Nurses have a variety of duties and, in many cases, many patients in their care. Because patient care requires many time-consuming tasks, delegation is an important tool that helps nurses spend their time in the most productive ways possible.
The American Nurses Association and the National Council of State Boards of Nursing describe delegation 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. E.g., Health Assistant, Ward Aid.
Delegation and assignment are different in a few ways. When you assign a task, that task must fall within the scope of the assignee’s job description, and the education and training required by that job must confer the skills required for completion of the task. When you delegate a task, however, that task is allowed to fall outside the purview of the delegatee’s role, provided delegating the task doesn’t violate hospital policy and that the delegatee has obtained additional education and training that covers the task in question.
During delegation, delegators transfer responsibility and authority for completing a task to the delegatee; however, the delegator is always accountable for the task’s completion. The registered nurse is always accountable for the overall outcome of delegated tasks.
THE 5 R’S (RIGHTS) OF NURSING DELEGATION
- Right Task
- Right Circumstance
- Right Person
- Right Directions/Communication
- Right Supervision/Evaluation
Delegation can be a good tool for teaching someone new skills, patient care, and safety always come first. When delegating nursing tasks, make sure you have a high degree of confidence that the task can be completed correctly and safely.
The task must fall within the scope of practice and job description of the person to whom it is being delegated and they must have demonstrated competency in performing said task. Also, the organizational policies and procedures of the hospital or facility must not prohibit the delegated person from performing said task.
The tasks must have a predictable outcome, a minimal potential risk, and a standard, unchanging procedure. Day-to-day tasks are typically safe to delegate, while more complex tasks should be handled only by those with the proper experience and training.
When deciding to delegate a task, it must be based on the nursing process and a careful analysis of the patient’s needs and circumstances prior to delegating.
It’s also necessary to be aware of the patient’s current state and to only delegate tasks when the patient is in stable condition and the outcome predictable.
It is necessary to avoid delegating a task when the patient’s condition is unstable or when the patient is in critical condition, as this places the patient in unnecessary danger.
In addition, one must be aware that delegating a task doesn’t mean that the delegatee replaces you in the task; as a skilled nurse, you must be on hand to observe, instruct, and step in if something goes wrong or if at any time the patient’s condition changes, the nurse must reassess the situation and may rescind the delegation.
The Registered Nurse delegating the task must ensure that the delegatee possesses and has demonstrated the knowledge base and appropriate skills and resources to perform the task and provide adequate supervision and evaluation to ensure the patient’s safety and appropriate outcome. Don’t delegate tasks to delegatees who have not demonstrated the ability to handle those tasks.
In nursing, clear, precise communication is important to any kind of delegation; unclear communication can directly impact a patient’s outcome. Provide clear, specific, and understandable instructions so your delegatee can easily follow them. Answer any questions and instruct as necessary during the procedure. Expectations must also be communicated, and the results of the procedure must be conveyed to the proper people as well, according to hospital policy.
Even though you are delegating the task to someone else, you are ultimately responsible for the outcome of that task. The nurse is responsible to ensure compliance with standards of care and the policies and procedures of the organization.
Be available to supervise your delegatee and make sure that the patient outcome is a good one. Make corrections and modifications as necessary and evaluate your delegatee’s work. Provide feedback to allow individuals to improve their skills in the future. After careful evaluation of the outcomes, the nurse also needs to ensure appropriate documentation is provided.