Delegation in nursing practice is the transfer of authority to an individual to perform a specific nursing activity in a selected situation. This process allows the Registered Nurse (RN) to direct patient care while managing a complex workload, optimizing safety and efficiency across the healthcare team. The Five Rights of Delegation serve as a structured framework governing this transfer of authority. Adhering to these rights ensures the task is appropriate, the circumstances are suitable, and the person receiving the task is competent to complete it safely.
Defining the Five Core Rights
The framework begins with the Right Task, which dictates that only activities delegable for a specific patient can be transferred. These tasks are generally routine, repetitive, noninvasive, and have predictable results with minimal risk. For instance, delegating routine vital signs collection for a stable patient is acceptable, but delegating complex intravenous medication administration is inappropriate. The task must fall within the delegatee’s job description and facility policies, ensuring the activity does not require the specialized knowledge or judgment of a licensed nurse.
The Right Circumstance requires the nurse to assess the patient setting, available resources, and the patient’s stability before delegation. Delegation is safe only when the patient’s medical condition is stable and predictable, meaning their status is not expected to change suddenly. An RN would not delegate a task to Unlicensed Assistive Personnel (UAP) for a patient with unstable vital signs or one requiring continuous assessment. The nurse must also ensure all necessary equipment and supplies are available for the delegatee to perform the task.
The Right Person focuses on the competency of both the delegator and the delegatee. The delegator (usually the RN) must have the legal authority and professional competence to delegate the task. The delegatee, whether a Licensed Practical Nurse (LPN) or UAP, must possess the necessary education, training, and documented clinical proficiency to perform the specific task safely. The RN must confirm that the delegatee has demonstrated competence and is comfortable accepting the responsibility.
The Right Direction/Communication involves providing clear, concise, and complete instructions regarding the task. This communication must include the specific task, when it needs to be completed, the expected outcome, and any specific patient limitations or concerns. The delegator must also specify the exact reporting requirements, including what information should be communicated back and when. Effective communication involves closed-loop confirmation, ensuring the delegatee understands the instructions and has the opportunity to ask clarifying questions.
The Right Supervision/Evaluation holds the RN responsible for monitoring the performance of the task and its outcome. The delegator must provide appropriate oversight and be available to intervene if necessary. This supervision includes follow-up to ensure the task was completed correctly and on time. The RN must evaluate the patient’s response to the delegated activity and provide feedback to the delegatee, which aids in professional development and maintaining patient safety.
Scope of Practice and the Delegation Process
Delegation is a specific process involving the transfer of responsibility for a task, which is distinct from assignment. Assignment refers to designating routine care activities that fall within the authorized scope of practice of a licensed professional or the routine functions of a UAP. Delegation often involves an activity that may be beyond the delegatee’s traditional role or basic education.
The authority to delegate is generally reserved for the Registered Nurse, whose scope of practice is defined by the state’s Nurse Practice Act (NPA). The RN is the only one who can delegate activities that involve patient assessment, planning, evaluation, and nursing judgment to other personnel. Licensed Practical Nurses (LPNs) may also delegate certain tasks, but their authority is often limited to delegating to UAPs and is subject to state-specific regulations.
UAPs, such as Certified Nursing Assistants (CNAs), are the most common recipients of delegated tasks. UAPs can receive delegation for tasks like assisting with activities of daily living or collecting vital signs for stable patients, but they cannot delegate tasks to anyone else. Delegation must always occur within the framework of the delegatee’s job description and organizational policies.
Accountability and Responsibility After Delegation
The transfer of a task through delegation creates a dual relationship of responsibility and accountability. Responsibility refers to the obligation of the delegatee to perform the specific delegated task correctly and according to the established standard of practice. The delegatee is answerable for their own actions or inactions while performing the activity.
Accountability remains with the Registered Nurse who made the decision to delegate. The delegating RN retains professional accountability for the overall patient outcome and the decision to delegate the task. This means the nurse is ultimately answerable for ensuring the task was appropriate, communication was clear, and the outcome was evaluated.
Documentation of the delegated task and the patient’s response is a requirement for both the delegatee and the delegator. If inappropriate delegation leads to a negative patient outcome, the RN is held accountable for the patient’s safety. The RN’s role is to direct care and determine the appropriate utilization of all team members.