Delegation and Supervision for Victorian
Nurses and Midwives
Element 1: Regulatory requirements
For nursing and midwifery leaders
Regulatory requirements
• The Nursing and Midwifery Board of Australia
(NMBA) undertakes functions as set by the
Health Practitioner Regulation National Law.
• NMBA sets the registration standards as well
as professional codes, standards and
guidelines that underpin safe and competent
practice.
• The NMBA’s requirements of nurses and
midwives relating to delegation and
supervision are outlined in its publication ‘A
national framework for the development of
decision-making tools for nursing and
midwifery practice’.
Delegation and supervision guidelines for
Victorian nurses and midwives
• In order to become registered, nurses
and/or midwives must meet the National
Board’s mandatory registration
standards.
• To be effective, nurses and midwives
need to have a clear understanding of the
requirements.
• Released in 2014, the guide seeks to
reinforce the NMBA publications around
decision making, by making practical
recommendations and outlining a
framework
Delegation and supervision guidelines for
Victorian nurses and midwives
• The guide was developed following consultancy with key
stakeholders, discussions with Victorian nurses/midwives
and an international literature review.
• Makes a number of recommendations, assuming a
shared responsibility between:
o individuals,
o employers,
o education providers,
o professional bodies, and the
o Department of Health & Human Services.
Accountability when delegating
• Delegation and supervision is, and always has been, a
core responsibility of Registered Nurses and Midwives
• The Registered Nurse or Midwife remains accountable
for monitoring and evaluating the effect of any care that
has been delegated
Accountability when accepting a delegation
Can include EN’s, unlicensed healthcare workers, junior
RN/RM’s, other workers:
•
A staff member who accepts a delegation is
accountable for their actions or decisions
•
A staff member should not accept a delegation if it is
beyond their training and competency, and/or if they
are not confident undertaking the delegation
Principles of Delegation
Delegation is an exercise in professional judgement by the RN/RM. It
involves the transfer of authority to a competent person to perform a
specific activity in a specific context.
Considerations when delegating include:
•
•
•
•
Patient health status (stability and complexity)
Complexity of the delegated activity
Context of care
Level of knowledge, confidence, skill and experience of the person to
whom the task has been delegated
• The expected outcomes of the delegated task
• How outcomes will be monitored and communicated
• Legislative requirements
The Five Rights of Delegation
1.
Right Activity
2.
Right Circumstances
3.
Right Person
4.
Right Communication
5.
Right Supervision and Evaluation
Acknowledgement: National Council of State Boards of Nursing, 2005
Right Activity
The right activity that, in the professional judgement of the RN/RM:
• can be safely delegated to another staff member who has the level of
knowledge and competency to perform the task, and
• is appropriate for the needs of the specific health consumer
• The activity being delegated needs to be within the scope of practice
of the enrolled nurse or role boundaries unlicensed healthcare
worker accepting the delegation
Right Circumstances
Consideration of appropriate and right circumstances include:
• The appropriate patient or patient group (based on the severity and
complexity of their condition)
• The resources available including skill mix, staff availability and
capacity for supervision, and
• other relevant factors including monitoring and communication of
progress
Right Person
The right person is delegating the right activity to the right
person with the right skills and knowledge to assist the right
patient:
•
The delegating RN/RM can only delegate care that they
themselves are competent to perform
•
The nurse/HA accepting the delegation needs to have the
appropriate training and knowledge and competence to
provide the required care
•
The Patient whose care is delegated must not require
complex observations, decision making, critical thinking
or nursing judgement
Right Communication
The right communication is clear, concise description of the activity
to be undertaken, including the objective and expected outcomes.
The delegating RN/RM should ensure that the enrolled nurse or
unlicensed healthcare worker clearly understands:
•
What activities are being delegated
•
Who and when to ask for assistance or report concerns
•
How concerns should be reported
• The enrolled nurse or unlicensed healthcare worker must inform the
delegating RN/RM if they have not been trained to perform an
activity or if they are uncertain of any aspect of the delegation
Right Supervision and Evaluation
The right supervision and direction refers to appropriate monitoring,
evaluation, intervention as needed, and feedback.
The delegating RN/RM retains accountability for ensuring that:
•
the delegated activities are performed to the required standard,
•
monitoring and evaluating the impact and outcome of delegated
care is undertaken,
•
direct or indirect supervision is available as required,
•
the enrolled nurse or unlicensed healthcare worker performing the
delegated activity has the necessary support and guidance.
Supervision
The NMBA identifies 3 types of supervision within nursing/midwifery
practice; specifically managerial supervision, professional supervision
and clinically focused supervision.
Clinically focused supervision
Clinically focused supervision specifically relates to supervision of
delegated nursing and/or midwifery tasks and activities, including:
•
providing education, guidance and support for individuals who
are performing the delegated activity
•
directing the individual’s performance
•
monitoring and evaluating outcomes, especially the consumer’s
response to the activity
Supervision
The level of supervision should be appropriate to the degree of
risk of the activity
Direct Supervision
• Is when the supervisor is present and personally observes,
works with, guides and directs the person being supervised
Indirect Supervision
•
Is when the supervising RN/RM is on site and easily
contactable and available for reasonable access but does
not directly observe the activity
Responsibilities when delegating
The professional’s responsibilities include:
• teaching (although this may be undertaken by another
competent person, and teaching alone is not delegation)
• competence assessment
• providing guidance, assistance, support and clinically focussed
supervision
• ensuring that the person to whom the delegation is being made
understands their accountability and is willing to accept the
delegation
• evaluation of outcomes
• reflection on practice.
Responsibilities when accepting a delegation
The recipient’s responsibilities include:
• negotiate, in good faith, the teaching, competence assessment
and level of clinically focussed supervision needed
• notify in a timely manner if unable to perform the activity for an
ethical or other reason
• be aware of the extent of the delegation and the associated
monitoring and reporting requirements
• seek support and direct clinically focussed supervision until
confident of own ability to perform the activity
• perform the activity safely
• participate in evaluation of the delegation.
Decision making tree
Is it the right activity?
• Has there been a RN/RM assessment of patient care need?
• Are there organisational guidelines that support the delegation?
• Can the task be routinely performed without complex observations, decision making or clinical
judgement?
NO
Is it the right circumstance?
• Does the RN/RM have the skills and knowledge to safely delegate?
• Does the skill-mix in your ward/unit/environment enable you to undertake appropriate supervision?
NO
YES
Is it the right person?
• Is the task within the scope of practice or role parameters of the person you are delegated to?
• Does the person you are delegated to have the appropriate knowledge, skills and competency to
perform the delegated tasks?
NO
YES
Is it the right communication?
• Does the person being delegated to understand and accept the delegated task; know when and
who to ask for assistance, and who to report to?
Do not delegate
YES
NO
YES
Is it the right supervision and evaluation?
• Is there ongoing monitoring and evaluation of the outcomes of care by the supervising RN/RM?
NO
YES
Delegation is appropriate
Acknowledgements:
• National Council of State Boards of Nursing, 2005
• Nursing Council of New Zealand, 2011
Strengthening nursing and midwifery delegation
within your organisation
• The guideline outlines a framework to support to
enhance nursing/midwifery delegation and supervision.
• Framework based on recommendations on skill and
knowledge development, alongside the development of
tools and activities to support safe and effective
practices.
• All parties play a role. As a nursing/midwifery leader,
you play a vital role in the area of regulation within your
organisation, by setting direction and enabling best
practice to occur.
Framework
Required skills and knowledge
Element 1:
Regulatory
Element 2:
Organisational
•
•
•
•
Decision making consistent with
stated delegator/delegatee
requirements
Policy and procedure
Capability framework
Roles and responsibilities
Recommended tools and activities
•
•
Checklist tool
Flow chart/summary card
•
•
Position descriptions
Role clarity statements and
activities
Competency and credentialling
processes
Organisational and unit-level
direction and leadership
•
•
Element 3:
Individual
•
•
Leadership and management
Communication and team
interaction
•
Interpersonal skill development
training package and activities
Supporting activities
•
Frequently asked questions resource
•
Comprehensive learning packages (covering all three key elements)
•
Partnering with education providers – pre-registration preparation
•
Partnering with nursing and midwifery leaders
Check-list of possible actions
Leadership:
 Consider obtaining a baseline, by asking staff about their current
delegation and supervision skills
 Ensure your nursing leaders are aware of and understand the key
regulatory, organisational and individual factors that influence safe
and effective delegation and supervision.
 Consider including a specific focus on critical thinking, effective
communication and team engagement into ongoing leadership
developmental and educational programs.
 Ensure that your managers are aware of rostering requirements
relating to maintaining an appropriate skill-mix, to enable safe and
effective delegation and supervision to occur.
Check-list of possible actions
Governance:
 Ensure you have a clear and consistent organisational
policy relating to safe and effective delegation and
supervision of nursing/midwifery tasks and activities, that
aligns with NMBA requirements and Victorian legislation.
 Ensure all other policies align and are consistent with the
overarching nursing/midwifery delegation and supervision
policy.
 Ensure policies are inclusive of roles and responsibilities for
delegators/supervisors and delegatees/supervisees.
Check-list of possible actions
Role Clarity:
 Ensure that the position descriptions for nurses, midwives
and assistive staff are clear and informative.
 Consider the development and implementation of a
capability framework to assist registered nurses/midwives to
identify skills and competency.
 Ensure that the role differentiation between registered
nurses/midwives, enrolled nurses and assistive staff is
clearly documented.
 Ensure that registered nurses/midwives have access to and
knowledge of the approved duty list and competency levels
achieved by any unlicensed assistive worker.
Check-list of possible actions
Education:
 Ensure delegation and supervision is a core component of
the ongoing education program for your nurses and
midwives
 Ensure that your nurses, midwives and assistant staff have
access to a range of educational learning tools addressing
effective and safe delegation and supervision.
 Consider working closely with your education providers and
university partners to enhance the opportunities to prepare
pre-registration students for the role as delegators and
supervisors.
Check-list of possible actions
Awareness:
 Consider utilising tools and promotional
material to raise awareness of
delegation and supervision
requirements within your
nursing, midwifery and
assistant workforce.
 Consider the
utilisation of a pointof-care tool to support
effective delegation
and supervision.
Questions and discussion
More information available:
• Nursing in Victoria
http://www.nursing.vic.gov.au/
• Nursing & Midwifery Board of Australia
http://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Codes-Guidelines.aspx#dmf
Full reference list included in the guideline.