Nursing Leadership &
Management
Patricia Kelly-Heidenthal
0-7668-2508-6
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 13
Delegation of Nursing Care
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Objectives

Upon completion of this chapter, the reader should be
able to:
• Review the history of delegation.
• Define delegation, accountability, responsibility, authority,
and assignment making.
• Identify responsibilities the health team members can
perform.
• List the five delegation rights.
• Identify three potential delegation barriers.
• List six cultural phenomena that affect transcultural
delegation.
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Historical Perspective of Delegation
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Delegation in nursing has been emphasized and
deemphasized at different periods in history.
Delegation has not always been emphasized in
nursing education.
Current staffing practices require a greater amount of
delegation from the nurse.
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Delegation Defined

Delegation is the transfer to a competent individual of
the authority to perform a selected nursing task in a
selected situation. The nurse retains accountability for
the delegation.
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Accountability and Responsibility
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Accountability means that the nurse is legally liable
for her actions and is answerable for the overall
nursing care of her patients.
Responsibility involves reliability, dependability, and
the obligation to accomplish work. Responsibility also
includes each person’s obligation to perform at an
acceptable level.
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Authority

Authority occurs when a person who has been given
the right to delegate, based on the state Nurse Practice
Act, also has the official power from an agency to
delegate.
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Assignment Making
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Assignment making is the process of
delegating the duties and all aspects of care for
a patient to individual personnel.
The assignment includes giving clear, concise
directions, and delegating the responsibility
and the authority for the performance of the
care.
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Assignment Making
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The education, skill, knowledge, and judgment
levels of the personnel being assigned to a task
must be relative to the assignment.
The expected outcome of the assignment, time
frame for completion, and any limitations on
the assignment should be specified when the
assignment is made.
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Responsibilities of Health Team
Members

Care should be used in delegating or accepting
responsibility for any action that:
•
•
•
•
•
May carry the potential for harm
May be highly complex or require advanced skill
May require a high level of problem-solving skill
Has a greater than average degree of unpredictability
Requires a complex level of patient interaction
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Functions of the Professional Nurse
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The registered nurse is responsible and accountable
for the provision of nursing care.
The registered nurse is always responsible for patient
assessment, diagnosis, care planning, and evaluation.
The registered nurse remains responsible for the
patient outcome.
Nurses must be alert and avoid misuse of UAPs and
LPN/LVNs.
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UAP Functions
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UAPs can deliver supportive care. They are expected
to document and report information related to such
activities.
UAPs cannot practice nursing or provide total patient
care. They cannot be delegated to assess or evaluate
responses to treatment.
The RN has an increased scope of liability when
delegation takes place to a UAP.
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UAP Functions
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The ANA states that since the RN is accountable for
the delegation of nursing care activities, the RN must
consider the following in determining the appropriate
use of a UAP:
•
•
•
•
•
An assessment of patient condition
The capabilities of the UAP
The complexity of the nursing task
The amount of supervision the RN will be able to provide
The available staff assigned to accomplish the unit
workload
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Licensed Personnel Functions
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Even though LPN/LVNs are able to perform duties
and functions that UAPs are not allowed to do,
LPN/LVNs are held to a higher standard of care and
are responsible for their actions.
The RN is still primarily responsible for overall
patient assessment, planning, and evaluation of the
quality of care delegated.
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Licensed Personnel Functions
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Common LPN/LVN duties include:
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•
•
•
Teaching from a standard care plan
Reinforcing teaching
Updating initial assessments
Removal of sutures
In some states, starting and or maintaining intravenous
lines, after receiving additional education
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Direct Delegation Versus Indirect
Delegation
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Direct delegation is usually verbal direction by the
RN delegator regarding an activity or task in a
specific nursing care situation.
Indirect delegation is done using an approved listing
of activities or tasks that have been established in the
policies and procedures of the health care institution
or facility.
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Underdelegation
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Usually occurs when a person is in a new job role
Potential causes:
•
•
•
•
Trying to avoid resentment from “old guard” staff
Not knowing who to delegate to
Not knowing scope of staff duties
Seeking approval by demonstrating competency
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Delegation Barriers
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Barriers in the delegator
• Do-it-myself attitude, inability to ask others, inability to
organize/manage, uncertainty

Barriers in the delegatee
• Inexperience, incompetence, disorganization,
irresponsibility

Barriers in the situation
• Inadequate support, hurried atmosphere, hostile
management
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Five Rights of Delegation
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The right task
The right circumstance
The right person
The right direction and communication
The right supervision and evaluation
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Transcultural Delegation
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Transcultural delegation is the process of having
personnel perform duties with the diversities of
culture taken into consideration.
Cultural phenomena (areas where cultures have
different interpretations or preferences) include:
•
•
•
•
•
•
Communication
Space
Social organization
Time
Environmental control
Biological variations
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