attitude scores, higher level of awareness about time wasters after implementation of the program.
A quasi-experimental intervention research design with pre-post assessment was used in the study.
2.2. Research SettingThe study was conducted at Kafrelsheikh General Hospital affiliated to the Ministry of Health, with total bed capacity of 403 beds. It consists of four floors: Ground floor which includes inpatients, a psychiatric unit for males and females, and administrative hospital offices. The first floor includes the intensive care unit (ICU medical & surgical), surgical male inpatient unit, emergency surgical unit, orthopedic unit, and Urology unit. The second floor contains operating rooms (ORs); burn unit, obstetric unit, surgical female unit and neonate intensive care unit (NICU). The third floor includes diabetic unit, medical unit, neurosurgery ICU, pediatric unit, and pediatric intensive care unit (PICU). Program classes were conducted at the Training Center for Women Health in Kafrelsheikh Directorate of Health
2.3. Research SubjectsThe subjects of this study is one group, namely nurse managers, including all nurse managers available (39) at the time of data collection, working in all inpatient departments of the Kafrelsheikh General Hospital. Inclusion criterion for nurse managers was one-year experience at least in the study setting.
2.4. Tools of Data CollectionThree tools for data collection were used in this study. These were the delegation questionnaire tool, time management tool, and time wasters’ tool.
It was aiming to assess the knowledge level that a nurse manager has regarding delegation before the training program and served to assess her gain after implementation of the designed program. Adopted from Mohamed 24, it consists of two parts:
Part I: collecting the personal data as name “optional”, age, qualification, years of experience, and marital status.
Part II: aimed to assess the ability of participant to use delegation. It consists of 22 statements. The response for each statement is one a five point Likert scale “strongly agree, agree, uncertain, disagree and strongly disagree”. These were scored 5, 4, 3, 2, and 1, respectively. Scores of the statement were summed up and the total divided by the number of the items, giving a mean score for the part. This score was converted into a percent score. The subject’s ability to delegate was considered adequate if the percent score was 60% or more and inadequate if less than 60%.
This tool included two parts: one for time management and the other for time wasters. This questionnaire adopted from 25, 26, 27, 28. It aims at assessing the time management skills among first line nurse managers. It consists of 26 statements; the responses for items are always, continuously, sometimes, and rarely. These were scored 4, 3, 2, and 1 respectively. Scores of the statements were summed up and the total divided by the number of the items, giving a mean score, which is divided into external and internal wasters sections, each consisting of ten items. The possible response for each item is either Yes or No. A checked item was scored 1= Yes and the unchecked zero= No. subject’s knowledge about time wasters was satisfactory if the score was ≥ 60% and unsatisfactory if score ≤ 60%.
It was adopted from 29, it aims to assess the effectiveness of the program. The participant assesses the content, methods of teaching, time, and environment of class.
2.5. MethodsThe study was implemented according to the following steps:
The questionnaires sheets were tested for visibility, relevance, applicability, understanding and ease for implementation by "three" expert professors and assistant professors from Nursing Administration Department.
The reliability of the three tools was tested using the internal consistency method. Cronbach's Alpha test for the reliability of delegation was 0.848, while the Cronbach's Alpha test for the reliability of time management was 0.830, and the Cronbach's Alpha test for the reliability of time wasters was 0.901 meaning that the tools are highly reliable.
A pilot study was carried out on 10% of the sample size (4 nurse managers), to experiment the content of the questionnaire as well as to rating the time needed for data collection. There were no necessary modifications. Subjects who participate in the pilot study were excluded from the main study sample.
The fieldwork of this study was accomplished through three phases as following:
First phase: Program planning: To assess the baseline participants’ knowledge about time management, delegation skills, and time wasters. Pretest forms were distributed to the participants in the classroom for continuing education for nurse managers, and were collected after 20-30 minutes. Based on the results of the pretest, the participants learning needs were identified. Accordingly, the objectives of the program were stated and contents were designed. The aim of the program was to improve the ability of nurse managers regarding delegation, time management, and time wasters, and identify the relation between delegation and time management and the barriers to delegation and time management.
Second phase: Program implementation: The total program duration 12 hours theory and practice was divided into three days (4-hours daily). A half hour break was given in the middle of the sessions. The program lasted for two months, from the beginning of December 2018 to the end of January 2019. Program classes were conducted at the Training Center for Women Health in Kafrelsheikh Directorate of Health.
Third phase follow up evaluation: evaluation of participants’ retained knowledge was assessed at the end of the second month post test program using the same tools as in the preprogram test.
It would have been better to repeat the assessment once again at a later time with a larger group.
An official letter was issued from the Dean of Faculty of Nursing at Kafrelsheikh University to the directors of Kafrelsheikh General Hospital. Nursing directors of the selected settings were also contacted. Verbal approval was obtained from each of them.
Research ethics were followed. The participants were informed about the purpose of the study, and their verbal informed consents were obtained. They were informed about their rights to refuse participation or retract at any time, without giving any reason. They were assured that all obtained information will be treated confidentially, and will only be used for the purpose of research. They were also reassured that the study maneuvers could not entail any harmful effects on them.
Statistical analyses were complete by using the Statistical Package for Social Science (SPSS) for windows, version 20.0 (SPSS, Chicago, IL). Data were tested for normality of distribution prior to any calculations. All continuous data were normally distributed and were expressed in mean ± standard deviation (SD). Categorical data were expressed in number and percentage. The comparisons between variables with continuous data were determined using Student’s t-test. Chi-square test was used for comparison of variables with categorical data. Pearson correlation test was used to determine correlation between variables with continuous data. Statistical significance was set at p<0.05.
The current study results include the following parts: 1) distribution of nurse managers according to their personal characteristics; 2) responses of the time management, delegation, and 3) Time wasters’ knowledge pre/post training program regarding nurse managers. Correlation of the time management, delegation, and time waster with the nurse managers’ age and years of experience, nurse managers’ skills of time management, delegation, and time wasters throughout study phases pre/posttests, the correlation between the time management with delegation and time wasters pre intervention, the correlation between the time management with delegation and time wasters post intervention, participants’ opinions about the training program and their suggestions, distribution of responses to reasons for non-attendance program, role of nursing administration in training attendance, and preferred time for training, and distribution of participants’ satisfaction with the training program. According to the study aim and hypothesis, the following findings will support the study hypothesis and achieve the study aim.
Table 1: Depicts characteristics reported at analytic baseline for nurse manager participants. It reveals that, the highest percentage of nurse managers (69.2%) was for the age group [30-<40 years]. As for years of experience, for more than half (53.8 %), it was [10 - <20 years]. Concerning marital status, more than three quarter (79.5 %) are married. As regards qualification, the majority of them (87.2 %) have a Bachelor degree.
Table 2: It presents a comparison between pre/posttests mean ±SD of the nurse managers’ knowledge as regards to time management domains, delegation, and time wasters internal and external. There are significant improvements in nurse managers’ knowledge related to time management, delegation, and time wasters from pre/posttests (p value < 0.001).
Table 3: It displays correlations between the scores of time management, delegation, and time wasters’ knowledge and the nurse managers’ age and years of experience throughout study phases. Statistically significant positive correlations are shown between age and years of experience in all time management domains, total time management, delegation, and time wasters (internal and external).
Table 4: It reveals the nurse managers’ skills of time management, delegation, and time wasters throughout study phases at pre/posttests. The results indicate statistically significant improvements in all time management domains, total time management, delegation, and time wasters (internal and external).
Table 5: It presents correlations between the time management with delegation and time wasters post intervention. The results indicate statistically significant improvements found between the time management with delegation and time wasters post intervention among nurse managers (p <0.001).
Table 6: It describes participants’ opinions about the training program and their suggestions. It shows that less than half of them (46%) had knowledge about delegation, time management from previous exposure to such training program. All of them (100%) agreed that with the training they became more organized, conflict decreased and they will advise peers to attend such training and want more similar training. As well, all got knowledge and skills in problem solving, and need such training in administration for own work.
Figure 1: It displays distribution of the participants’ responses to reasons for non-attendance program, role of nursing administration in training attendance, and preferred time for training. It reveals that more than half of them (59%) reported reason for non-attendance was accumulation of problems during training time leave. The role of nursing administration in training attendance as mentioned by more than half of them (56%) was try to solve problems till nurse manager returns, while less than half of nurse managers (46%) preferred time for training to be in early morning.
Figure 2: It displays participants’ satisfaction with the training program. The majority of them were satisfied with all the program training elements as language, terms, media, and methods, while only 32% of them considered the program duration as medium.
The present study aimed to examine the effect of time management training program on delegation skills regarding nurse manager working at Kafrelsheikh General Hospital.
Regarding the personal characteristics of the participants, the results of the current study revealed that the entire sample consists of (39) females. In addition, 69.2% of total sample were in the age group 30- <40. Total experience in the same hospital for 53.8% of nurse managers was 10- < 20 years. As for the marital status of sample, 79.5% are married, and 17.9% are single. Concerning education, the majority most of them 87.2% had bachelor degree. In this respect, the Board of Registered nursing 30 denoted that, the degree of education affects the technical leadership skills, while the unlicensed personnel should never be assigned tasks that require a substantial amount of scientific knowledge, as more learning leads to mature one’s skills and conceptions.
Furthermore, the current study findings showed that, organizing and managing were the lowest domains in knowledge related to time management (Mean ± SD 14.3±2.1, &14.7±2.4) sequentially, in pre training program implementation, whereas the best domain was related to planning (Mean ± SD 24.4±4.6). These findings are incongruence with those of Mohamed 29, who attributed to organizing that it was the best time management skills, and the worst was related to planning. This may be due to that the planning was the most important step in time management and general management endeavor involves the skills of planning, organizing, implementing and controlling.
In the same line, during the post training program the nurse managers’ knowledge had increased after implementation of the training program and it was a highly statistically significant improvement related to time management, delegation, and time wasters (p value < 0.001). Marquis and Huston 31 clarified that, to be use time management efficiently, the person may be practice the delegation skills during their life at home, in their work place, and interactive group to exchange one's activities with others that deliver more time for education and focuses. In other ways, recognized time management as an essential component of work execution and nursing practice different strategies of time are using by nurses. Nurses work smarter instead of harder through learning time management skills in nursing. 32.
In addition, the current study results reported that there is a correlation between age, and years of experience in the current position of the nurse managers and their skills in time management, delegation and time wasters. The experience gave them the chance to learn more about leadership skills, and clarified their strengths and capabilities to use those talents for improving management skills. This finding is incongruent with that of Mohamed 24, who reported that there was no correlation detected between delegation and age or experience. Meanwhile, nurse managers’ knowledge about time wasters was decreasing with the increase in their age and years of experiences. On the same line, Marquis and Huston 33 emphasized that lower level managers with less years of experience have more interruption than higher level managers with longer years of experience.
Furthermore, the current study findings showed that, a positive relation between delegation and time management. This finding is consistent with that of Marquis and Huston 31, who mentioned that to be using one’s time effectively one should be using the delegation skills at home, at work, and in group activities. In the same line, Huber 34 explained that, essentially delegation it is a leader’s strategy designed to maximize time management by achieving activities through others. Furthermore, 35 Sullivan and Decker highlighted that delegating tasks to others can be an efficient time management tool, this might be due to that the nurse manager needs free times for handling another critical management problem.
Concerning the correlations between time management with delegation and time wasters post intervention, the present study results demonstrated statistically significant improvements found and had a direct correlations between time management, delegation skills, and time wasters leading to the greater use of delegation skills, where the time management improved, which led to knowing the time wasters to avoid it. On the same side, Anderson and Pulich 36 claimed that in health care workplace delegation plays a very important role and it is used their skills for successful nurse managers. The foregoing present study improvements are in agreement with those of Mohamed 29, who mentioned that there was an improvement between the pre and posttest of knowledge for all participants in training program.
Finally, it is clear from this study figures that the nurse managers’ reason for non-attendance of these programs was due to accumulation of problems during training time leave, while, the role of nursing administration in training attendance is to try to solve problems till program attendant nurses return and they are preferring the early morning time for training. These findings are in agreement with Rofaiel 37 who highlighted that every nursing staff is in need for acquiring theoretical and technical information that is necessary to develop own skills and competencies at work.
Based on the results of the present study, it is presumed that the hypothesis of the study is accepted. All nurses archived better scoring in both knowledge and skills after implementing the program than before it. This is mirrored the effect of the program.
The study concluded that there were strong positive relationships between time management and effective delegation skills and time wasters. As well, there were clear correlations between age, and years of experience, and effective use of time management skills, and effective delegation skills that lead to avoid time wasters.
Ÿ Educational program should be focused on preparation of new graduates to undertake responsibilities of delegation and time management skills as theoretical components
Ÿ The ministry of higher education, combines the use simulation-based learning into course specification that would promote student's self-confidence and learn delegation skills and time management.
Ÿ Identify the time wasters during work setting and what are the strategies to deal with them.
Ÿ Nurse Managers must accept and support the concept of delegation to other lower levels of management.
Ÿ Nurse Managers should follow strategies using time management tools.
Researcher would like to express thankfulness and appreciation to all Nurse Managers who participated in this study for their effective cooperation.
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Published with license by Science and Education Publishing, Copyright © 2019 Nagwa Gouda Ahmed Abd-Elmoghith
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| [36] | Anderson, P., Pulich, M. (2002). Managerial competencies necessary in today's dynamic health care environment. Health Care Manage? (Frederick), 21, 1-11. | ||
| In article | View Article | ||
| [37] | Rofaiel, N.O. (1998). Impact of internship training experience on nurse intern skill acquisition. Master of Nursing Science, H.I.N., Ain Shams University. | ||
| In article | |||
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