EFFECTIVE

DELEGATION
AND
SUPERVISION
 Delegation
 Process of transferring a
selected task in a
situation to an individual
who is competent to
perform that specific
task
 Delegation
 A Multifaceted Process
 Communication, conflict resolution,

feedback, and evaluation

 Knowledge of the person to whom a

task is delegated
 The nurse practice acts define which
aspects of care may be delegated by the
RN.
 Delegation and
Supervision
In the twenty-first
century the reality exists
that RNs are becoming
increasingly responsible
for delegation and
supervision.
 Delegation and
Supervision
RNs should know what aspects
of nursing and health care to
delegate and what level of
supervision is required to
ensure that the patient
receives safe, competent,
and effective care.
 DELEGATION -
 is the transfer of responsibility for the
performance of an activity from one
individual to another while retaining
accountability for the outcome.

 Although RNs can transfer the responsibility

and authority for the performance of an
activity, they remain accountable for the
overall nursing care.
 Delegation is a two-way
process
 the RN requests that a qualified staff
member (UAP, LPN/LVN) perform a
specific task.
 a task is delegated, the delegator shares
with the delegatee the ultimate
responsibility and authority for the
accomplishment and outcome of the task.
 the RN delegator remains accountable for
the nursing care outcomes.
 The RN delegator is accountable
for:
 The act of delegation.
•
 • Supervising the performance of
the delegated task.
 • Assessment and follow-up
evaluation.
 • Any intervention or corrective
actions that may be required to
ensure safe and effective care.
The delegatee (LPN/LVN, UAP)
is accountable for:
 • His / her own actions.
 • Accepting delegation within the
parameters of his / her training and
education.
 • Communicating the appropriate
information to the delegator.
 • Completing the task.
 Delegation is a management strategy that,
when used effectively, can ensure the
accomplishment of cost-effective health
care services.
 Johnson (1996) has identified 10
essential elements related to
delegation criteria in nursing
practice acts as follows
 1. Definition of delegation
 2. Items that cannot be delegated

 3. Items that cannot be routinely

delegated
 4. Guidelines for the RN about what

can be delegated
 5. Description of professional nursing
practice
 6. Description of LPN/LVN and

unlicensed nursing assistant roles

 7. Degree of supervision required

 8. Guidelines for decreasing the risk

of delegation
 9. Warnings about inappropriate

delegation
 10. Restricted use of the word

"nurse" to licensed nurse

 Policies common to many
nursing practice acts
 Only nursing tasks can be delegated,
not nursing practice.
 The RN must perform the patient
assessment to determine what can
be delegated.
 The LPN/LVN and UAP do not
practice professional nursing.
 The RN can delegate only what is
within the scope of nursing practice.
 Policies common to many
nursing practice acts
 The LPN/LVN works under the direction and
supervision of the RN.
 The RN delegates based on the knowledge
and skill of the person selected to perform
the tasks.
 The RN determines the competency of the
person to whom he or she delegates.
 The RN cannot delegate an activity that
requires the RN's professional skill and
knowledge.
 Policies common to many
nursing practice acts
 The RN is accountable and responsible for
the delegated task.
 The RN must evaluate patient outcomes
resulting from the delegated activity.
 Health care facilities can develop specific
delegation protocols, provided they meet
the state board delegation guidelines.
 Delegation requires critical thinking by the
RN.
 Patient Needs
 Tasks can be delegated, nursing
practice cannot
 The functions of assessment,

evaluation, and nursing judgment

cannot be delegated
 Tasks that can be delegated may

also carry with them a nursing

responsibility
 Job Descriptions and
Competencies
 The RN has the responsibility of
knowing the background, skill level,
training received, and job
requirements of each person to
whom tasks are delegated.
 The RN should be aware of what type

of education and training the person

received to function as described in
the job description.
 Organizational Policies and
Procedures
When delegating, RN should
 comply with the specific skill requirements
designated in the organization's written
policies and procedures, which usually describe
the supervision required for a specific task and
how problems or incidents should be reported
and documented.
 know the organization's general standards of
care, such as infection control, and ensure that
the delegatee has the necessary knowledge
and skills to comply with the standards.
 Professional Standards of
Nursing Practice
To practice safe delegation, the RN
should:
 be familiar with the standards for any
specialty area in which the RN practices.
 use professional judgment to determine
activities that are appropriate to delegate
based on the concept of providing safe
and effective patient care and protecting
the public
 In delegation the RN will
consider the following:
 Assessment of the patient condition
 Capabilities of the nursing and

assistive staff
 Complexity of the task to be

delegated
 Amount of clinical oversight

(supervision) the RN will be able to

provide
 Staff workload
 Activities that the nurse may not
delegate include:
 •Initial nursing assessment and any
subsequent assessment that requires
professional nursing knowledge, judgment,
and skill.
 • Determination of nursing diagnoses,
establishment of nursing care goals,
development of the nursing plan of care, and
evaluation of the patient's progress with the
nursing plan of care.
 • Any nursing intervention that requires
professional knowledge, judgment, and skill.
 DEVELOPING SAFE
DELEGATION PRACTICES
The RN must

 have a strong foundation of knowledge

related to the legal criteria and
standards of practice governing
delegation decisions,
 know the patient, the staff members to
whom he or she is delegating, and the
tasks to be performed,
 provide for effective outcomes
by clearly communicating
expectations,

 supporting and appropriately

supervising the delegatee,

 evaluating the outcomes, and

reassessing the patient after the
delegated task is completed.
 The RN delegator must
 Establish a Foundation of Knowledge
As a Basis for Decisions
 Know the Patient
 Know the Staff Member
 Know the Task(s) To Be Delegated
 Explain the Task and Expected
Outcomes
 Expect Responsible Action From the
Delegatee
Steps from the decision to delegate
has been made
 A . Communicate effectively
 1. The delegatee accepts the delegation and
accountability for carrying out the task correctly.
 2. The RN delegator provides clear directions to
the delegatee: What specific task is to be
performed, for whom is the task to be done,
when is the task to be done, how is the task to be
performed, what data are to be collected, and
any patient specific instructions.
 3. The RN delegator clearly communicates
expected outcomes and timelines for reporting
results.
 B. Provide appropriate
supervision

 1. Monitor performance to
ensure compliance with
established standards of
practice, policies, and
procedures.
 2. Obtain and provide feedback.
 3. Intervene if necessary.
 4. Ensure proper documentation.
 SUPERVISION
 Supervision - the active process of
directing, guiding and influencing the
outcome of an individual's performance of
an activity.
 Supervision may be categorized as on-
site, in which the nurse is physically
present or immediately available while
the activity is being performed, or off-site,
in which the nurse has the ability to
provide direction through various means
of written, verbal, and electronic
communication.
 Three levels of supervision

 based on the task delegated and the

education, experience, competency, and
working relationship of the people
involved.
 1. Unsupervised
 2. Initial direction/periodic inspection
 during the shift.
 3. Continuous supervision:
 BUILDING DELEGATION AND
SUPERVISION SKILLS
 Effective delegation is an underlying
quality for the success of working with
others efficiently and cost-effectively.
 Clear communication is the key to
successful delegation .
 Create an Environment of Teaching and
Learning.
 Promote Patient Satisfaction
 Provide Feedback and Follow-Up
Evaluation