Delegation is the process of transferring responsibility for the task to be performed to another person.
The ANA Code of Ethics (2001) claims that delegation should be based on the judgment of RN (Registered nurse) taking into consideration condition of patient, nursing team members and their competence, and the supervision degree which is required in each specific case. It coincides with Five Rights of Delegation (NCSBN, 1995) which include:
- the right task;
- the right circumstance;
- the right person;
- the right direction/communication;
- the right supervision.
The principle of the right task presumes that appropriate specific activities will be considered and delegated by the nurse to specific person concerning specific client, so that to avoid any misunderstandings and mistakes in actions of the person who the task was delegated to.
The right circumstance relates to the analysis of client’s health status, goals and needs of nursing care, providing the person with all the equipment and instructions needed in order to provide proper nursing assistance.
The right person principle is defined as a requirement for a person, who the task is delegated to, to meet all the educational and training standards needed in order to be given the responsibility of assisting the patient.
Provision of proper communication between nursing staff while delegation of tasks, including specific instructions, reports, timelines, expected results etc., is defined by the right direction/communication principle.
The right supervision includes performance monitoring, feedback, patient evaluation, performance evaluation, proper documentation, etc.
For example, RN has a patient who is 91 years old with post operative arthroplasty. After careful consideration and evaluation of geriatric patient’s needs RN has to decide on specific actions that have to be taken and delivers this information to the person the task is delegated to. This person has to be chosen out of, for example, two LPNs (Licensed practical nurse). One of them is an LPN with five year experience of long term care, and second available LPN has less experience in geriatric patients care. To choose the right person RN will take into consideration geriatric patient’s needs and will delegate the task to the first LPN. The RN will periodically evaluate the patient’s health status and instruct the LPN about what should be monitored.
What are the different levels of nursing and how can delegation of tasks be done safe and within their individual scope of practice?
There are three main levels of nursing: Licensed practical nurses (LPNs), Registered nurses (RNs), and Advanced practice registered nurses (APRNs).
APRNs may assign tasks to any Registered or Licensed practical nurse, but it has to be within his/her scope of practice and licensure level. An advanced practice registered nurse can not give assignments to RNs or LVNs that exceed their scope of practice. Same rules and recommendations are applied when RN delegates tasks to LVNs.
Why is it important for nurses to delegate appropriately?
Delegation of tasks is an important professional skill of nurses requiring clinical judgment, responsibility, and final accountability for patient’s health status and care. Effective delegation serves to increase patient care resources. If delegation in nursing is performed not properly (the task is not clear, patient’s health status is not evaluated, the assignment is given to someone who is not qualified enough for this case etc.) it may lead to unprofessional care provision and have negative effect on patient’s health.
References
Anderson, L. (2013). General Guidelines to Effective Delegation in Nursing. Nurse Together LLC. Retrieved from http://www.nursetogether.com/guidelines-to-effective-nursing-delegation
Delegation as a management function. (2011). Nursing Management. Retrieved from http:// currentnursing.com/nursing_management/delegation.html
Delegation. (2012). Nursing and Midwifery Council. Retrieved from http://www.nmc-uk.org/ Nurses-and-midwives/advice-by-topic/a/advice/Delegation/
Five Rights of Delegation. (2014). The Official Website of the Executive Office of Health and Human Services (EOHHS). Retrieved from http://www.mass.gov/eohhs/gov/ departments/dph/programs/hcq/dhpl/nursing/nursing-practice/advisory-rulings/ unlicensed-assistive-personnel/five-rights-of-delegation.html#task
Frequently Asked Questions – Delegation. (2013). Texas Board of Nursing. Retrieved from https://www.bon.texas.gov/faq_delegation.asp
The Five Rights of Delegation. (1997). National Council of State Boards of Nursing. Retrieved from https://www.ncsbn.org/fiverights.pdf
Weydt, A. (2010). Developing Delegation Skills. OJIN: Online Journal of Issues in Nursing, 15. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANA Marketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No2May2010/Delegation-Skills.html
