Delegation in Nursing: 7 Guidelines for Facilities
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?
If your facility doesn’t already have a policy guide for delegation in nursing, it’s time to establish one. In this article, we’ll introduce the concept of nursing delegation, review national guidelines for nursing delegation, and provide tips to facilities looking to improve on 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 can delegate above or below their skill level. For example, an LPN may delegate a task to an RN or vice versa. 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
Nurses are responsible for using clinical judgment to determine the appropriateness of delegation. A task must be within a delegatee’s scope of practice according to the state nurse practice act (NPA) and the organization’s policy guidelines.
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, 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 for the PCA to manage this task.
Nursing Delegation Examples
The responsibility being delegated depends on a number of factors, such as the patient’s needs, the complexity of the task, and the needs of other patients. If deemed appropriate, the delegatee should carry out the task (with supervision, if necessary), follow up with the delegator, and document accordingly.
Nurses should be familiar with the duties allowed in their scope according to their state NPA. This helps determine which tasks they may accept or decline. Here’s a sample of delegation guidelines from the Texas Board of Nursing:
- Another licensed nurse may supervise if the delegating nurse can’t be present.
- A UAP may be delegated finger stick blood glucose monitoring.
- A nurse should only cosign a UAP’s documentation if they observed the task being performed.
- Nurses may delegate to nursing students employed by a facility, such as a nurse extern or PCT, but not nursing students visiting for a clinical rotation.
5 Rights of Delegation in Nursing
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 nursing, which include:
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| 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. |
How to Follow the National Guidelines for Nursing Delegation: 7 Steps
As with any practice change affecting patient care, organizations must have a clear plan for how delegation will be carried out. Healthcare administrators can do this by creating delegation policies and procedure guides for staff to follow. Below is a step-by-step guide for facilities to use when developing their nursing delegation strategy.
Step 1: Identify a Nurse Leader
First, the organization identifies a nurse leader to oversee delegation. The nurse leader is accountable for patient safety and must understand the skills necessary to deliver high-quality care in a given environment.
Step 2: Enlist in a Delegation Committee
Next, the nurse leader establishes a delegation committee with other facility leaders. Together, they determine which tasks can be delegated and under which circumstances. They also work to identify barriers to effective delegation in nursing and plan improvement strategies that are effective and helpful to healthcare staff.
Step 3: Create Policies and Procedures
The committee establishes written policies for delegation in nursing. The policy guide should state nursing tasks that can be delegated and to whom. It should also list nursing tasks that cannot be delegated. Healthcare leaders should review policy guides periodically to ensure they’re up-to-date with the latest evidence-based research.
Step 4: Communicate to Staff
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? Now, it’s time to deliver staff education about delegation policies and procedures.
Staff training should cover delegation expectations while clearly specifying the competencies of the staff members involved. Consider providing education during staff meetings or at annual competency sessions. You could even cover guidelines during new-hire orientation.
Step 5: Determine Competency
If a licensed nurse or UAP will act as a delegatee, they must be able to demonstrate competency in the task. Training and education sessions will be provided for any new or unfamiliar tasks. Remember to consider the practice restrictions for UAPs and be careful not to delegate out of their scope of practice. For example, CNAs can’t administer medications unless they have extra certification as a certified medication aide.
Step 6: Evaluate Policy Effectiveness
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.
Step 7: Build a Positive Work Environment
Finally, administrators should create a healthy work culture that is conducive to safe patient care. The work environment allows for clear lines of communication and the teamwork necessary for delegation. Leaders should listen to nursing staff feedback on the delegation process and make necessary changes.
Stay Updated on Practice Standards
Delegation in nursing is an essential component of the care delivery workflow. If your facility is looking for more ways to deliver safe, high-quality care, don’t miss out on the latest updates from IntelyCare’s free newsletter.