Nurse delegation is a structured process used in healthcare to ensure patients receive consistent and comprehensive care, particularly in settings like assisted living facilities or home care environments. It involves a Registered Nurse (RN) authorizing an unlicensed individual to perform specific nursing tasks that would otherwise be outside their scope of practice. This mechanism addresses staffing needs and maintains the quality of life for individuals with stable, predictable health conditions. The practice is strictly regulated by state law, ensuring patient safety remains the highest priority in the delivery of delegated care.
Defining the Core Concept and Roles
Nurse delegation is the transfer of responsibility for a selected nursing task from a licensed nurse to a competent individual not otherwise authorized to perform it. The Registered Nurse (RN) assumes the role of the delegator, initiating the process and retaining overall professional accountability for the patient’s care. The individual receiving the task is known as the delegatee, often an Unlicensed Assistive Personnel (UAP) or certified nursing assistant.
A fundamental distinction exists between responsibility and accountability in this context. The delegatee accepts the responsibility to perform the task correctly and safely. However, the delegating RN retains the ultimate accountability for the decision to delegate and the overall patient outcome. The entire framework of nurse delegation is governed by each state’s Nurse Practice Act (NPA), which outlines the specific legal provisions for this practice.
Permitted and Prohibited Tasks
The tasks an RN can delegate are limited to those that are routine, predictable, and do not require professional nursing judgment. Commonly delegable tasks include routine assistance with activities of daily living (ADLs), such as ambulation or feeding. More specific tasks often delegated involve blood glucose monitoring or the administration of pre-measured, oral, or topical medications.
Tasks that require the RN’s specialized nursing knowledge, clinical judgment, or assessment skills are universally prohibited from delegation to UAP. This includes performing initial patient assessments, developing the plan of care, or conducting any activity that involves sterile technique. Additionally, tasks like calculating medication doses, giving initial intravenous (IV) push medications, or maintaining central venous access devices are never delegated. If the patient’s condition is unstable or the outcome of the task is not highly predictable, delegation is inappropriate as it requires the RN’s ongoing evaluation.
The Formal Delegation Process
The formal process of delegation begins with the RN’s comprehensive assessment of the patient’s health status and the specific task to be delegated. The RN must first establish that the patient’s condition is stable and predictable, making the performance of the task safe in that particular care setting.
After assessing the patient and the task, the RN must evaluate the delegatee’s competency, availability, and willingness to accept the responsibility. This involves verifying that the UAP possesses the necessary knowledge and skills for that specific task. The RN then provides specific training and verification of skills, demonstrating the procedure and observing the delegatee perform it correctly to ensure proficiency.
Once competence is verified, the RN provides written documentation and authorization. This authorization includes clear, specific instructions on how the task is to be performed, what observations to report, and when to notify the nurse. The process concludes with the RN providing ongoing supervision and monitoring of the delegatee’s performance and the patient’s response to the care.
Accountability and Safety Measures
While the UAP is responsible for carrying out the delegated task with competence, the Registered Nurse remains fully accountable for the decision to delegate and the final patient outcome. The RN must maintain a supervisory relationship, ensuring the task is performed according to established standards and policies. This accountability extends to monitoring the patient’s condition and intervening if the delegatee’s performance is inadequate or the patient’s status changes.
Safety within the delegation model is enforced through regulatory oversight by the State Board of Nursing. The Board establishes the rules and regulations that govern what can be delegated and the required competency standards. Comprehensive documentation of the RN’s assessment, the delegatee’s training, and the supervisory actions provides a legal record of compliance.