Delegation in Nursing: Principles and Rights

Delegation in Nursing: Overview

• Delegation is a process where a nurse directs another person to perform nursing tasks and activities.
• Delegation means transferring the responsibility for completing a task, but not the accountability for the task.
• Delegation is the transference of responsibility and authority to a competent individual.
• The delegate assumes responsibility for the delegated task.
• The delegator assigns the task.
• Delegation allows the delegator to devote time to other tasks.
• Delegation increases the skills and abilities of the delegate.

Benefits of Delegation

• Nurses gain more time for complex client care.
• Delegates acquire new skills and abilities.
• Delegation brings trust and support.
• Managers have more time for tasks that cannot be delegated.
• The organization sees a decrease in overtime and absences, with an increase in productivity.

The 5 Rights of Delegation

• Right Task
• Right Circumstances
• Right Person
• Right Direction/Communication
• Right Level of Supervision

The Right Task

• The task must be one that is appropriate for delegation to a specific patient.
• It should be a task that can and should be delegated.
• Decisions should be based on the Nurse Practice Act (NPA).
• Skills checklists and position descriptions can guide the decision-making process.

The Right Circumstance

• The patient setting must be appropriate.
• Available resources, such as staffing and adequate supervision, must be present.

The Right Person

• The right person is delegating the right task to the right person to be performed on the right patient.
• UAP competency, education, and training requirements must be considered.
• The desired outcome for the patient needs to be identified.
• Example: a patient who is stable and needs a bath versus a patient and family who will learn skin assessment as part of a bath.

The Right Direction and Communication

• The description of the task should be clear and concise.
• Objectives, limits, and expectations should be included.

The Right Supervision and Evaluation

• Appropriate monitoring, evaluation, and intervention should be provided as needed.
• Immediate intervention should be possible if problems occur.
• Appropriate feedback should be given.

Delegation to Unlicensed Assistive Personal

• Delegation can include:
  • Certified nursing aides/assistants (CNAs)
  • Home health aides (HHAs)
  • Medical technicians
  • Orderlies
  • Assistive personnel (AP)
  • Surgical technicians
• There are diverse levels of training and experience.
• Each state's NPA defines what acts may or may not be delegated to UAP within that state.
• Example: https://codes.ohio.gov/ohio-administrative-code/chapter-4723-13

Principles for Delegation to UAP

• The nurse assesses the patient before delegating tasks.
• The patient must be medically stable or in chronic condition and not fragile.
• The task must be considered routine and safe for the patient.
• The nurse must know and understand agency procedures and policies about delegation.
• The nurse must be aware of individual variations in ability and training.
• If unsure of UAP's abilities, the nurse must observe while UAP does the task or get a return demonstration before allowing UAP to perform independently.
• The nurse must clarify reporting expectations.
• The nurse must create an atmosphere fostering communication, teaching, and learning.

Delegation "Decision Tree": 4 Steps

• Assessment and planning
• Communication
• Surveillance and supervision
• Evaluation and feedback

Assessment and Planning

• The Ohio Board of Nursing's rules on delegation, Chapter 13 of the Ohio Administrative Code, include three guiding concepts:
  • A registered nurse must assess the situation or circumstances involved when delegation is being considered.
  • The trained unlicensed person must have the current ability to perform the task safely; when competencies have been established, tasks can be delegated.
  • The delegating nurse or other licensed nurse must supervise the performance of the task.
• Assessment and planning is the critical first step in the delegation process.
• Before delegating questions to consider:
  • Is the task within the nurse's practice?
  • Have the patient's needs been assessed?
  • Is the task consistent with recommended criteria for delegation?
  • Does the delegate have the appropriate training, skills, and knowledge to perform the task safely using current standards of practice?
  • Are organizational policies, procedures, and protocols available for the task?
  • Is adequate supervision available?
• If all questions can be answered "yes," the nurse may continue to the next step.

Communication

• The nurse (delegator) must clearly explain the expectations for the task.
• The nurse (delegator) must allow enough time to:
  • Clearly describe the task and expectations for completing it.
  • Answer delegate's questions.
  • Address any situations that must be reported to the delegate.
• The UPA's (delegate's) responsibilities include:
  • Communicating understanding of the task.
  • Informing the delegator if the delegate has never performed the task before.
  • Requesting training if needed.

Surveillance and Supervision

• Validation is needed that the delegated task is being done in compliance with the agency's policies, procedures, and current standards of practice.
• How much supervision is needed depends on the task, the delegate's experience, and the patient's condition.
• The delegator should remain accessible, however, monitoring that is too close may convey distrust.
• Surveillance may reveal the need for closer supervision of the delegate or assistance with the task.

Evaluation and Feedback

• After the task is done, the nurse reviews if it was completed properly and safely.
• If problem areas are identified:
  • The nurse should promptly investigate and explain any concerns to the delegate.
  • The delegate must be given the opportunity to provide feedback.
  • The nurse should instruct the delegate on how to prevent such problems in the future.
• Giving praise and recognition for the job well done is important.

Tasks That May Be Delegated to UAPs

• Taking vital signs
• Measuring and recording intake and output
• Assisting with patient transfers and ambulation
• Collecting specimens
• Bathing
• Feeding
• Weighing
• Attending to safety

Tasks That May NOT Be Delegated to UAPs

• Assessments
• Interpreting data
• Making a nursing diagnosis or a problem list
• Creating a nursing care plan
• Care of invasive lines
• Administering parental medication
• Inserting nasogastric tubes
• Patient education

Factors Affecting Delegation

• Complexity of the task
• Patient's condition
• Organizational policies and procedures
• Legal and ethical considerations
• Delegate's skills and training
• Delegate's experience level
• Delegate's willingness to accept the task
• Delegate's workload
• Delegator's trust in the delegate
• Communication skills
• Supervision style
• Staffing levels
• Work culture
• Resources and equipment
• Time constraints

Certain tasks that should never be delegated by RN

• Discipline of other employees
• Highly technical tasks
• Complex patient care tasks that require specific levels of licensure, certification, expertise
• Any situation that involves confidentiality or controversy

Explore delegation in nursing, focusing on its benefits and the crucial '5 Rights'. Understand how nurses can effectively assign tasks while maintaining accountability, fostering skill growth, and improving overall healthcare efficiency.