About

➀ Read and Learn

The following course content

Introduction   

In the 21st century, particularly in acute and long-term care settings, patients in the United States are admitted with increasing levels of complexity and acuity. The lack of adequate staffing at many organizations is an exacerbating issue, leading to unsafe patient conditions and increased litigation against healthcare providers.  

Furthermore, inappropriate delegation can lead to patient deterioration, lawsuits, and action against a nurse’s license (e.g., 1). Thus, it is paramount that nurses know and understand the components of safe delegating before engaging in this crucial aspect of nursing. 

Done correctly and efficiently, proper nursing delegation can include the following benefits (2): 

• Decreasing job burnout  
• Encouraging employee empowerment 
• Increasing job commitment and satisfaction 
• Improving patient safety 
• Building a high-functioning clinical team 

Definitions and Terms 

In order to better understand delegation, several concepts should be reviewed by the nurse. The first is what, exactly, comprises delegation. According to the American Nursing Association (ANA) and the National Council of State Boards of Nursing (NCSBN), there are three essential components of delegation (3, 10).  

These include: 

• Responsibility: Nurses have a professional duty to dependably and reliably perform their patient care tasks. These tasks are specified by each state’s Nurse Practice Act (NPA).  

• Authority: This is the nurse’s ability to perform specific duties within their role. This authority is given by NPAs, job descriptions, and organizational policies.  

• Accountability: This refers to the nurse’s legal liability for their actions related to patient care. Though the delegator transfers responsibility and authority to the delegatee, the ultimate accountability always lies with the nurse delegating. Accountability is also regulated by each state’s NPA provisions.  

 Furthermore, the ANA and NCSB define these terms related to delegation (4):  

• Assignment: The routine care, activities, and procedures within the RN’s or LPN’s scope of practice, and part of the routine role functions of the AP. 

• Assistive Personnel, or AP (formerly unlicensed assistive personnel, or UAP): Any assistive personnel trained in a supportive role- regardless of title- to whom a nursing responsibility may be delegated. This includes, but is not limited to, patient care technicians (PCTs), certified nursing assistants/aides (CNAs), medical assistants (MAs), certified medication aides, and home health aides (HHAs). 

• Delegated Responsibility: A nursing skill, procedure, or activity transferred from a licensed nurse to a delegatee. 

• Delegatee: One who is delegated a nursing responsibility by an APRN, RN, or LPN/VN, as allowed by the state’s NPA. This individual must be competent to perform the task and accept the responsibility. The delegatee may be an RN, LPN/VN, or AP.  

• Delegator: One who delegates nursing responsibility. This may be an APRN, RN, or LPN/VN, as the state’s NPA allows.  

• Licensed Nurse: This includes APRNs, RNs, and LPN/VNs. Depending on the state’s NPA, LPN/VNs may or may not be allowed to delegate.  

The Five Rights of Delegation 

Since there are significant ethical and legal considerations when delegating, the ANA and NCSBN have developed five rights of delegation for nurses. These rights allow for consistency and patient safety and reduce the risk of legal repercussions against the delegator. Here, nurses are defined as the following: advance-practice registered nurse (APRN); registered nurse (RN); and licensed practical/vocational nurse (LPN/VN).  

 The rights of delegation include the following situations (4):  

• APRNs when delegating to RNs, LPN/VNs and assistive personnel (AP)  
• RNs when delegating to LPN/VNs and AP  
• LPN/VNs (as allowed by their state/jurisdiction) when delegating to AP. 
• Per the NCSBN, the Five Rights of Delegation are (3, 4): 

1. Right task: The activity being delegated is part of the delegatee’s job description or is part of the established written policies and procedures of the nurse practice setting. The facility also needs to define the expectations and limitations of the activity and provide any necessary competency training.
2. Right circumstance: The patient must be in a stable health condition; if their condition changes, the delegatee must communicate this to the licensed nurse, who must then reassess the situation and the appropriateness of the delegation.
3. Right person: The delegatee, according to the employer and licensed nurse, has the appropriate skills and knowledge to perform the duties delegated.
4. Right directions and communication: Each delegation should be specific to the situation; this includes the patient, the licensed nurse, and the delegatee. This encompasses the following components and actions:
   1. The licensed nurse communicates specific instructions to the delegatee about the delegated activity.
   2. The delegatee asks any clarifying questions to fully understand the task.
   3. The delegator also includes any data that needs to be collected, the method of data collection, the timeframe for reporting the data, and any additional information relevant to the situation.
   4. The delegatee must communicate understanding and accept the delegated activity.
   5. The delegatee cannot modify the activity without first consulting the licensed nurse.
5. Right supervision: The licensed nurse is responsible for:
   1. Following up with the delegatee upon completion of the task
   2. Evaluating patient outcomes
   3. Ensuring that proper communication was received from the delegatee
   4. Intervening as necessary with the task
   5. Documenting the completion of the activity

Case Study 

Janice, a home health nurse, is busy with a full patient load. She receives a call from one of the nursing assistants, Steve, that their client with terminal cancer, Mr. Smith, has a problem. Mr. Smith’s peripherally inserted central catheter (PICC) has come disconnected from his intravenous (IV) pump which is giving him pain-control medications around the clock. Mr. Smith has been writhing in pain and the family at bedside is distressed at the situation.  

Janice is at another client’s house and tells Steve to have Mr. Smith’s family take him to the hospital for management or to call 9-1-1 if no transport is available. Janice explains that it will be a few hours until she can arrive at Mr. Smith’s house, so the quickest and safest course of action is to get Mr. Smith the proper medical care. 

Steve talks to the family, who refuses both transport and calls 9-1-1. They tell Steve, “Just hook him back up! It takes a few seconds, and then he won’t be in pain anymore!” Steve asks Janice if he can “just reconnect the PICC line so Mr. Smith is out of pain.” Janice sighs, knowing this will help the situation immediately, but is also out of Steve’s scope of practice as a nursing assistant.  

Janice finally says to Steve, “Ok. Go ahead and hook Mr. Smith back up. I’ll come check on him as soon as I can.”  

Steve reconnects Mr. Smith’s PICC line to the IV pain medications, and everyone is relieved for the time being. When Janice finally makes it to Mr. Smith’s house four hours later, Mr. Smith has a 103◦F fever and is diaphoretic. When he is taken to the emergency room, he is found to be septic. 

Other Considerations 

Detailed above are the major concepts of task delegation. However, other considerations should be considered as well. The relationship between the licensed nurse and the delegatee is of utmost importance to effective communication and task sharing.  

The delegating nurse should always be prepared to perform the task themselves and should have confidence in the delegatee’s ability to independently complete the assignment. Ideally, the nurse would already have witnessed or be aware of the delegatee’s clinical competence. If time permits, the nurse can do the task concurrently with the delegatee, allowing for any clarification and necessary teaching. This shows the delegatee that the nurse is both competent and helpful and will increase the likelihood of the task being successfully delegated in the future.  

If problems arise within delegation, especially if continued issues arise with the same delegatee, it is appropriate to involve management in the process. Delegating in general involves mutual respect among caregivers, as the competency of both the delegator and delegatee need to be in constant and direct communication.  

 Practices to Avoid When Delegating 

While the art of delegation lies mostly in communication and professional relationships, there are times when problems may arise. Here are some common pitfalls to avoid (6, 7, 8, 9, 10):  

• Over-delegating: This may stem from laziness, a heavy assignment, or burnout on the nurse’s part, but delegating too many tasks – especially to the same person- can lead to burnout and resentment from that individual as well. It’s best to be judicious when delegating tasks; every effort should be made to keep the workload even among employees.  

• Under-delegating: Some nurses feel uncomfortable delegating tasks they themselves can do. This may be related to shyness, lack of confidence, or not wanting to be a burden to coworkers. However, a lack of delegation can sometimes lead to an unrealistic workload for the nurse, leading to poor time management and even patient harm.  

• Not following-up on the delegated task: Since the responsibility of the delegated task’s completion ultimately lies with the nurse, it is their duty to go back to the delegatee and ensure the task is properly finished and documented. This crucial follow-up may get overlooked on a busy shift, but it is key to maintaining one’s nursing license and ensuring quality patient care.   

• Confounding job descriptions with delegation: Many nurses assume that if a task (e.g., taking vital signs, giving a bed bath) is in a job description, it is not a task to be delegated, but rather an expectation. Simply because a particular duty is routinely involved in the role of an employee does not mean it cannot be delegated. In fact, it is the responsibility of the nurse to ensure that all necessary nursing tasks are completed, and this very frequently involves delegation to the appropriate team member.  

• Delegating inappropriately: Certain tasks cannot be delegated, depending on each team member’s role and licensure (or lack thereof). It is paramount to patient safety and for license maintenance that the nurse knows what constitutes inappropriate delegation. For example, here are some tasks that may not be delegated by role (10):  

• LPNs may not: 

• • Titrate IV medications 
  • Give high-risk medications like chemotherapy 
  • Complete initial patient assessments or teaching 
  • Discharge patients

• Assistive personnel (AP) may not:
  • Delegate tasks to others
  • Insert urinary catheters
  • Administer tube feedings
  • Perform wound care or dressing changes

Tips for Good Communication and Delegation Practices 

In addition to the strategies listed above, the following are other helpful tips and tricks for nurses who need to delegate (5, 6, 7, 9, 10).  

• Get to know your team. Whether you are new to a nursing assignment, or there are new teammates hired to work with you, you will eventually need to form new professional relationships. Whenever possible, try to learn who your delegatees are before giving them their first task to complete. This fosters respect and will help your working relationship in the future. Some of your colleagues may even surprise you with their initiative or observational skills. 

• Show appreciation. Even if it is obvious that your task must be delegated, it is helpful to express thanks in some way. This expression of gratitude will go a long way in building a strong team and increasing your colleagues’ motivation to do a good job. 

• Recognize the opportunity for professional development. Delegating is not only an essential part of nursing but also an opportunity for the delegatee to learn and grow in their field. When proper guidance and mentoring are given by the nurse, the delegatee has the opportunity to gain extra experience and competence in their role. Furthermore, delegating is a great skill set for any leader to have on their resume as a job responsibility.  

• Respect cultural differences. In a multicultural society like the United States, differences in language and culture are bound to occur in professional settings like those encountered by nursing staff. It is paramount that the delegator recognizes and respects any cultural differences they may have from the person to whom they are delegating. For example, in some cultures, there are taboos with men and women seeing each other in various stages of undress, as is common in an exam or hospital room. In this situation, it is ideal to delegate any personal care to someone who has the same gender as the patient.  

• Encourage management to implement team nursing where appropriate. During the COVID-19 pandemic, nursing shortages were frequently at dangerous levels around the country. To combat this problem, some hospitals moved to a team nursing model, where a team of nurses provides care for all patients on the floor during a shift, instead of the traditional primary nurse model (9). Team nursing can allow staff members to safely and effectively care for a large number of patients, as long as good work culture and delegation practices are in place (9).  

• Listen to fellow team members. Oftentimes, assistive personnel spend more time with patients than nurses or primary care providers and thus may have valuable observations to share. With continued respect and open communication, nurses can ensure that their colleagues’ talents are used effectively.  
  

Conclusion

Delegation of nursing tasks is necessary in modern nursing, as patients are increasingly medically complex, and staffing shortages abound in the United States. Fortunately, there are steps in place to ensure safe, competent, and legally sound ways to delegate tasks in the clinical setting. For consistency’s sake, various nursing organizations have developed the five rights of delegation to remind all clinical staff what the expectations are.  

When done properly, nursing task delegation can benefit staff and patients alike, leading to better outcomes for all involved.  

➁ Complete Survey

Give us your thoughts and feedback

➂ Click Complete

To receive your certificate