04.02 Delegation

Overview

  1. Delegation
    1. What is delegation?
    2. Why delegate?
    3. What can be delegated?
    4. 5 Rights of delegation

Nursing Points

General

  1. What is delegation?
    1. Delegation
      1. Request of an act or task be done by someone else
      2. Delegation only transfers the ACT of the task to someone else
      3. RN maintains the responsibility of the act or task
    2. Who an RN can delegate a task to:
      1. Other nurses (both RNs and LPNs)
      2. UAP (unlicensed assistive personnel)
  2. Why delegate tasks?
    1. Delegating tasks is efficient
      1. There is only a finite amount of time during a shift
      2. RNs should utilize their time as much as possible
    2. Delegate tasks that:
      1. Need little to no supervision
      2. Do not detract from RN care
      3. Do not REQUIRE RN care
  3. What can be delegated to UAPs?
    1. Ok to delegate:
      1. ADLs
      2. Feeding
      3. Toileting
      4. Bathing
      5. Ambulating
    2. Not Ok to delegate:
      1. Assessments
      2. Meds
      3. Education
      4. IV Access
      5. Anything that fosters the primary RN to patient relationship (i.e. plans of care)
  4. Facilities/Institutions and State Laws all vary
    1. It’s important to know what you can delegate
      1. RN v. LPN Scope of Practice
    2. Rule of thumb: If you don’t know if you can delegate it to a UAP, then do it yourself
    3. Ok to delegate tasks of equal competency to equal staff
      1. RN to RN delegation ok
      2. UAP to UAP delegation ok
  5. 5 Rights of Delegation
    1. Right Person
      1. Ensure they are authorized by the facility/institution AND state to perform the task
      2. Make sure it falls within their license
      3. Question to ask: Is this person allowed to do it?
    2. Right Task
      1. Ensure the task is appropriate for the person
      2. Ensure competency
      3. Question to ask: Is this person competent to do this task?
    3. Right Circumstances
      1. Make sure the patient can tolerate the task being performed by that person
      2. Question to ask: Will the patient tolerate this task if it isn’t performed by an RN? or Does this patient need an assessment afterward?
    4. Right Communication
        1. Communicate clearly and succinctly with the person assigned a task
        2. Questions to ask: Did I, as the nurse, clearly explain what I needed done? Did I specify a time frame and what should be reported back?
    5. Right Supervision
        1. Make sure that the task if properly supervised
        2. Question to ask: Have I followed up with care? OR At what level should I supervise this task? OR How much involvement should I have?

Nursing Concepts

  1. Clinical Judgment
  2. Teamwork & Collaboration

Reference Links

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Video Transcript

All right. We’re going to talk about delegation. This is one that I really like talking about, because it’s so important in your care, and it’s something that you need to learn how to do not just for tests, not just for school, but because it’s going to help you greatly as a practicing nurse.

So, first of all, what is delegation? Delegation is the transfer of an act to another person. So, you’re requesting an act or a task to be done by someone else. Now, delegation only transfers the act of the task to someone else. The RN remains responsible of the act, of the task, and of the patient.

So, who an RN can delegate a task to? RNs can delegate tasks to other RNs, both RN, and then they could also delegate tasks to LPNs, and they can delegate tasks to UAP. UAP is unlicensed assistive personnel. Okay, UAP.

Why do we delegate? What’s the purpose of delegation? Well, first of all, it’s efficiency. We really have a finite amount of time during a shift. We have 12 hours. There’s so much to do. There’s a million things to do, so delegating helps the RN to get everything done that needs to be done during a shift. RNs must use their time as efficiently as possible.

What kind of tasks can we delegate? We should delegate things that need little supervision. We should delegate things that do not detract from our care as an RN, and then we can also delegate things that do not require an RN to do, and we’ll talk about that a little bit more in just a second.

So, what can we delegate to UAPs? Things that are okay to delegate are ADLs, which is daily tasks that need to be done for a patient. We can delegate feeding. We can delegate toileting. We can delegate bathing, and we can delegate ambulating.

Things that are not okay to delegate, these are things that we should not delegate to UAPs. We should not delegate assessments. Now, reassessments can be done by an LPN. But if any task requires and assessment or reassessment, we should not delegate that task, and we’ll talk about some examples of that in just a minute. We should not delegate medication administration. We should not delegate education. New education must be done by an RN, but reinforcement can be done by an LPN. If we’ve already given the original education to our patient on how to use something, or how to take a med, or something like that, we can then delegate to the LPN to do the reeducation.

We shouldn’t delegate IV access, that’s something that we should do as the RN. And then, anything that fosters the primary RN to patient relationship, like the plans of care … you know, we get there, we tell the patient what we’re going to be doing, we introduce ourselves, those things really need to be done by the RN. We need to develop that strong RN patient relationship, and so those things should be done by us as the RN.

Now, laws are going to vary, so it’s really important that you look at your state practice acts, and that you also look at facility rules. So, you need to look at state practice act, RN versus LPN scope of practice, and you look at facility rules about what can be delegated, and what needs to be done by an RN, versus LPN, versus UAP. So it’s really important to know those things.

Rule of thumb. If you don’t know that you can delegate something to a UAP, then you need to do it yourself. If there’s any ambiguity, or you’re unsure in your own mind, do it yourself to make sure that you’re working within those scopes of practice.

Now, it’s okay delegating tasks of equal competency to someone with an equal training education degree. So, for example, RN to RN can be done. UAP to UAP, LPN to LPN. That kind of delegation is going to be okay.

So, what are the five rights of delegation? I’m sure you’ve heard of this, let’s talk about what the five rights are, what they mean, and how to implement them in practice. First of all, the right person, then the right task, the right circumstances, the right communication, and the right supervision. Let’s talk about each one of these individually.

For the right person, ensure the person is authorized the facility, the institution and the state to perform the task. Make sure that it falls within their license. The question you can ask yourself is, is the person allowed to do this task? That’s how you know you’re working within the right person, right of delegation.

Next, is right task. Ensure the task is appropriate for the person. Ensure the person has competency in this task. The question you can ask yourself here is, is the person competent for the task? This one, I think, is so important to ask yourself. Because you have a UAP there, because it’s okay for them to do the task, doesn’t mean that they’re okay for the task. If something were to happen, do you trust that individual in doing that task? Please ask yourself that question. That might not be one that you necessarily see on an exam, but in your practice, please ask yourself that question.

Now, right circumstances. Make sure the patient can tolerate the task being performed by the person. The question you want to ask yourself here is, will the patient tolerate the task if it isn’t performed by an RN, or if isn’t performed by you? Does this patient need an assessment afterward? One example here might be, let’s say you have a patient who has maybe has been struggling a little bit with their oxygenation, and it’s time for baths. Should you delegate bathing to a UAP or to someone else? You probably shouldn’t in that circumstance, because this is a patient who’s having oxygenation issues. You need to make sure you’re there if something happens to be there and assess that patient during the math, or maybe it’s not the right circumstance, the right for a bath for that patient.

Then there’s right communication. You must communicate clearly and succinctly with the person the task is being assigned to. The question you can ask, did I, as the nurse, clearly explain what I needed done? Did I use a specific time and task outlined and explained to that person, and when I should be reported back to?

The last one here is right supervision. Make sure the task is properly supervised. The question you should ask is, have I followed up, or at what level should I supervise this task, or how much involvement should I have? Is this something that can be done without me watching, without me supervising, without me seeing, or is this something that I need to be close by watching with, and then have I followed up to make sure that task has been completed?

Some of the nursing concepts you need to be aware of, and some of the nursing concepts that would apply here would be clinical judgment. This one’s so important here. Are we using sound clinical judgment in delegation, and in delegating tasks to others? And then, teamwork and collaboration. It’s so important in the healthcare environment to be working as a team. One nurse, one UAP, cannot do everything that needs to be done. We must work as teams. We must work together. We must delegate and work as a team.
So let’s sum up some of the key points with this. First of all is, why delegate? Delegation leads to efficiency. Our time is so valuable on the shift, and even as a team of nurses, our time is so valuable. To help us use our time wisely, it’s important that we safely delegate to other people.

What is delegation? Delegation is the transfer of an act to someone else, but the responsibility still remains with us as the RN, or as the nurse. Now, know who an RN can delegate to. This is so important. Refer to state laws, refer to facility laws, for who who can delegate tasks to who.

Then, assessment. If the task requires an assessment of some sort, or to be followed up, like removing an art line where you need to be there, you need to be applying pressure, then the RN should do it, don’t delegate it. Keep that in mind.

Then there’s the five rights of delegation. Know the five rights of delegation. Refer to them, understand them, so you can consciously make informed decision about who tasks can be delegated to, and what tasks you can delegate.

All right, guys, that’s a summary of delegation. I hope that helps, and what I want you to get from this, guys, is that, yes, delegation’s important for tests, yes, it’s really important for NCLEX. But more importantly, delegation is crucial, it’s critical on the practicing floor, so make sure that you understand how to do it. Make sure that you understand how to do it right, and make sure you start doing it as you start working as a nurse. Now, make sure you refer to all the different resources within this lesson. Now, go out and be your best selves today. Happy nursing.

Read more

  • Question 1 of 10

The nursing staff on a critical care unit must routinely check the crash cart each shift to ensure that all supplies are in place. The RN wants to delegate the task of checking the crash cart to a nursing assistant who is working with her. Which of the following is true regarding this action?

  • Question 2 of 10

A registered nurse has a large caseload of clients to care for in a rehabilitation facility. She has a certified nursing assistant working with her who is able to provide some patient care as well. Which of the following tasks would be most appropriate to delegate to the certified nursing assistant?

  • Question 3 of 10

A registered nurse is working on a busy medical-surgical unit. She decides to delegate the task of collecting vital signs of a recent post-op patient to the LPN who is working with her. This situation is the best example of what type of right according to the five rights of delegation?

  • Question 4 of 10

A nurse is working in a busy clinic and must provide teaching to a client about caring for a new colostomy. The nurse has a nurse aide to help with some tasks. Which of the following tasks could the nurse delegate to the unlicensed assistive personnel while working with this client?

  • Question 5 of 10

A school nurse works at an elementary school and monitors the health needs of 500 elementary students. The school also has a health aide who is trained in first aid. A student is brought in to the health office because of an allergic reaction from exposure to peanuts. Which task would be most appropriate for the nurse to delegate to the health aide?

  • Question 6 of 10

A nurse is providing post-mortem care for a client who died 30 minutes ago. Which of the following components of this care can the nurse delegate to unlicensed assistive personnel?

  • Question 7 of 10

A nurse works as part of an interdisciplinary team that discusses care for a patient who is being admitted from a long-term care facility. Which task is not appropriate for the nurse to delegate to the LPN that is part of the team?

  • Question 8 of 10

A registered nurse is setting up parenteral nutrition for a patient in the medical-surgical unit of the hospital. Which of the following actions is most appropriate for the RN delegate to an LPN who is assisting with starting TPN?

  • Question 9 of 10

Which of the following tasks should the nurse delegate to the nursing assistant?

  • Question 10 of 10

The nurse has the following tasks to perform. Which of these can be delegated to the unlicensed assistive personnel? Select all that apply.

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