DELEGATION: AN

ART OF
PROFESSIONAL
PRACTICE
P R E PA R E D B Y: R E P O N T E
 Nursing management is truly an art. Whether an experienced manager or newly
hired for the first professional position, the registered nurse (RN) seldom works
alone.

 The interdisciplinary and interactive nature of nursing calls for juggling

creative applications of the art of nursing. Skills for interdependent health-care
delivery begin with direct patient care and can culminate in directing large
groups or organizations

 The ideal nursing practice incorporates many skill levels of health-care

personnel with goals for patient care, yet within legal definitions and fiscal
awareness.

 Delegation is seen not only as a management skill but also as an ethical issue
for nurses. The Code of Ethics for Nurses (American Nurses Association, 2001)
endorses delegation where, “[t]he nurse is responsible and accountable for
individual nursing practice and determines the appropriate delegation of tasks
consistent with the nurse’s obligation to provide optimum patient care.”
Within health-care systems, the nurse may delegate to a
technician, an orderly, a management assistant, or another
nurse. The National Council of State Boards of Nursing
(NCSBN, 1995) views delegation as “transferring to a
competent individual, the authority to perform a selected
nursing task in a selected situation.

The nurse retains accountability for the delegation.” The

importance of delegation in the delivery of nursing care is
emphasized on the NCLEX-RN study guide within the
topics of leadership, staffing, and communication (NCSBN,
2004).
 Components of Delegation

Delegation to others in the workplace involves

four principal components: delegator, delegatee,
task, and client/situation.
DELEGATOR

 The delegator possesses the authority to delegate by virtue of both

position in the agency and state government license to do certain
tasks. The license defines the scope of practice within a profession,
whereas agency policy describes the role of employees.

 The RN degree, license, and policy create the authority to delegate

to another individual in the workplace. Finally, delegation does not
change the delegator’s accountability or responsibility for task
completion.

 These two concepts mean that the delegator can only delegate tasks
within his or her scope of practice and that the responsibility for the
skillful completion of the task remains with the delegator.
DELEGATEE

 A delegatee receives direction for what to do from the delegator. The

relationship between the two individuals exists within the workplace
environment or through agency policy.

 The delegatee has the obligation to refuse to accept tasks that are outside of
his or her training, ability, or job description.

 Although the delegatee may be registered or certified for certain skill sets, that
is not always the case. In fact, even when assistive persons holds a permit to
work as unlicensed assistive personnel (UAP), that permit stipulates that
performance of activities occur under the direction or supervision of a
licensed nurse.

 A trained delegatee should have skills that relate to the work setting, but the
delegator is responsible for knowing the performance level of each delegatee.
TASK

The task is the delegated activity. The delegated activity

generally should be a routine task. Routine tasks have
predictable outcomes, and a step-by-step method exists to
complete the task.

Decision making on the part of the delegatee for delegated

tasks is limited to how to organize time and complete the
task with different patients or variations in equipment. The
procedure for the task is found in training manuals for
teaching skills.
CLIENT/SITUATION

 Identification of a specific client or situation for delegated nursing care is necessary to ensure that goals
for patient care can be met by the delegate

 Familiar situations and environments enhance client safety and competent performance of any task.
Situations include client care, such as direct care, responding to client calls for assistance, and distributing
meals, or involve other tasks such as data entry, cleaning areas, stocking supplies, or phoning to confirm
appointments

 Delegation is not easy and not simple. Delegation is about getting other people to perform activities to meet
specific client and organizational goals

 Client care goals range from daily personal hygiene to treatment or recovery from a health problem.
Organizational goals, on the other hand, relate to providing cost-effective services to help meet client care
goals. Awareness of the rights, benefits, and pitfalls of delegation helps you recognize how to work through
others with greater trust and confidence.
Rights of Delegation
Delegation is a precursor to the management functions of
coordination and supervision. Without a delegatee, there is no one to
supervise and no activities to coordinate.
 The NCSBN developed Rights of Delegation to guide the nurse in safe
delegation in response to an increasing number of nurse assistants or UAP in the
workplace.

 The delegator nurse assigns the Right Person to perform the Right Task under the
Right Circumstances and provides the delegatee with the Right Direction and the
Right Supervision.
Without delegation, your work will not be done.

DO:
Select the right person for the task(s).
Communicate directions clearly.
Provide sufficient authority and independence to complete tasks.
Remain available and approachable.
Supervise and give feedback on performance.
Recognize efforts by others.
Use nursing staff for nursing decisions.
Know the scope of your practice and agency policy on delegation.

DON’T:
Think that you can delegate accountability.
Expect good results from poor delegation
THE RIGHT PERSON
 Delegation involves the nurse as either delegator or delegatee. Matching the specific
client care goals and activities with the person to entrust with the appropriate
responsibility and authority is a challenge.

Delegating to UAP
The RN delegates client care to UAP in order to provide nursing care to more patients.
Knowing the training of UAP can help make better delegation decisions. Both RNs and
licensed practical/vocational nurses (LPN/LVN) are licensed nurses within federal and
state statutes unless specifically differentiated. Both RNs and LPNs might have
authority to delegate care in circumstances defined by law and agency policy.
Names for UAP
Attendant Assistive Personnel
Certified Nurse Assistant (CNA.)
Dietary Assistant
Home Health Aide
Medication Technician
Nurse Aide
Nursing Assistant
Orderly Patient Care Assistant (PCA)
Health-Care Assistant
Unlicensed Assistive Personnel
Registered Nurse Assistant (RNA.)
Technician
Training for Home Health Aides (42
CFR §484.36)
Duration: 75 hours classroom; 16 hours
supervised practice
Content: Reporting, documentation
observation of patient, and reading and
recording of temperature, pulse and
respiration; basic infection control;
basic body function; clean and safe
environment; respect for privacy and
property; personal hygiene and
grooming; transfer techniques; range of
motion and position; nutrition and fluid
intake; and any other task that the HHA
may choose to have the. . . aide
perform.
Delegating to Nurses

 To be promoted, a nurse manager must have competent personnel

to step into her position. In health care, advancement in the
workplace often starts in the same work area. Here, supervisors
have an opportunity to select from among the staff for promotion to
management levels within their supervisory sphere.

 Selecting the right person requires creative thinking: Who is

reliable? Who has the most appropriate experience? Who will take
acceptable risks? Who understands the workload? Who wants to
succeed?

 Delegation can help the manager to assess the ability and potential
of staff nurses, provide motivation through new challenges, and
contribute to development of other skills on the team
Physician Assistant Delegation APN Delegation

 Where delegation of patient orders or Delegation is clearly an empowerment issue. The nurse
treatment plans becomes less clear is when a is empowered, by statute and often by agency policy,
physician assistant (PA) is the delegator. A PA to give direction to others. However, along with the
works in collaboration with an MD or DO and power to direct others remain the authority and
generally evaluates and treats patients in responsibility to see that the delegated activity is safely
clinics, medical offices, and sometimes in and correctly performed. This principle exists for
hospitals nurses who delegate to UAP or for APNs who give
 In any event, the response is to do something verbal or written orders for other nurses to perform
and not ignore the order for patient treatment. such activities as treatment or medication
Lack of response to a patient treatment order administration
can result in issues of negligence or
malpractice. Questions about the authority of a
prescribing professional can be referred to a
unit supervisor until clear guidelines exist for
the work setting. If you happen to be the
supervisor, the physician of record can be
contacted for clarification
Student Delegation
 Can a student nurse accept delegation from an RN
who is not a faculty member? What are the
consequences of refusing to complete a delegated
task? The student role is fraught with ambiguities:
the student wants a variety of clinical experiences
but might not have covered the content in class, or
a long time might have elapsed since learning
academic content relative to the clinical practice.
 Before entering the clinical setting, faculty
members should provide clear guidelines to
students on accepting delegated tasks not yet
addressed in the curriculum.
 Guidelines might include options for the student:
contact the faculty to ask permission to proceed
with the task; ask the delegator to observe the
student doing the task; ask if the task can be
delayed until the faculty is present; assist task
completion with the staff person.
RIGHT TASK
 One reason to delegate is that each nurse has
finite time and energy to care for clients,
maintain the environment, and communicate with
other health professionals. Tappen (2001) uses a
framework of time management to explain
delegation. When a nurse has responsibility for 5,
8, or 20 patients, routine and repetitive aspects of
care can be assigned to “a competent individual
with the authority to perform in a selected
situation a selected nursing task included in the
practice of professional nursing as defined by
state statute in the Nurse Practice Act” (Colorado
Revised Statutes, 2004)
Appropriate tasks for delegation to UAP must fall within the
delegator’s scope of practice unless otherwise prohibited and
should meet all five criteria: Standardized procedure,
Technical in nature, Routine task, Unlikely risk, and
Predictable results (STRUP).
■ Standardized procedure: A standardized procedure is taught
in training classes, written in an agency manual in a “how to”
approach, and performed the same way by persons with similar
training. Often, one standardized procedure, such as Bed Bath,
is coupled with another, such as Changing Bed Sheets, to
become a series of standardized procedures that comprise
Personal Hygiene.
 Technical in nature: Technical tasks require little decision
making about performance of the task. However, the ability
to recognize normal from abnormal condition of the client
and usual from unusual response to the task is part of UAP-
tested competency
 Routine task: Routine implies that the task is recurring for
both the client and the UAP. UAP are experienced in
completing the task; the client has experienced the task
previously. There is no task that is routine the first time
 Unlikely risk: The stability of the client’s
condition predicts risk. Here, focus is on
delegator knowledge of the person and the
task. Unlikely risk of adverse or unexpected
events during the task also relates to safety.
■ Predictable results: Before delegation of any
activity, the nurse anticipates the result of the
activity. Outcomes of tasks assigned to UAP
need to be predictable. Assignment of Personal
Hygiene for a group of clients can be predicted
and easily assessed. Are the clients clean? Is
there an odor about anyone? Is hair combed? Is
the area clean and orderly? Are clients safe in
their environment?
Refusing Delegated Task
 Refusal to administer an inappropriate medicine or
to carry out a procedure that may place the patient at
risk or cause harm are common occurrences.
Medication orders that create risk for patient well
fare include routes, dosage, frequency, and the drug
itself.
RIGHT CIRCUMSTANCES
 When one nurse cares for one client, there is little
need to delegate care. True or false? False.
Complexities of science and technology have
changed the concept of “private duty” nursing
except in the realm of home care. Even nurses in
critical care units require assistance with the
multiplicity of client, housekeeping, and non-
nursing tasks. Delegating tasks that do not require
decision making, assessment, or evaluation allows
the nurse to concentrate on complex interventions.
RIGHT DIRECTION
 Clear, accurate, written directions convey the best
direction for delegation. When that information is
both written and verbal, chances are even greater
that communication is understood.
 Any delegated direction should provide the
 Communication that provides more information or
direction in delegation is preferred to too little
detail. Directions should include what is to be done,
where or to whom it is to be done, how it should be
done, when it should be done, and what criteria will
judge completeness.
 The manner of delegation is important as well.
Directions can be defined verbally, in writing, or
both. Written client assignment(s) reinforced with
up-to-date verbal information is superior to a single
communication method.
 Provide time to confer briefly with each
delegatee at least twice during the shift to
collect information about clients and evaluate
the progress of UAP performance
opportunity to ask questions or clarify
information. To achieve clarity, the delegator
must be available. Availability is sometimes a
specific board of nursing criterion for
delegation to UAP. Availability may be direct
or indirect and is defined by the agency and
board of nursing
RIGHT SUPERVISION

 Just as training is a critical component of the delegation decision, supervision of personnel is

essential to ensure safety and completeness of client care. Pairing experienced UAP with a less
experienced supervisor does not eliminate the need for supervision.

 NCSBN (1997) defined supervision as “provision of guidance and direction, evaluation and
follow-up by the licensed nurse for the accomplishment of a nursing task delegated to UAP.”
Onsite supervision becomes a strong tool for gathering information for personnel evaluation or
corrective action.

 The amount of supervision depends upon the competency of the delegatee for nursing care or
other duties. The key to delegation is to understand how your board of nursing defines nursing
practice and the skills required by UAP that define competence. The NCSBN (1997) describes
competence of the licensed nurse as “applying knowledge and interpersonal, decision-making,
and psychomotor skills expected in the practice role within the context of public health, safety
and welfare.”