Communication factors appear to play not only a vital role in delegation effectiveness, but also a leading factor in the success of nursing teams on acute-care units.29 Practices to improve unit teamwork including team leadership, team orientation, mutual performance, backup behavior, adaptability and mutual trust, and communication should also be implemented. Communication failures such as handoff disconnects, lack of knowledge about the workload of other team members, inability to deal with conflict, and inconsistent staff members are likely linked to omissions of nursing care and delegation ineffectiveness.
Nurse managers should routinely complete a baseline assessment of delegation, communication, and teamwork practices on their individual units. Identification of RN-NA communication and relationship problems, so often at the root of ineffective delegation practices and teamwork failures, could be linked to undesirable outcomes such as missed care and/or care rationing. These recommendations for future performance improvement initiatives and nursing research can serve as a guide for nurse executives and frontline nurse leaders.