What is Delegation and to Whom Should I Delegate Aspects of Nursing Care?

Avoiding Liability Bulletin – March 15, 2013

One author has stated that the delegation of patient care, the assignment of patient care to another member of the health care team, and the supervision of the care delegated are “core competencies for the 21st Century (registered) nurse”.1  Although delegation by the registered profession nurse has been around for a long, long time, it is becoming an increasingly important tool in the delivery of patient care due to limited resources (including nursing staff) and the number of patients or individuals who need nursing care in all health care delivery settings.  

Delegation of patient care by the registered nurse is also essential because it is necessary to keep professional nursing practice as just that.  If the registered nurse is doing inappropriate work or work that others could do (e.g., an L.P.N. or U.A.P.), the very essence of registered professional nursing is eroded.2

Delegation has been defined by various organizations and professional associations.  For example, the National Council of State Boards of Nursing defines it as a “complex, skillful process that requires sophisticated clinical judgment and final accountability for patient care”.3  The Council also defined delegation as giving someone a task from the delegator’s practice based on job descriptions and policies. 4  

Delegation is also often defined in state nurse practice acts; 44 state nurse practice acts currently do so.  When it is defined by the state board of nursing, the definition, and any additional guidance nt the act or rules, are constant parameters for the registered nurse as to how delegation is to take place.

Although delegation of patient care is important, it is imperative that the registered nurse remember that the nursing process itself, including the assessment of a patient’s condition and the evaluation of the patient’s care, cannot be delegated to an L.P.N. or a U.A.P.5  These individual team members certainly assist the registered nurse in the assessment and evaluation process, but they cannot do it alone or be responsible for the nursing process.

There is a wealth of information available on delegation by the registered professional nurse and I encourage you to search for resources in addition to those listed in the Footnotes.  

So what should you keep in mind about delegation of patient care to other staff on your unit, in your school setting, in your out-patient clinic?  Here are some guidelines:

• Know your nurse practice act and rules inside and out, paying special attention to sections governing delegation and scope of practice of those who are licensed under the act;
• Read and incorporate information on delegation and the registered nurse’s role in it;
• Be open to using delegation in your nursing practice—You can’t do everything for the patient/client, so you need to use your skills and expertise as a registered nurse for those who need that care and allow competent, skilled other health team members, including other registered nurses, to participate in the provision of quality, safe patient care;
• Utilize the 5 rights of delegation:  right task, right circumstances, right person, right direction/communication, and right supervision and evaluation; 6
• Utilize resources in your workplace to support the delegation process: policies, procedures, organizational support people (CNO, risk management);
• Remember that the purpose of delegation is to provide safe and efficient care to patients/clients;
• The ANA Code of Ethics for Nurses and other professional association codes also provide baselines for delegation; and
• Establish good interpersonal relationships with fellow staff and open lines of communication with them as well to help with the delegation process.

FOOTNOTES

1. American Nurses Association and the National Council of State Boards of

Nursing (2006).  Joint Statement on Delegation.  Available at: http://www.ncsbn.org/Jointstatement.pdf .  Accessed 2/2/13.

1. Murphy, E., S. Ruch and J. Pepicello and M. Murphy (1997), “Managing

An Increasingly Complex System”, 28(10) Nursing Management, 33-38.

1. Weydt, Alice (2010), “Developing Delegation Skills”, 15(2) The Online

Journal of Issues in Nursing.  Manuscript 1.  Available at: htpp://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OIJN.  Accessed 2/1/13.

1. Id. at 2.
2. ANA and NCSBN, Joint Statement on Delegation , supra note 1, Appendix A.
3. National Council of State Boards of Nursing (1997).  The Five Rights of Delegation.  https://www.ncsbn.org/fiverights/pdf .  Accessed 2/2/13.

THIS BULLETIN IS FOR EDUCATIONAL PURPOSES ONLY AND IS NOT TO BE TAKEN AS SPECIFIC LEGAL OR ANY OTHER ADVICE BY THE READER. IF LEGAL OR OTHER ADVICE IS NEEDED, THE READER IS ENCOURAGED TO SEEK SUCH ADVICE FROM A COMPETENT PROFESSIONAL.