What is nurse delegation?

Nurse delegation when a registered nurse transfers responsibility for performing a nursing task to a competent individual while retaining accountability for the outcome. 

An article by the NIH, Five Rights of Nursing Delegation, states: “According to the American Nurses Association and the National Council of State Boards of Nursing, delegation is defined as the process for a nurse to direct another person to perform nursing tasks and activities. Delegation involves at least two individuals: the delegator and the delegatee. The delegator is a registered nurse who distributes a portion of patient care to the delegatee.”

The practice varies by state, with each jurisdiction having specific regulations about which tasks can be delegated and under what circumstances. Common delegated tasks may include medication administration, wound care, catheter care, and routine monitoring.

The five rights of delegation

In the National Guidelines for Nursing Delegation, the American Nurses Association (ANA) outlines five rights of delegation: 

• Right task: The activity falls within the delegatee’s job description or is included as part of the established written policies and procedures of the nursing practice setting. The facility needs to ensure the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
• Right circumstance: The health condition of the patient must be stable. If the patient’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.
• Right person: The licensed nurse along with the employer and the delegatee is responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.
• Right directions and communication: Each delegation situation should be specific to the patient, the licensed nurse and the delegatee. The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee, as part of two-way communication, should ask any clarifying questions. This communication includes any data that need to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation. The delegatee must understand the terms of the delegation and must agree to accept the delegated activity. The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.
• Right supervision and evaluation: The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary. The licensed nurse should ensure appropriate documentation of the activity is completed.

Benefits of delegation in nursing

According to the ANA, potential benefits of nurse delegation include: 

• Empowering employees: Delegation empowers nursing assistants and other team members by giving them opportunities to develop new skills and take on greater responsibility.
• Decreasing burnout: By distributing workload appropriately, delegation helps prevent registered nurses from becoming overwhelmed with tasks that don't require their level of expertise. 
• Increasing commitment: When team members are entrusted with delegated tasks, they tend to develop stronger commitment to both their role and the organization.
• Improving job satisfaction: Delegation creates a more balanced distribution of responsibilities across the healthcare team, which typically leads to greater job satisfaction for all involved. 

Risks of improper delegation

The study Delegating Care as a Double-Edged Sword for Quality of Nursing Care: A Qualitative Study by the NIH states that, “In certain instances, due to high workload, nurses may delegate complex and challenging care tasks to individuals with lower skill levels, and there may be a lack of adequate monitoring of the delegated activities. Consequently, care may be missed, duplicated, or administered improperly. GransjönCraftman’s study highlighted that the high workload experienced by nurses and the challenges they face have led to the delegation of drug administration tasks to unlicensed personnel, potentially compromising the quality of care.”

Furthermore, “Poor delegation practices can result in nurses and nursing assistants working in parallel and separately, rather than functioning as an integrated team. It leads to ineffective communication, inappropriate work dynamics, conflicts between nurses and nursing assistants, and ultimately a decrease in the quality of care. Improper delegation of authority can result in non-compliance with care standards, inadequate documentation of provided care, and poor assessment and monitoring of patient conditions. Some nurses lack understanding of the concept of delegation and do not provide proper monitoring when delegating authority. This lack of monitoring also may lead to missed nursing care and potential adverse events for patients.”

FAQs

Do all states have the same nurse delegation laws?

No, regulations vary significantly by state.

Can delegatees refuse delegated tasks?

Yes, if they feel inadequately trained or if the task exceeds their scope of practice.

Who is ultimately responsible if a delegated task results in patient harm?

Both parties share responsibility - the nurse remains accountable while the delegatee is responsible for the specific task.