Delegation
Continuing Education Presentation
2008
Objectives
Define delegation and its component parts.
Discuss the need for delegation.
Discuss the five rights of delegation.
Explain the process of delegation.
Identify a delegation model to select the
appropriate delegatee
 Identify the legal authority for an RN to delegate.
 Identify challenges with delegation.
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Definitions of Delegation
 National Council of State Boards of Nursing
(1995)
 Transferring to a competent individual the authority to
perform a selected nursing task in a selected situation.
 American Nurses Association (1996)
 Transfer of responsibility for the performance of a task
from one individual to another.
Definition of Delegation
Achieving performance of care outcomes for
which you are accountable and responsible by
sharing activities with other individuals who have
the appropriate authority to accomplish the work
(Yoder-Wise, 2008).
Four Components of Delegation
 care outcomes - patient care is safely provided
 accountable and responsible - both RN and delegatee
have an obligation to care for that patient and ensure
the task is completed
 sharing activities – both the RN and delegatee work
together to accomplish care
 appropriate authority – the RN selects the appropriate
person to delegate the task
Need for Delegation
 Increased acuity of patients
 Increased use of Unlicensed Assistive Personnel
(UAPs) and Practical Nurses (PN)
 Increased RN responsibilities in the management of
the nursing unit/organization
 Accelerated pace and changing health care
environment.
Five Rights of Delegation
 Right Task
 Right Circumstance
 Right Person
 Right Communication
 Right Supervision
Right Task
Questions to ask when determining the right task
 Is there potential for harm – if there is a great
potential for harm if the task is done incorrectly, be
careful with delegation
 How complex is the task – if the task is very
complex, be careful with delegation
 What problem-solving is required to carry out the
task – if significant problem-solving is require while
performing the task, be careful with delegation
 What is the predictability of the outcome – if in
completing the task there is potential for many
different outcomes, be careful with delegation
 Patient interaction/ability – if the patient has limited
ability to assist or respond to the task, be careful
with delegation
Right Circumstances
Delegating a task under the right circumstances
includes
 Considering the condition and acuity of the patient
 An awareness of the staff mix – distribution of
Practical Nurses(PNs) and Unlicensed Assistive
Personnel(UAPs)
 Organization documents – the job descriptions,
policies, and procedures within the organization will
guide to whom and what can be delegated.
Right Person
 Nurse Practice Act – each state has a nurse practice act
that will define and determine what task can be delegated
to what level of personnel.
 Determines the scope of practice for each position
 Issues standards of care that guide practice
 Renders official opinions which guide practice
 Organization guidelines – each organization has
statements that guide practice.
 Mission statement
 Policies and procedures (determine what can be done and what
level of personnel can carry out the task)
 Job descriptions – identifies job responsibilities
Right Communication
 Clear and concise communication is imperative from
the RN to the delegatee. This communication should
include the :
 Task with clear expectations of what is to be done, why
it is being done, and when the task should be
completed
 Correct patient
 Information that should be reported back to the nurse
and when that information should be given to the nurse
 Expected outcome of the task
Right Supervision
 The RN must provide sufficient follow up including:
 Checking on the progress of the task
 Checking on the outcomes once the task is
performed
 Obtaining feedback about the completed task from
the delegatee
 Evaluate the effectiveness of the delegation with the
delegatee
Right Supervision
 Giving feedback to the delegatee is important. To create
an environment where feedback is seen as constructive,
consider the following.
 Timing of the feedback – the RN should give the delegatee
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feedback as soon as possible after the task is completed
Focus on the behavior/performance of the task
Provide clear feedback addressing the completion of the task
Use assertive “I” statements
Ask for a restatement of the feedback from the delegatee so there
is clear understanding of what was said
Provide feedback privately with the delegatee
Ask for feedback from the delegatee to clarify any concerns that
person may have as well
Five Rights of Delegation
Please go to this web site for further information on
the five rights of delegation.
https://www.ncsbn.org/fiverights.pdf
Delegator
As the delegator, the RN must
 Have a view of the big picture in the care of the
assigned patients
 Select the appropriate activities to delegate
 Select the appropriate staff to carry out the activities
 Clearly communicate the expectations and required
follow up
 Follow up periodically while the task is being completed
 Evaluate and provide feedback on the effectiveness of
the delegation to staff
Delegatee
The delegatee also has responsibilities including
 Accepting the delegated activities as directed by the RN
 Give report to RN as requested on the delegated task
 Give feedback to delegator on the effectiveness of the
delegation process
Delegation Model
The National Council of State Boards of Nursing
have a decision model to assist the RN to correctly
delegate the task to the correct delegatee. Please
go to this web site to view this decision model.
http://www.ncsbn.org/pdfs/delegationtree.pdf
Legal Authority to Delegation
 Legal responsibility for the RN to delegate a task to
the PN or UAP is determined by
 Nurse Practice Act
 Employer’s statements including job descriptions,
policies, and procedures
 National standards of care
 American Nurses Association (ANA)
 Other national organizations
ANA Standard of Care
 According to the ANA Standards of Care, RNs
can not delegate the following tasks
 Initial nursing assessment and additional
assessments that require nursing judgment
 Nursing diagnosis related decisions
 Decisions about patients outcomes
 Approval of plan of care
 Tasks that require nursing judgment
 Evaluation of nursing care
Additional Legal Principles
 RN remains legally responsible for delegated activities
 RN is accountable for appropriateness of delegated
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activities and its accurate completion
UAPs can not supervise other UAPs
UAP or PN can not redelegate activities.
UAP can not complete a pain assessment
PN can not complete discharge teaching
Challenges with Delegation
 Delegatee refuses to accept the delegated task.
 Delegator – go rapidly through the 5 rights
 Ask the delegatee why the request is being refused
 May be due to
 Fear – afraid can not complete the task correctly and safely
 Told not to do by others – other RNs have told the delegatee
never to carry out this task
 Lack confidence – the delegatee may be new or lack the
confidence to complete the task
 Overwhelmed – may be concerned about the workload already
assigned
Challenges with Delegation
Some additional challenges with delegation include
 “I have to do it myself” belief system – the RN feels that
because of the responsibility of care, the tasks need to be
completed by the RN
 Lack of confidence in PN/UAP – the RN may not know the
PN or UAP and therefore is not comfortable with delegation
Conclusion
Delegation is a powerful tool when used correctly
can create an effective and safe environment in
which staff and patients work together to achieve
positive outcomes.
References
 National Council of State Boards of Nursing
(http://www.ncsbn.org)
 Yoder-Wise, P. (2007). Leading and Managing in
Nursing (4th ed.).
 Sullivan, E. & Decker, P. (2005). Effective
Leadership & Management in Nursing.
 Huber, D. (2006). Leadership and Nursing Care
Management.