Delegation of Nursing Tasks – Comprehensive Study Notes

Concept of Delegation

  • Delegation: Transfer of responsibility for performing a task to another person while the nurse retains accountability for the outcome.

    • Explicitly endorsed by ANA & NCSBN as a critical leadership skill.

    • Optimises time‐management, workload distribution, staff development, and patient outcomes.

  • Delegation ≠ Assignment ≠ Supervision

    • Assignment

      • Full transfer of responsibility, authority, and accountability of patient care to another member of the healthcare team.

    • Delegation

      • Responsibility transferred; accountability remains with delegator (RN).

        • If you are uncomfortable with being delegated an assignment, speak to the charge nurse why.

    • Supervision

      • Continuous process of directing, monitoring, evaluating another’s performance; intrinsic to delegation cycle.

Key Definitions

  • Authority – Legal power/right to give orders, make decisions, enforce obedience.

    • Looking at delegation → asking person who is capable of a task to do it.

  • Responsibility – Duty/obligation to perform tasks and make decisions within one’s scope of practice.

  • Accountability – Answerability for outcomes; willingness to accept responsibility for one’s own and delegated actions.

    • All three are interlinked; delegation distributes responsibility, never accountability.

Decision-Making Framework for Delegation

  • Begins with RN’s clinical judgement.

  • Core references to consult before delegating:

    • State Nurse Practice Act (NPA).

    • Facility policies & procedures.

    • Written job descriptions.

    • Documented staff competencies.

    • Current clinical environment & acuity.

    • Patient’s immediate needs & complexity.

    • Applicable professional standards & legal precedents.

  • General rule: Delegate to lowest appropriate person in hierarchy with demonstrated competence (knowledge and skills).

Activities RNs Cannot Delegate (per text p.166)

  • Nothing that you can EAT-Evaluate, assess, teach.

  • NEVER delegate if the patient is unstable.

  • Initial/admission assessments or specialised follow-up assessments.

  • Elements of the Nursing Process: assessment, diagnosis, planning, evaluation → “ADPIE

  • Comprehensive patient education (except reinforcement of previously taught material).

Roles & Scopes of Team Members

Registered Nurse (RN)

  • Education: Diploma, Associate, Baccalaureate, or higher; typically \ge 2 years.

  • Licensure via NCLEX-RN; scope defined by state NPA.

  • May manage stable and unstable, high-acuity patients; independent clinical judgment.

  • APN (Master’s+) pass specialty certification exam.

Licensed Practical/Vocational Nurse (LPN/LVN)

  • Education: 12\text{–}18 months accredited program; licensure via NCLEX-PN.

  • Must practice under supervision of RN or provider (MD, DO, PA, APN).

  • Can:

    • Care for stable clients.

    • Reinforce education → NO initial education.

    • Calculate & monitor IV fluids.

    • Administer oral meds & IVPB solutions.

  • Cannot:

    • Administer high-risk meds (e.g., heparin, chemotherapy) or titrate infusions.

    • Formulate nursing care plans or discharge patients.

Assistive Personnel (AP) / Certified Nursing Assistant (CNA)

  • May hold certificate; works under RN or LPN.

  • Direct skills: hygiene, grooming, ADL support (nutrition, elimination), non-sterile VS, I&O.

  • Indirect skills: transport, stocking, clerical duties.

  • Limitations:

    • No independent clinical decision-making or delegation.

    • May reinforce previously taught material but provide no original education.

    • Must not perform tasks prohibited by agency, even if trained elsewhere.

Unlicensed Assistive Personnel (UAP)

  • Often trained on the job; practice strictly per written job description.

*Five Rights of Delegation (NCSBN, 1997)*

  1. Right Task

    • Falls clearly within delegatee’s scope/job description.

    • Predictable outcome; minimal need for nursing judgment; frequent & standardised.

  2. Right Circumstance

    • Patient’s condition is stable/controlled; environment resources adequate.

    • Delegatee’s current workload permits safe completion.

    • Delegate to lowest level.

  3. Right Person

    • Verified competencies, education, experience, strengths/limitations.

    • In line with state NPA & facility policy.

  4. Right Direction/Communication

    • Clear, complete, concise instructions: what, when, why, expected result & reporting parameters.

    • Delegatee confirms understanding; knows not to alter task or make clinical judgments without RN.

  5. Right Supervision/Evaluation

    • RN monitors performance, resources, outcomes; provides feedback.

    • Determines if patient goals met; modifies plan if necessary.

    • Licensed nurse remains accountable

Assignment Acceptance Checklist (For the Nurse Receiving an Assignment)

  • Review tasks/patients.

  • Verify each activity lies within personal scope & competency.

  • Confirm preparedness to assume accountability for safe care.

  • If uncertain:

    • Discuss with charge nurse—explore modifications or redistribute among more qualified staff.

Learning Strategies for Delegation

  • Pairing – RN teams with LPN/NA for a single shift; delegation grows organically.

  • Partnering – Same RN‐LPN/NA consistently scheduled; trust & efficiency improve.

Priority-Setting with SMART Goals

  • Specific

  • Measurable

  • Attainable

  • Relevant

  • Timed

  • Apply SMART lens to decide what to delegate and when; priorities shift throughout shift.

Practical Considerations & Tips

  • Know every coworker’s scope before shift begins.

  • Delegate as much as safely possible—"you cannot do it all".

  • Never delegate a task you would not be willing/able to perform yourself.

  • Ask for help early; re-evaluate priorities frequently.

Common Obstacles to Effective Delegation

  • Limited clinical skills or experience (delegator or delegatee).

  • Reluctance to relinquish control; preference to work solo.

  • Inadequate training on delegation process.

  • Fear of being disliked, appearing lazy, or intimidating others.

  • Role confusion; poor interprofessional communication.

Algorithmic Approach (Suggested)

  1. Assess patient & task complexity.

  2. Verify legal & policy allowances.

  3. Match task to qualified personnel (Five Rights).

  4. Provide explicit instructions & timelines.

  5. Monitor execution; be available for questions.

  6. Evaluate outcomes; give constructive feedback.

  7. Document delegation & results.

Ethical, Legal, and Professional Implications

  • RN’s accountability is non-transferable: Board of Nursing may hold RN liable for improper delegation.

  • Proper delegation upholds patient safety, quality care, and continuity while fostering staff growth.

  • Delegation failure (under-delegation or over-delegation) can lead to burnout, errors, and ethical breaches.

Key Numerical References (Wrapped in LaTeX per requirement)

  • LPN program length: 12\text{–}18\text{ months}.

  • RN education: \ge 2\text{ years} depending on pathway.

Take-Home Summary

  • Delegation = transfer of responsibility to another; accountability retained.

  • Five Rights provide standardized safety net.

  • Know scopes of practice, NPAs, and facility policies before delegating/accepting tasks.

  • Develop delegation skill via pairing, partnering, and SMART priority setting.

  • Recognise and mitigate personal & systemic barriers to delegation for optimal team functioning and patient care.