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.
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.
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).
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).
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.
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.
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.
Often trained on the job; practice strictly per written job description.
Right Task
Falls clearly within delegatee’s scope/job description.
Predictable outcome; minimal need for nursing judgment; frequent & standardised.
Right Circumstance
Patient’s condition is stable/controlled; environment resources adequate.
Delegatee’s current workload permits safe completion.
Delegate to lowest level.
Right Person
Verified competencies, education, experience, strengths/limitations.
In line with state NPA & facility policy.
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.
Right Supervision/Evaluation
RN monitors performance, resources, outcomes; provides feedback.
Determines if patient goals met; modifies plan if necessary.
Licensed nurse remains accountable
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.
Pairing – RN teams with LPN/NA for a single shift; delegation grows organically.
Partnering – Same RN‐LPN/NA consistently scheduled; trust & efficiency improve.
Specific
Measurable
Attainable
Relevant
Timed
Apply SMART lens to decide what to delegate and when; priorities shift throughout shift.
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.
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.
Assess patient & task complexity.
Verify legal & policy allowances.
Match task to qualified personnel (Five Rights).
Provide explicit instructions & timelines.
Monitor execution; be available for questions.
Evaluate outcomes; give constructive feedback.
Document delegation & results.
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.
LPN program length: 12\text{–}18\text{ months}.
RN education: \ge 2\text{ years} depending on pathway.
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.