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Delegation in the Profession of Nursing
Lluvia I. Carbajal Posadas, S.N.
Associate Degree in Nursing, Southwest University
HC 105: Introduction to Nursing
Dr. Sandra G. Imperial and Mrs. Kelly Crowley
July 25, 2021
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Defining Delegation
Nursing is not an easy profession, and it may appear overwhelming, as nurses face
countless challenges in their work environment, from being short-staffed, complex patients, and
physical/mental fatigue. These events can lead to burnout and a deficit in conveying proper
health care to patients. To avoid such problems from arising, health practitioners must cooperate
to ensure patient safety and the quality of their services. As Fisher (2000) explains in her work,
‘Do you have delegation savvy?’ Registered Nurses (RN) can delegate specific tasks from their
workload to other health care practitioners, ensuring that all work is completed efficiently and
timely, and frees time for the registered nurse to focus on higher risk patients and perform duties
better.
Delegation is a creative and fundamental skill that nurses use when planning their
workday; it transfers the responsibility of performing a task or action onto another capable
person while maintaining accountability for the results (ANA, 2021). Being able to delegate
successfully requires the knowledge of what acts or tasks can be delegated and to whom, by
knowing other healthcare practitioners’ scope of practice, institution (hospital/provider office)
policies, and procedures, state nurse practice acts, and the five rights of delegation: right task,
right circumstance, right person, right direction and communication, and right supervision.
Health practitioners must understand the five rights as they set the standard for safe medication
practices by assisting nurses to detect crucial elements during the decision-making process and
define the legal accountability of nurses at all levels (Barrow and Sharma, 2018).
The right task is to identify activities that follow the institution’s policies, procedures,
and standards and fall under the registered nurse’s time-consuming competencies, but that can be
performed by another health practitioner that will provide the same results. The patient’s
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condition, the difficulty of the task, and how much supervision they will need must be
considered. By transferring these tasks, the delegator frees times that can be used on more
complex patients or work.
The right circumstances consider that the delegatee has the resources needed and
capabilities to perform the tasks transferred to them. Since registered nurses are responsible for
all steps of the nursing process (assessment, diagnosis, planning, implementation, and
evaluation), the only legally appropriate tasks to be delegated are those that do not need
independent judgment.
The right person considers the scope of practice, experience, and skills of the other health
practitioners. Registered nurses must take the time to know each member’s competencies; new
and inexperienced practitioners may be given tasks where risk is minimum; while they develop
their confidence and prove themselves to be reliable members, more experienced practitioners
realize more risky and complex tasks that can be delegated. A patient who may become unstable
must not be delegated to another health practitioner under any circumstances.
The right direction and communication are clear, specific, and direct instructions about
each delegated activity, including objectives, expectations, limits, and deadlines. Delegation is a
two-way street, meaning that there is responsibility for both the registered nurse in providing the
appropriate information about the task and ensuring that the delegatee comprehends how and
when the finished tasks must be reported, the delegatee, in turn, must clarify any questions that
arise before starting the delegated task.
The right supervision is the registered nurse’s involvement in monitoring, evaluating, and
guiding the health practitioner during the delegated activity to ensure the work meets their
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expectations. The registered nurse must be available to intervene, as needed, and provide
feedback as it is crucial for a good patient outcome and tasks. Another vital objective after the
activity has been completed is documentation, and nurses must make sure that it is appropriately
done.
Delegation is effective when used correctly but challenging to master; institutions
identify leadership and management capabilities of registered nurses by judging their skill in
how effective they get their work done when successfully delegating specific tasks or activities
to other members of their unit. Lounsbury Fish (1972, as cited in Anbuvelan, 2014) explained
that a person can only do so much on their own in a day and that the only way to achieve more is
by delegating; splitting the workload with others to optimize time and resources. This process
also helps build strong work relationships with other care practitioners, helps other team
members’ growth in reaching their full potential in the institution, and free time for the registered
nurses to care for the more complex patients.
Ultimately, to deliver good health care to patients, registered nurses must understand
what can be delegated and their team members’ strong areas and competencies so that they may
know whom they can delegate a task to as it will positively impact the patient outcome and the
institution’s productivity.
Health Practitioners and Scope of Practice
To delegating any tasks, registered nurses must know and understand their scope of
practice and that of those that may work with them as it may be necessary to delegate activities
or tasks to other health practitioners with a narrower scope of practice, such as:
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Unlicensed Assistive Personnel (UAP): unlicensed personnel who can work under the
direct supervision of a professional, registered nurse can perform repetitive non-invasive and
basic patient care tasks, such as ambulation, hygiene, linen change, bathing, positioning, some
specimen collection, transport, grooming, range of motion services, skincare.
Licensed Practical or Vocational Nurse (LPN/LVN): perform the same duties as UAP, as
well as offer more intensive care and specific invasive tasks, such as administering medications
via oral/rectal/vaginal/eye/ear/nose/PEG tube/topical routes, change dressings, irrigating wounds,
monitor and IV flow rate, suctioning, teaching basic hygiene and nutrition, urinary catheters,
administering some selected IV piggybacks, reinforcing, education, administering
intramuscular/subcutaneous injections, using the nursing process.
As for registered nurses (RN), they can perform all tasks done by UAP and LVN/VPN;
registered nurses provide the most detailed patient care, such as nursing process, initial patient
education, discharge education, clinical judgment/assessment, initiating blood transfusion,
administering IV medications by continuous/piggyback/push IV (Silvestri et al., 2020).
By understanding the scope of practice of each health practitioner, a registered nurse will
be able to determine who is the most qualified delegate to perform certain activities or tasks
safely. For example, a registered nurse may need to delegate the task of bathing a patient and has
to decide between delegating to a licensed practical/vocational nurse (LPN/LVN) or unlicensed
assistive personnel (UAP); both are trained to perform this procedure, but the nurse has to
consider other tasks that may need to be done by a more qualified practitioner than the UAP. It
makes more sense to leave this task to the unlicensed UAP as it is a non-invasive procedure and
will free time for both the RN and the LVN/LPN to focus on other activities or patients.
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Just as with any organization, delegation and communication have different forms
(Abbott, 2012). The most widely known is the process of downward delegation where, a health
practitioner in a higher position of the hierarchy delegate to those below them, the upward
delegation is when a health practitioner realizes that a task is beyond their scope of practice or
one of their assigned clients have developed into a high-risk patient. They reach out to a higherranking member of the hierarchy with the appropriate set of skills and competency needed to
give care, and lateral delegation is when a health practitioner delegates a task or action to a
member at the same level as them.
Precautionary Measures
Nurses will have a specific structured approach or guidelines that helps them analyze the
situation when delegating to another health practitioner. Silvestri (2020), enlists these guidelines
as follows:
1. Undertake a risk assessment, the safety of the patient takes precedence.
2. Review the delegate’s competence and training, confirm if there is existing evidence.
3. Confirm that the delegated task falls under the health practitioner’s scope of practice.
4. Determine the amount of supervision the delegatee will need.
5. Provide clear and concise information about the delegated tasks and ask the delegate
to repeat the expectations and directions. This feedback helps the RN confirm
understanding.
6. Convey confidence on the delegatee, evaluate the outcome and provide feedback on
their performance upon completing the delegated task.
7. For tasks with deadlines, brief the delegatee with the time limit to complete the task
or activity.
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8. Maintain feedback mechanisms, monitor progress, and determine the need for aid.
There are times when the registered nurse may be tempted to take back a delegated task,
creating a reverse delegation situation, and there are different reasons for this to happen, but a
good example is when the delegate is struggling to complete the task, and the registered nurse
decided to do the task because it is time-sensitive or to save resources. Delegated tasks must not
be taken back. Taking health practitioners out of their comfort zones will help them grow and
strengthens the unit.
Responsibility and Accountability
Only registered nurses may delegate nursing tasks, and functions and delegated activities
cannot be re-delegated. They must also evaluate the outcome of the finished tasks and remember
that only the performed tasks are delegated and that the accountability is not as easily
transferable. Registered nurses that delegate is accountable for their decisions; to their patient,
institution, and state (Quallich, 2005). A nurse’s registration is at risk of suspension if a delegate
performs a task inadequately.
Accountability and responsibility are the reason for communication to be so important
during the delegation process; both the registered nurse and health practitioner must
communicate effectively about the delegated task; what the task entails, and if it fails in their
scope of practice, institution’s policies, procedure and standards, the delegate’s competence and
that they accept the responsibility to perform the task. Honesty is the key, and if the health
practitioner lacks self-confidence whether they will be able to perform the task, even if they have
the proper education and training, then the registered nurse must explain to them that they will
receive the appropriate supervision while carrying out the task assigned to them and will be
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provided with feedback about their execution. Once the practitioner has accepted the
responsibility to carry out the task, the registered must supervise the task as it is a critical step
when delegating; registered nurses must provide support and guidance to ensure that the delegate
is competent to perform the activities and ensure the safety and quality of care provided to the
patient. Registered nurses should delegate only to those that can safely perform the tasks.
Benefits of Delegation
Some of the benefits of delegating have been mentioned, such as freeing time for the
registered nurse to concentrate on other activities, tasks, or high-risk patients, help health
practitioners to grow, improves communication, develop strong working relationships and trust
among the members of the institution, ensures patient safety and proper delivery of care in an
efficient and timely manner.
Fisher (2000) notes that the delegation of tasks and activities can also help reduce health
costs by using the institutions’ resources and the registered nurse’s time effectively, improving
efficiency, time management, and productivity. Successfully delegating according to state
requirements, institution’s practices, and procedures, and scope of practice a registered nurse
decreases the risk of liability.
Obstacles of Delegation
Delegation is a challenging skill that takes time to develop, so it is not unusual for cases
where health practitioners would prefer not to delegate. According to Quallich (2005), this
response stems from the following fears:
Some health practitioners believe themselves to be the better healthcare professional and
that only they can deliver quality care to their patients, so they avoid delegating work that
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another unit member could do. This lack of teamwork is a fear of losing control over the
patient’s outcome when delegating. Some nurses may not delegate tasks or activities to other
members if there is a lack of trust; the nurse may begin to handle everything themselves. Making
it difficult for other healthcare practitioners to grow, develop, and prove themselves to be
dependable.
There is a fear of appearing unknowledgeable and incompetent when transferring tasks to
another healthcare practitioner below them in the institution’s hierarchy. It could also be because
the nurse lacks the knowledge of the competencies of the other member of the unit, skills,
experience, scope of practice, so they cannot determine to whom they can delegate specific tasks
or activities. The issue can also be poor communication or an inability of the nurse to relate with
their peers.
Conclusion
In summary, delegation is an art that requires the implementation of critical thinking and
medical judgment that improves with experience and develops over time. The process of
delegation is based on the understanding of what the nursing practice entails, and how it varies
by each state’s nurse practice act, and the understating of other healthcare practitioners’ scope of
practice to be able to determine who are the best candidates to delegate a task or activity. Some
tasks registered nurses cannot delegate, such as the ADPIE steps of the nursing process. While
the responsibility to carry a task lies on the delegate, registered nurses must follow up with the
delegate to ensure the outcome of the care provided and patient safety, give feedback, and ensure
proper documentation. Registered nurses are accountable for delegation decisions of
tasks/activities, and nurses need to be cautious when delegating to protect their license. As
anxious as it may be delegating tasks, if the nurse follows the five rights of delegation and
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preventive measures, not only will nurses will benefit from a good execution but the patient,
institution, and other team members will do as well.
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References
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American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.).
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Anbuvelan, K. (2014). Principles of Management: Mg 1351. University Science Press.
Barrow, J. M., & Sharma, S. (2018). Five Rights of Nursing Delegation. StatPearls.
https://doi.org/https://pubmed.ncbi.nlm.nih.gov/30137804/
Fisher, M. (2000). Do you have delegation savvy? Nursing, 30(12), 58–59.
https://doi.org/10.1097/00152193-200030120-00021
Quallich, S. A. (2005). A Bond of Trust: Delegation. Urologic Nursing, 25(2), 120–123.
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