Nurse Mangers' Time Management Strategies and its Relation to Their Effective Delegation in Intensive Care Units

Background: Time management is important component of work performance and professional nursing practice. Delegate skill is an important part of time management for managers’ success, abilities and performance in hospital. So,the present study aimed at assess the relation between nurse managers time management strategies and its relation to their effective delegation skill in intensive care units . Subject and . Method: Descriptive-correlational research design was utilized in current study. Setting: The study was conducted at Tanta University Main Hospitals and El-Menshawy General Hospital, which affiliated to Ministry of Health in El-Gharbia Governorate. Subject: included all (n=200) nurse mangers working in the previously mentioned settings and available at time of data collection. collected by using two tools: 1-nurse managers perception of time management strategies questionnaire. And 2-nurse managers perception of delegation making effectiveness scale. Results: Regarding overall time management and over all delegation more than two - third (68.2%) of nurse managers had unsatisfactory level at Tanta university Hospital and El-Menshawy General Hospital. Conclusion: There was statistically significant correlation between nurse managers overall time management strategies and effective delegation skills . It was recommended: to support nurse managers time planning and establishing prioritizes lead to raise organization and improvement


Introduction
Nurse mangers are professional nurses appointed leadership position with authority on nurses for effective performance, responsibility for resource utilization and accountability for work outcome. (1)They provide services to health care organization in appropriate, efficient equitable manner.Nurse mangers, as other managers, have four types of resources which are personnel, equipment, finance, and time .(2)Time management is the ability to use time effectively by quality of doing the right task correctly and efficiently by right utilization of resource for right task.Nurse manager can use time effectively through learning time management strategies, these include time planning and establishing prioritize, completingthehighest priority task, reprioritize what tasks importance, not urgency, setting short term and long term goal ,making to do list. (3)he position of nurse mangers in ICUs requires essential skills including good supervision, interpersonal communication ,delegation and time management skills in order to lead and direct staff nurses. (4)So, they should be familiar with human resources procedures regarding promoting nursing personnel to manage and evaluate staff nurses.Vol.28.No. 1 (Suppl) ,Febrauary 2023 Nurse managers have four kinds of resources ,people, equipment, money, and time.They perform the managerial task.Effective management of time helps get more work done, produces a higher work quality, and decreased stress with good time organization.Additionally, there is a better sense of self-control, improved selfimage.Time management is essential to successfully performing and progressing as a nurse along. (5)Nurse mangers face time wasters as disorganization, excessive supervision, under delegation procrastination, interruptions, too much information, inability to say no.Time management is a skill like other skills, it requires behavior modification by replacing wasteful time habits with more effective habits. (6)here many factor affecting time management including; inadequate information and communication systems; unnecessary phone; over-employment; bad management; unexpected visits, hesitation in decision -making, unsound delegation; wrong order of priorities.Interruption during work, starting to implement tasks without prior thinking and planning, moving to new task before accomplishing a present one, and obsession with less important routine matter Time management skills mean focusing time on the things that are most important It also means spending less time on everything else.Effective time management includes better scheduling, improved decision-making, better organization, and time leverage, increases job satisfaction and improves mental health. (7)Nurses manager need to improve their time management skills in order to provide health care services with high quality include prioritizing, goal setting, and delegation. (8)Delegation is a leadership and management strategies designed to maximize time management , transfer of responsibility for performance of an activity from one nurse manager to another while retaining accountability for the outcome. (9)There are many reasons for delegation , the most important reason of delegation is saving time.Delegation maximizes the use of the talents of nurse manager.It can build trust and increase self-esteem, and job satisfaction. (10)Nurse mangers learn by doing.Their involvement tends to increase their management skills, motivation, and commitment to delegation, the delegation, or sharing of the work and responsibility with other nurse managers involves three important concepts and practices: responsibility, authority, and accountability. (11)Responsibility refers to the assignment itself and the intended result that means setting clear expectations.It also means nurse manager avoid prescribing nurses how the assignment should be completed .(12)Authority refers to the appropriate power given to the individual or group including the right to act and make decisions.It is very important to communicate boundaries and criteria such as budgetary considerations.Accountability refers to the fact that the relevant nurse managers must 'answer' for their actions and decisions along with the rewards or penalties that accompany those actions or decisions . (13) There are basic guidelines to help nurse managers to delegate more effectively: including what task to delegate, clarify the results, clearly define the nurse manager responsibility, define nurse manager authority over the delegated task, fairness in delegating staff nurses, be sure nurse manager understand authority, establish a time limit and establish a follow-up schedule . (14)ffective delegation allows nurse managers to promote high productivity and efficiency, generate a culture of enthusiasm, innovation, creativity, cooperation, and openness.It reduces nurse turnover and furnish the organization with better-qualified, more skilled nurse managers.Delegation maximizes the use of the talents of nurse manager.It can build trust and increase self-esteem, pride, and job satisfaction .(15)Barriers of delegation .Under -delegating, over -delegating, and improper delegating.Nurse mangers make recurrent mistakes in delegation.Nurse managers have a false guessing that delegation may be explained as lack of ability to do job correctly or completely that means under delegation. (16)Nurse managers make under delegation because they fail to anticipate the help they will need .Nurse managers are emerging from the clinical nurse role under delegate because they find it difficult to assume the manager role.There are some of activities need to do by nurse managers, but their first task is to make sure every nurse accomplish assigned task to achieve organizational goals and mission team. (17)ignificance of study Nurse managers work in a context with high level of pressure, uncertainty and rapid changes accompanied by the challenges in intensive care units.So, the The effective use of time management tools becomes even more important to enable nurse mangers to meet personal and professional goals, nurses managers need to be good time management to cope with health organization. (18)elegation build trust and increase selfesteem, and job satisfaction.Nurses manager define which responsibilities to delegate to achieve their plan as timeline, cooperate with others in the organization Second tool II: Nurse mangers' effective delegation questionnaire .This tool included (25) items, it will be used to reflect nurses manger' uses of effective delegation.It will be covered the three basic concepts and practice of delegation as Authority (8) items as involve employees in goal setting.Responsibility (7) items as when they delegate a project, they make sure that everyone involved knows who is in charge.Accountability (10) items as control about work of the delegate member.Nurse mangers, responses will be measured on three points.Scoring system Likert scale ranging from (1) "rarely"(2) sometimes and (3) always.The total score will be calculated by summing scores of all categories.The total scores represent varying levels as -Satisfactory delegation ≥60% Unsatisfactory delegation skills < 60%.Method 1-Official permission to conduct the study was obtained from the dean of Faculty of Nursing to Emergency Hospital and Main University Hospital Director.Ethical consideration a-Approval of ethical committee at faculty of nursing was obtained.b-Nature of the study will not cause any harm or pain to the entire subjects.c-Oral formal consent for participation was obtained after explanation of the nature and the purpose of the study.
2-The tools were translated into Arabic and presented to a jury of five experts in the area of specialty to check content validity and clarity of the questionnaire.
3-Suitable statistic test was done for its reliability, reliability of the study tools was used tested using Cronbach's alpha coefficient test, where reliability of tool (1) = 0.953, reliability of tool = 0.906, and it's both value = 0.942 and the content validity value was 0.985.4-Pilot study was carried out on a sample (10%) n=200 of nurse managers to test the tools for its clarity, applicability estimate time needed to fulfill it , the sample was included in the total study subjects.this table shows correlation between nurses manager time management strategies and their effective delegation except accountability for all domains, as total ,there was positive statistically significant correlation among three domains.

Discussion
Time management is a way to develop and use processes and tools for maximum efficiency, effectiveness, and productivity.It involves mastery of a set of skills like setting goals, planning, assigning priorities, and the effective use of time to achieve desired results.In time management, nurse managers are managing their time better and are simply making better decisions about what they do and how they will do it (20).Delegation is an art and skill of professional nursing that is considered as one of the core concepts and major element of the organizing and directing functions of nursing management by which nurse managers entrusting someone else to accomplish parts of their job to meet specific client and organizational goals .Effective delegation gives the nurse managers more time to concentrate on what is urgent and important and can improve job satisfaction, responsibility and productivity . (21)Nurse managers' time management strategies.The present study finding showed more than half of nurse managers hadunsatisfactory level regarding overall time management strategies with statistically significantly difference This is result is consistent with Abilio, andMaria, (2021) (22) who reported that learning to manage time is a problem for many nurse managers and many nurse not try to use time management skills.Also, Dudovskiy, (2020) (23) reported that time management is complex concept.The finding of current study, showed that first rank was for time planning and establishing prioritizes domain of time management strategies.This result may be due to majority of nurse managers force theirselves to make time for planning, do not postpone today's work to tomorrow, Silva, Khan, Jung, and Han, (2020). ( 24)hey found that more than half of nurse manager had high rank for time planning and establishing prioritize tasks in working.On other hand, Ageiz, and Eid, (2019) (25), disagreed with this result and reported that more than two-fifth of nurse manager had poor time planning.The present study showed that more than half of nurse managers had unsatisfactory level regarding completing the highest priority task, this result may be due to high workload, improper planning of nurses, and poor organization of technique and ineffective time management, and had no chance of training programs.This result is in agreement with El-Shaer, et al., (2020) (26) and Kisa, and Ersoy, et al, (2019) (27) who found that more than half of nurse managers unsatisfied with completing the highest priority task .The current study result showed that nearly twothirds of nurse managers had unsatisfactory level regarding to reprioritizes of task.This result may be due to shortage of staff nurses, increase stress and pressure on nurse manager and increase wokload with limited supplies.The result supported with Grissom, Loeb, and Mitani, (2021) (28) reported more than forty of nurse manager had high unsatisfaction level with reprioritizes of task.Nurse managers' factor.Specifically, the current study regarding overall factor ,demonstrated more-two fifths of nurse manager had moderate level of administrative factor at both hospital.This finding is consistent with, Habib, Afzal, Hussain, and Naseer, et al., (2019) (29) who found that one third of manager nurses had high level administrative factor.Also Hardiker, and Staniland,.et al, (2018) (30) who demonstrated that high percent of nurse managers had high perceived organizational factor.Specifically, the result showed that more than half of nurse managers had neutral agreement that not able to implement time management guidelines.
The current study demonstrated that administrative and organizational factor had the first rank with statistically significantly difference at Tanta University Hospital and Elmenshawy General Hospital among nurse managers .This result may be due to nurse managers had adequate information about polices and laws of their organization ,fair delegation of duties to personnel according to personnel capabilities .This result supported with Qteat, and Sayej, et al, (2020) (31) (33) who reported majority of nurse managers had perceived personal factor.Nurse managers' effective delegation.The finding of current study showed that nurse managers had unsatisfactory level regarding over all delegation.This result is in consistent with Abu-Bakr, et el., (2020) (34) and et Alfadli, and Al-mehaisen al.,(2019) (35) who reported that majority of nurse manager unsatisfication with delegation of authority.The current study finding showed that nurse managers had first rank for authority with statistically significantly difference between both hospital regarding authority, responsibility and accountability of effective delegation skill.This is may be due to nurse managers repeat the details of the task to delegate, give person authority for accomplishing task.Thomas.et al., (2020) (36) who found that the highest percentage of nurse managers had proper delegation in their tasks with subordinates.This result showed that more than twothirds nurse managers had unsatisfactory levels regarding responsibility.This result is accordance with Demers,, et al., (2021) (37) who supported that the majority of nurse managers were unsatisfied with delegation of responsibility.Also Gamal, and Adam, et al 2020, (38) who reported that high level satisfied with responsibility.Specifically, the result finding regarding responsibility, showed that more than half of nurse managers sometimes use the ideas of outside experts to develop nursing care, make their decisions in line with the goals of the organization.This result is supported by Gassas,.Mahran, and Banjar, et al., (2020) (39) who agreed that more than forty of nurse manager had delegation of responsibility.The current result finding showed that more than half of nurse manager had unsatisfactory regarding accountability.This result is in accordance with Josephsen, (2021) (40) found that more than forty nurse managers unsatisfied with accountability of delegation.Also, Judge, Weiss, Kammeyer, and Hulin.(2020) (41) agreed with this result Correlation between nurse manager's time management strategies and their effective delegation.The current study finding showed that there was statistically significant correlation between nurse managers overall and all domains of time management and their effective delegation skills. .The result is supported with Linnen, and Rowley (2021) (42) who found that a significant correlation of authority and accountability on time management strategies

Conclusion
The study result concluded that , as total, there was statistically significant difference at El-Menshawy General Hospital and Tanta university Hospital, more than twothirds of nurse managers had unsatisfactory level ,regarding overall time management strategies, with first rank for time planning and establishing prioritize.In addition around half of nurse managers had high level of perceived factor regarding over all factor with first rank for administrative and organizational factor.Also around twothird of nurse managers had unsatisfactory levels with first rank for authority regarding over all delegation skill.There was statistically significant correlation between nurse managers overall time management strategies and effective delegation skills.

Figure ( 1
Figure (1): Distribution of nurse manager according to overall time management

Figure ( 3
Figure (3): Distribution of nurse manager according to levels of over all delegation affecting nurse managers time management strategies.

Table ( 2): showed mean score, percent score and rank of time management strategies among nurse managers, with
statistically significantly difference at both hospitals regarding domain of time management strategies.The first rank was for time planning and establishing prioritizes.As total (61.0±21.37)nurse managers had mean score ,while (64.22±21.82),(56.59±19.84)their mean score at Tanta University Hospital and at

Table ( 3): shows mean score, percent score and rank of factors affecting nurse managers time management strategies.
As total there was statistically significant difference at both hospital regarding overall factors, personal factor and administrative factor affecting nurse managers.

Table ( 4): shows mean score,percent score and rank of nurse managers effective delegation domain.
As total (58.95±20.50)nurse managers had mean score, while, (62.78±19.89),(50.59±18.64)their mean score at Tanta University Hospital, and at El Menshawy General Hospital respectively