Nursing delegation is a management technique where a licensed nurse transfers the authority to perform a specific nursing task to another competent individual in a particular care situation. This transfer is a structured sharing of workload designed to maximize efficiency in patient care settings. The core rules governing this professional practice are established primarily by each jurisdiction’s State Nurse Practice Act (NPA). These laws define the legal scope of practice for nurses and dictate which activities can be safely and appropriately delegated to other members of the healthcare team.
The Foundational Rules of Delegation
The framework of nursing delegation is built upon a legal and ethical structure known as the Five Rights of Delegation. These rights serve as a comprehensive checklist for the Registered Nurse (RN) before any task authority is transferred. The first is the Right Task, meaning the activity must be within the scope of practice for the delegating nurse and legally allowed to be delegated according to state regulations.
The nurse must assess the Right Circumstance, which involves evaluating the patient’s condition and the setting in which care is delivered. Delegation is appropriate only when a patient’s condition is stable and predictable, and the required task does not involve complex observation or decision-making. The Right Person must then be selected, ensuring the delegatee possesses the necessary knowledge, skills, and documented competence to perform the specific task safely and effectively.
Before the task begins, the RN must ensure Right Direction and Communication, providing clear, concise, and specific instructions regarding the task, the expected results, and any limitations or potential complications to watch for. This instruction includes the timeline for completion and when the delegatee must report back. Finally, the nurse maintains the Right Supervision and Evaluation, which requires monitoring the performance of the task and evaluating the patient’s response and the outcome after completion.
Tasks Requiring Nursing Judgment
Certain activities are reserved exclusively for the Registered Nurse because they rely on specialized professional judgment and advanced knowledge. These non-delegable tasks form the core of the nursing process and cannot be transferred to any other personnel, regardless of their training or competence. A primary non-delegable activity is the initial and ongoing patient assessment, where the RN collects, synthesizes, and interprets complex patient data to form a clinical picture.
This initial assessment directly informs the formulation of the nursing care plan, which is another task that mandates RN involvement. Developing the plan requires the nurse to analyze the collected data, establish patient-specific goals, and determine appropriate nursing interventions to achieve those outcomes. This cognitive process of planning and prioritizing care is foundational to the RN role.
Patient teaching that requires an assessment of the patient’s specific learning needs and abilities is also non-delegable. While support staff can reinforce previously taught material, the initial determination of what needs to be taught, how it should be presented, and the evaluation of the patient’s comprehension must be performed by the RN.
The specialized skill of triage or the interpretation of patient data also remains solely within the RN’s scope of practice. Triage involves making complex, time-sensitive judgments about the severity of a patient’s condition and the urgency of their need for care. Interpreting data, such as recognizing subtle changes in a patient’s status and understanding the clinical significance, requires the RN’s educational background.
Delegating to Unlicensed Assistive Personnel (UAP)
The Unlicensed Assistive Personnel (UAP) role is designed to support the RN by performing routine, standardized tasks under direct or indirect supervision. Delegation to a UAP is appropriate only when the patient is in a stable, predictable condition and the task itself is low-risk, requiring minimal independent judgment. The RN must confirm that the UAP has received documented training and demonstrated proficiency in the specific task before any authority is transferred.
Tasks related to basic activities of daily living (ADLs) constitute a significant portion of what can be delegated to UAPs. This includes assisting patients with personal hygiene, such as bathing, grooming, and dressing, as well as helping with mobility tasks like ambulation and transfers. Feeding a patient who does not have swallowing precautions or other complex nutritional needs is also a routine activity often delegated to support staff.
Routine measurement tasks on stable patients are also commonly delegated, provided the nurse has established clear parameters for reporting abnormal findings. For example, a UAP can measure routine vital signs, such as temperature, pulse, respiratory rate, and blood pressure, on a patient whose condition is not expected to change suddenly. The nurse retains the responsibility for interpreting these findings and deciding on subsequent actions.
The collection and measurement of bodily fluids are often within the UAP’s delegated scope when the procedure is non-invasive and standardized. This includes tasks like accurately measuring and recording intake and output (I&O) and collecting non-sterile specimens such as urine or stool samples. The nurse must provide specific instructions on the collection procedure and the required documentation standards for these measurements.
Post-mortem care is another standardized procedure that can be delegated to a UAP. This task involves preparing the body according to facility policy, which includes cleaning and positioning. While the UAP performs the physical task, the RN must complete the final legal documentation and the necessary notifications.
The determination to delegate these tasks always rests on the nurse’s professional judgment regarding the patient’s individual status. Even routine tasks like obtaining a blood pressure measurement become non-delegable if the patient is experiencing a sudden, unexpected drop in pressure or is recovering from a recent surgical complication. The patient’s need for complex observation or assessment requires the RN to intervene and perform the care directly.
Accountability and Supervision
The act of delegation does not relieve the Registered Nurse of professional responsibility for the patient’s overall care and the outcome of the delegated task. While the UAP or other delegatee is accountable for their own actions and how they perform the specific task, the RN retains full accountability for the decision to delegate and the subsequent results. The nurse is responsible for the overall nursing process, including assessment, planning, and evaluation.
Effective supervision is a component of accountability. The RN is required to monitor the delegatee’s performance, ensuring the task is completed correctly and within the appropriate timeframe. This includes providing immediate, constructive feedback to the delegatee, whether for corrective action or positive reinforcement of their performance.
The nurse must maintain an accessible presence, ready to intervene immediately if the delegatee encounters an unexpected situation or the patient’s condition changes. If a patient’s stability suddenly deteriorates, the RN must promptly take over the task and initiate the necessary professional assessment and intervention.
Proper documentation and follow-up evaluation are the final steps in the accountability process. The RN must ensure that the delegated task is accurately recorded in the patient’s health record, including any observed outcomes or complications. A follow-up evaluation is required to assess the patient’s response to the care provided by the delegatee, closing the loop on the nursing process.