Nursing delegation is a foundational practice in modern healthcare, serving as a tool for the effective and safe delivery of patient care. It allows the Registered Nurse (RN) to manage increasing patient needs and a growing workload by distributing certain tasks among the healthcare team. Delegation promotes efficiency in the care environment while maintaining the quality and oversight of services provided to the patient. It allows the RN to prioritize complex tasks that require specialized knowledge.
Defining Nursing Delegation
Nursing delegation is the process by which a licensed nurse transfers the authority to perform a specific nursing task in a specific situation to an appropriately qualified person. This transfer does not relinquish the delegating nurse’s responsibility for the overall patient outcome. The licensed nurse retains accountability for the decision to delegate and the subsequent results of the task. This differs from an assignment, where a nurse directs staff to perform routine tasks already within their established job description. Delegation often involves a task outside the delegatee’s usual role but for which they have received validated training. The legal framework for delegation is established at the state level through the Nurse Practice Act (NPA), which dictates what activities can be delegated and to whom.
The Roles in Delegation
Two primary roles define the delegation process: the delegator and the delegatee. The delegator is typically the Registered Nurse (RN), who holds the highest level of clinical licensure and is responsible for assessing the patient and developing the plan of care. The RN is the only team member permitted to delegate tasks that fall outside the traditional scope of practice of other personnel.
The delegatee is the person receiving the task, which may include a Licensed Practical Nurse (LPN) or Unlicensed Assistive Personnel (UAP), such as Certified Nursing Assistants (CNAs). LPNs have a narrower scope of practice than RNs, often focusing on data collection, reinforcing teaching, and performing routine tasks. UAPs perform basic care activities, like bathing, feeding, and ambulation, but they require direct supervision and cannot perform tasks demanding independent nursing judgment. The RN must evaluate the delegatee’s training, experience, and competence before transferring any responsibility.
The Five Rights of Delegation
The decision to delegate is guided by the Five Rights of Delegation, a framework designed to ensure patient safety and appropriate workload distribution. The RN must apply this decision-making process to every potential delegation scenario, using clinical judgment to assess the situation thoroughly. Adherence to this framework provides a rationale for the delegation decision and helps mitigate risk for the patient and the nurse.
Right Task
The task considered for delegation must be legally permitted under the state’s Nurse Practice Act and organizational policy. A right task is routine, does not require complex problem-solving, and has predictable results. Tasks involving implementation, such as assisting a patient with feeding or collecting a simple urine specimen, are often suitable for delegation. The RN must confirm that the task can be safely performed without specialized nursing knowledge or independent clinical reasoning.
Right Circumstance
The right circumstance refers to the patient setting, the stability of the patient’s condition, and the availability of resources. Delegation is appropriate when the patient’s status is stable, the outcome is predictable, and the environment contains the necessary equipment and supervision. If a patient’s condition is volatile, complex, or rapidly changing, the task should be performed by the RN. Assessing the stability of the patient is a prerequisite to determining whether the current circumstances allow for safe delegation.
Right Person
The right person means the RN must ensure the delegatee has the necessary skills, training, and documented competency to perform the task safely. The RN must confirm the delegatee’s prior experience with the specific task and their ability to perform it according to the required standard. Delegation involves matching the complexity of the activity with the delegatee’s verified knowledge, not just their job title. The delegatee also has a responsibility to accept only those tasks for which they feel competent and prepared.
Right Direction and Communication
Right direction requires the delegator to provide clear, concise, and complete instructions regarding the task. Communication must include specific details about the task, the expected time frame for completion, necessary documentation, and expected patient outcomes. The RN must also specify what information to report back and when, especially any unexpected findings or changes in the patient’s condition. Successful delegation includes verifying the delegatee’s understanding and allowing clarifying questions.
Right Supervision and Evaluation
Right supervision and evaluation require the RN to monitor the delegatee’s performance and the patient’s response to the delegated task. The RN must be available to intervene, provide guidance, and offer support while the task is performed. Upon completion, the RN must follow up with the delegatee and the patient to evaluate the results against the expected standards. This ensures the task was completed correctly and that patient safety was maintained.
Tasks That Cannot Be Delegated
Certain high-level nursing activities require the specialized education, judgment, and licensure of a Registered Nurse and can never be delegated to an LPN or UAP. These non-delegable tasks are the core components of the nursing process, involving independent professional judgment and decision-making.
The RN exclusively performs the initial and ongoing comprehensive patient assessment, as this requires synthesizing complex data to determine the patient’s overall status. Formulation of the nursing care plan, which involves setting goals and designing interventions, is also non-delegable. The RN cannot delegate the final evaluation of the patient’s response to care, which requires determining if the plan is effective and requires modification.
Patient education that involves interpreting data or developing a teaching plan cannot be delegated, though an LPN or UAP may reinforce teaching already provided by the RN. Tasks requiring sterile technique, such as central line maintenance, or the administration of medications by specific high-risk routes, like intravenous push, are also restricted from delegation.
Accountability and Supervision
The concept of accountability in delegation establishes that the Registered Nurse remains legally and professionally answerable for the overall patient care. When an RN delegates a task, they transfer the responsibility for the performance of that task to the delegatee, but accountability for the delegation decision and the outcome remains with the RN. This means the delegator is accountable for ensuring the Five Rights were appropriately considered before the task was assigned.
Supervision is the mechanism through which the RN fulfills this ongoing accountability, requiring continuous monitoring and intervention as needed. The RN must provide accessible support and be ready to step in if the delegatee encounters difficulty or if the patient’s condition unexpectedly changes. Documentation of the delegated task, the delegatee’s performance, and the patient’s response is a mandatory part of the RN’s accountability. Failure to properly supervise, document, or intervene exposes the delegating RN to potential legal and ethical consequences.