Nursing Delegation

• Delegation is the process of directing others to perform nursing tasks.
• It allows the delegator to use their time for other tasks and increases the skills and abilities of the delegate.
• It is a process in which a nurse directs another person to perform nursing tasks and activities.

Benefits of Delegation

• For the Nurse: more time for complex client care, improved patient care, and easier teamwork.
• For the Delegate: gaining new skills and abilities, and builds trust and support.
• For the Manager: more time for tasks that cannot be delegated.
• For the Organization: decrease in overtime and absences, and an increase in productivity.

The Five Rights of Delegation

• Right Task: Task suitable for delegation based on patient condition, is delegable for a specific patient, and aligns with the Nurse Practice Act (NPA). Skills checklists and position descriptions help guide the decision.

• Right Circumstance: Ensuring patient stability for delegated tasks; appropriate patient setting and available resources (staffing, adequate supervision).

• Right Person: Qualified individual receiving the delegated task who has UAP competency, education, and training requirements.

• Right Direction: Clear, concise description of the task including objectives, limits, and expectations.

• Right Supervision: Appropriate monitoring, evaluation, and intervention with timely feedback.

• Delegate: Assumes responsibility (PCNA, NAT, etc.).

• Delegator: Assigns task (RN).

• Accountability: Responsibility for the outcome of delegated tasks.

• UAP Competency: Education and training requirements for unlicensed assistive personnel.

Task Delegation

• Suitable for delegation based on patient condition and delegable for a specific patient.
• Delegable in accordance with the Nurse Practice Act (NPA).

Unlicensed Assistive Personnel (UAP)

• Examples: certified nursing aides/assistants (CNAs), home health aides (HHAs), medical technicians, orderlies, assistive personnel (AP), and surgical technicians.
• Each state's Nurse Practice Act (NPA) defines acts that may or may not be delegated to UAPs.
• They have diverse levels of training and experience.
• Certified Nursing Aides: UAPs trained to assist with basic patient care.
• Home Health Aides: UAPs providing care in patients' homes.
• Medical Technicians: UAPs performing specific medical tasks and procedures.
• Orderlies: UAPs assisting with non-medical patient transport and care.
• Assistive Personnel: UAPs supporting nursing staff in various tasks.
• Surgical Technicians: UAPs assisting in surgical procedures and environments.

Principles for Delegation to UAP

• Nurse must assess patient before delegating tasks.
• Patient must be medically stable or in chronic condition (not fragile).
• Task must be considered routine and safe for the patient.
• Nurse must know and understand agency procedures and policies about delegation.
• Awareness by the nurse of individual variations in ability and training is required.
• If unsure of UAP's abilities, the nurse must observe while UAP does the task or do the task and get a return demonstration before allowing UAP to perform independently.
• Nurse must clarify reporting expectations and create an atmosphere fostering communication, teaching, and learning.
• Nurse Practice Act (NPA): Defines delegation limits by state.

Delegation Decision Tree

• Four Steps: assessment and planning, communication, surveillance and supervision, and evaluation and feedback.
• Assessment and Planning: Initial evaluation before delegating nursing tasks.

The Three Guiding Concepts in Ohio NPA for Assessment and Planning

• Registered nurse must assess the situation or circumstances involved when delegation is considered.
• Trained unlicensed person must have the current ability to perform the task safely.
• When competencies have been established, tasks can be delegated.
• Delegating nurse (or other licensed nurse) must supervise the performance of the task.
• Communication: the nurse (delegator) must clearly explain the expectations for the task.
• The nurse (delegator) must allow enough time to clearly describe the task, answer delegate's questions, and address any situations that must be reported by them.
• The UPA's (delegate's) responsibilities: communicate understanding of the task, inform delegator if they have never performed the task before, and request training if needed.
• Surveillance and Supervision: Monitoring compliance with agency policies during tasks.
• Validate that the delegated task is being done in compliance with agency's policies, procedures, and current standards of practice.
• The level of supervision needed depends on the task, the delegate's experience, and the patient's condition.
• Delegator should remain accessible; excessively close monitoring may convey distrust.
• Surveillance may reveal need for closer supervision of delegate or assistance with the task.
• Evaluation and Feedback: Involves reviewing task completion and providing constructive feedback.
• The nurse reviews if the task was completed properly and safely.
• Giving praise and recognition for a job well done.
• If problem areas are identified: Nurse should promptly investigate and explain any concerns to the delegate.
• Delegate must be given the opportunity to provide feedback and the nurse should instruct delegate on how to prevent such problems in future.

Tasks That May Be Delegated to UAPs

• Vitals
• Is & Os
• Patient transfer and ambulation
• Collecting specimens
• Bathing
• Feeding
• Weighing
• Attending to safety

Tasks that May NOT be delegated

• Assessment
• Interpretation of data
• Making a nursing diagnosis or problem list
• Creation of a nursing care plan
• Evaluation of care effectiveness
• Care of invasive lines
• Administering parental medication
• Inserting NG tubes
• Patient Education
• Certain Tasks May Not Be Delegated: Discipline of other employees, and highly technical tasks.
• Complex patient care tasks require specific levels of licensure, certification, and expertise.
• Avoid any situation that involves confidentiality or controversy.
• Immediate Intervention: Promptly intervene when problems arise.

Questions to consider before delegating

• Is the task within the nurse's practice?
• Have patient's needs been assessed?
• Is the task consistent with recommended criteria for delegation?
• Does 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?
• Proceed only if all questions can be answered "yes."
• Delegation Factors: complexity, patient's condition, policies and procedures, legal and ethical considerations, UAP skills and training, UAP experience level, UAP willingness to accept task, UAP workload, RNs trust in delegate, RN's communication skills and supervision style, staffing levels, work culture, resources and equipment, and time constraints.

Delegation in nursing involves directing others to perform tasks, freeing up the delegator's time and enhancing the delegate's skills. Benefits include improved patient care, skill development, and increased productivity. The 'Five Rights of Delegation' ensure tasks are appropriate and safe.