Delegation Description
the process for a nurse to direct another person to perform
nursing tasks & activities transfer of
responsibility to another person to complete task,
but RN retains accountability for the outcome
Sources of Authority for Delegation
Federal, State, NPA employer policies &
standards professional nursing standards ANA
Code of Ethics specialty nursing organizations
The Joint Commission National Committee for Quality
Assurance (NCQA)
Effective Delegation When RN...
knows parameters regulating practice as well as institutional
policy has assess pt & ID'ed their need for task that can
be delegated knows the unlicensed staff capabilities to
perform task task is performed & RN is able to evaluate
expected outcome has been achieved
Direct Delegation
usually verbal direction by RN regarding an activity or task in
a specific nursing situation
Indirect Delegation
is usually an approved listing of activities or tasks that have
been established in the health care facility
Five Rights of Delegation
Right Task - potential for harm, complications
Right Circumstance - acuity & condition of pt,
staff mix, job description, policy
Right Person - defined by NPA (RN, LPN, UAP)
Right Direction/Communication - task to be done,
why, what, when, right pt, when to be reported back
Right Supervision - progress of task, outcomes
performed, feedback, effectiveness by delegatee
Delegation Criteria
potential for harm to pt complexity of nursing
activity extent of problem solving required
predictability of outcome
Delegation Obstacles
lack of training, experience, or confidence with
delegation poor communication or interpersonal skills
lack of resources, inadequate staffing lack of
organizational support delegator insecure or unwilling
nurse unwilling to trust others or to let go, lack of mutual
trust between staff members staff mix
Activities That Can be Delegated
ADL's: bathing, ambulating, oral care, VS complex
basic activities: catheterization, dressing changes, oral med admin,
Accuchecks nursing activities/tasks which do not require
nursing assessment or judgment during implementing
collecting, reporting, & documentation of simple data (inc.
anything w/ elimination) activities which meet or assist
the pt in meeting basic human needs
Activities That Can't be Delegated
initial nursing assessment & additional assessments that
require nursing judgment evaluation of nursing care
tasks that require nursing judgment formulation &
evaluation of plan of care NDx related decisions
IV med admin, except where allowed (LPN IV certified)
consultation with other medical professionals
Steps of Delegation Process
define task select delegatee communicate
reach an agreement delegator to delegatee monitor &
evaluate
Tasks Delegated to LPN/LVNs - Examples
non-IV meds: PO, SQ, IM, topical, vaginal, rectal
second assessments reinforce education previously
given dressing changes treatments trach
care feeding tube NG foley
delegate to PCT
Tasks Delegated to PCTs - Examples
VS I&O's ambulation, transfer to
chair bathroom use Accuchecks feeding
oral care bed baths, other hygiene daily
weights turning, repositioning set up, remove tele
(if trained) SCDs & Ted hose splints
ROM
Typical RN Tasks The CAN'T be delegated
initial assessments care plan evaluation
teaching unstable pt care CP, SOB IV
meds blood products trach suction