Practices and challenges of supervision and delegation in nursing in Africa: a scoping review.

BACKGROUND

Nursing supervision and delegation are essential components of healthcare delivery, significantly impacting patients' care and outcomes. In low-resource settings, such as Africa, where shortage of professional nurses has been reported, effective delegation optimises task allocation and nursing workforce use, while supervision ensures safe care and promotes skill and knowledge transfer to less experienced staff. The review aimed to map existing evidence on the practice and challenges of supervision and delegation in the nursing profession across Africa.

METHODS

This review adhered to the six steps outlined in the guidelines by Askey and O'Malley. Search was conducted across five main databases, including PubMed, JSTOR, Scopus, Dimensions AI, and Web of Science, using Medical Subject Headings (MeSH) terms for PubMed and refined for other databases. Additional searches were performed in Google Scholar and university repositories. Reference lists of eligible records were also checked for other relevant articles. The last search was conducted in July 2024. Both peer-reviewed and grey literature were included. Search results were screened against predefined inclusion and exclusion criteria, and extraction was done using a data extraction form. Thematic analysis and synthesis were carried out with evidence presented as narrations and summarized in tables.

RESULTS

A total of 16 studies met the inclusion criteria for this review, highlighting both practices and challenges in nursing supervision and delegation across Africa. Effective supervision practices included comprehensive orientation, continuous training, robust monitoring with feedback, and clinical assessments. Key components of effective supervision include clear communication, teamwork, and supportive environments. However, challenges such as inadequate supervisory skills, time-consuming, enormous administrative tasks, and resource constraints were identified. Delegation practices emphasized feedback, continuous instruction, worker empowerment, strength-based task allocation, and task evaluation and verification. Challenges in delegation were primarily related to staffing shortages, skill gaps, role misalignment, insufficient resources, and the complexity of tasks.

CONCLUSION

Addressing the challenges and improving supervision and delegation practices in nursing is critical for enhancing healthcare delivery in resource-limited settings like Africa. Implementing evidence-based strategies and developing clear policies will improve the effectiveness of supervision and delegation, ultimately enhancing patient care. Collaborative efforts focusing on staff training, resource allocation, and support systems are essential for overcoming these challenges.