What Are the 5 Rights of Delegation in Nursing?
A busy healthcare facility relies on teamwork to deliver safe, timely care. It’s a common practice for nurses to delegate tasks to coworkers when a workload gets cumbersome, but how can healthcare leaders ensure this is done safely?
Many rely on the 5 rights of delegation mnemonic, a tool similar to the 5 rights of medication administration safety device. It establishes a self-check routine to ensure that delegation is governed by critical thought in conjunction with policy and protocol. In this article, we’ll examine these essential 5 rights, review nurse delegation examples, and provide tips for facilities looking to improve their delegation practices to optimize safety and care quality.
What Is Delegation in Nursing?
The American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) collaboratively established national guidelines for nursing delegation. The organizations define delegation as a process by which a nursing activity, skill, or procedure is passed from a licensed nurse to a delegatee. According to the guidelines:
- A delegator is the person assigning the task.
- A delegatee is a person receiving instructions.
Both the delegator and delegatee can be an APRN, RN, or LPN/LVN where the state practice act allows. A licensed nurse may delegate tasks that are within their scope of practice to a nurse with the appropriate skill level. Assistive personnel, also called unlicensed assistive personnel (UAP), are support staff who may also be on the receiving end of nursing delegation. Examples of UAP include:
- Certified nursing assistants (CNAs)
- Patient care assistants (PCAs)
- Certified medication aides
- Certified home health aides
What Are the 5 Rights of Delegation?
Patient safety is the priority during nurse delegation. All parties involved, from clinical to administrative staff, should be familiar with the five rights of delegation in healthcare settings, which include:
| Right Person | The nurse delegating a task should know if the delegatee is suited for the task. This includes knowing their credentials, past experience, and comfortability with the task. |
| Right Task | Determine whether the task is appropriate to delegate. Evaluate whether the task is allowed to be passed on to another provider. |
| Right Communication | The delegator gives clear instructions and timeframe expectations for the care that will be delivered. |
| Right Circumstance | The situation is appropriate for a transfer of responsibility, meaning there’s a safe environment and resources available to perform the task. Patient stability should always be evaluated before delegating any task. |
| Right Supervision | Certain tasks require the supervision of a licensed nurse, depending on the practice act. The RN or LPN needs to ensure they will be free to monitor and supervise the delegatee. |
Nurses are responsible for using clinical judgment to determine the appropriateness of delegation. There are situations where a task may be within a delegatee’s scope of practice according to their state’s nurse practice act (NPA) and the organization’s policy guidelines, but does not meet all 5 rights of delegation.
Example: A nurse receives orders to ambulate a post-op patient three times a day. The nurse has six other patients with various needs, including pain control, labs, and other post-op orders. The RN delegates ambulation to the PCA. Walking patients is within the PCA’s scope of practice and therefore meets the right person and right task requirements. But this patient has two chest tubes and is on oxygen and continuous IV fluids. The nurse must use their judgment to determine if the patient is stable enough — or, that the right circumstance of delegation has been met — for the PCA to manage this task.
This situation highlights how nurse delegation examples must consider not just policies and guidelines, but the 5-rights metric. Once a handover is deemed appropriate, the delegatee should then carry out the task (with supervision, if necessary), follow up with the delegator, and document accordingly.
Promoting Compliance With the 5 Rights of Delegation: 5 Best Practices
Completing care tasks in a timely manner often relies on handoff and interdisciplinary teamwork, signifying the importance of delegation in nursing. However, as with any practice that affects patient care, organizations must have a clear plan for how delegation will be carried out. Here are 5 best practices to ensure — alongside the 5 rights of delegation — nursing staff members consistently delegate in a safe, appropriate manner.
1. Implement Clear Policies
All healthcare facilities must establish a policy guide for delegation in nursing that maintains compliance with federal and state guidelines and encourages best practice approaches. Policies should clearly state nursing tasks that can be delegated and to whom. They should also list nursing tasks that cannot be delegated.
Tips:
- Healthcare leaders should review policy guides periodically to ensure they’re up-to-date with the latest evidence-based research.
- Enlist a nurse leader or delegation committee to identify barriers to effective delegation in nursing and plan improvement strategies that are effective and helpful to healthcare staff.
2. Provide Ongoing Education
Even after policy development, many staff members may still wonder — What can a nurse delegate to a UAP? What does RN delegation to LPNs entail? The proper education about delegation policies and procedures can answer all these questions, clarifying scope of practice considerations in delegating.
Tips:
- Educate beyond new-hire orientation and consider providing additional education during staff meetings or at annual competency sessions.
- Utilize simulation or scenario-based delegation training to fully establish the significance of the 5-rights in decision making.
3. Encourage Clear Communication
Clear communication not only improves teamwork and morale, but promotes patient safety. Making good communication a priority shows commitment to a safe work environment and can avoid misunderstandings in delegation that could negatively impact patients.
Tips:
- Consider training staff on closed-loop communication and incorporating communication tools such as ARCC (Ask, Request, Concern, Chain of Command) to help navigate difficult situations.
- Host regular team huddles to streamline teamwork and improve clarity around roles and task obligations.
4. Utilize Standardized Safety Tools
The 5-rights mnemonics for safe medication administration and delegation practices are just two of many healthcare safety-oriented tools. Consider implementing other standardized approaches to ensure consistent, effective delegation.
Tips:
- Train staff and mandate the use of tools like SBAR (Situation, Background, Assessment, Recommendation) and I-PASS (Illness Severity, Patient Summary, Action List, Situation Awareness, Synthesis by Receiver) during handoff.
- Embed 5-rights stop-gaps into customizable EHR documentation to further impress their consistent use among staff.
5. Perform Real-Time Monitoring and Feedback
The nurse leader and healthcare administrators periodically evaluate the delegation procedures within an organization. Staff involved in the process should report any issues to the leadership team.
Tips:
- Engage in periodic competency checks and incorporate delegation as a topic during routine evaluations or employee check-ins.
- Listen to nursing staff feedback on the delegation process and make necessary changes to optimize teamwork and help promote a healthy work culture that is conducive to safe patient care
Continue Developing a Culture of Safety With the Latest Healthcare Resources
The 5 rights of delegation ensure the safe transfer of responsibilities based not just on policy, but clinical judgment. With IntelyCare’s best practice advisories and facility guides, you can continue to hone your staff’s clinical judgment and decision-making skills while promoting a culture of safety.
IntelyCare writer Alexa Davidson, MSN, RN, contributed to the research and writing of this article.