Introduction

Many definitions for delegation exist in professional literature. One of the most commonly cited definitions of the word was jointly established by the American Nurses Association and the National Council of State Boards of Nursing. These groups 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.

Essential Components of Delegation

Responsibility

Based on individual states’ nurse practice acts, registered nurses have a professional duty to perform patient care tasks dependably and reliably.

Authority

Authority refers to an individual’s ability to complete duties within a specific role. This authority derives from nurse practice acts and organizational policies and job descriptions.

Accountability

Accountability within the nursing context refers to nursing professionals’ legal liability for their actions related to patient care. During delegation, delegators transfer responsibility and authority for completing a task to the delegatee; however, the delegator always maintains accountability for the task's completion. The registered nurse is always accountable for the overall outcome of delegated tasks based on each state's nurse practice act provisions.

Possible legal and ethical constraints arise regarding delegation in nursing. Therefore, the American Nurses Association developed the five rights of delegation to assist nurses in making safe decisions.

Five Rights of Delegation

• Right task

• Right circumstance

• Right person

• Right supervision

• Right direction and communication[1]

Clinical Significance

Reasons Delegation is Necessary for the Modern Health Care Environment

If delegation decisions are so challenging and legally charged, why should nurses delegate? Fiscal constraints, nursing shortages, and increases in patient care complexity have cultivated an environment in which delegation is necessary. If appropriately used, delegation can significantly improve patient care outcomes.

Improper Delegation

Improper delegation can negatively impact patient care while also potentially exposing the delegator to legal action.[5] All members of the health care team have valuable contributions to make toward safe, effective patient care.

Essentials of Communication

While employing the five rights of delegation in nursing practice, it is important to remember that the way the delegator asks the delegatee to perform a task can make a big difference. The delegator must use direct, honest, open, closed-loop communication to encourage teamwork and safe task performance.[6] Of the five rights of delegation, the right communication and direction are arguably the most important in ensuring good quality and safety outcomes.[7] Common delegation deficiencies for registered nurses occur when delegating tasks to unlicensed assistive personnel. These include unclear delegation directions from the registered nurse, a lack of retained accountability and follow-through, and the failure of the registered nurse to obtain the agreement of the unlicensed assistive personnel.[8]

References

1. Neumann TA. Delegation-better safe than sorry. AAOHN J. 2010 Aug;58(8):321-2. [PubMed: 20704120]

2. McMullen TL, Resnick B, Chin-Hansen J, Geiger-Brown JM, Miller N, Rubenstein R. Certified Nurse Aide scope of practice: state-by-state differences in allowable delegated activities. J Am Med Dir Assoc. 2015 Jan;16(1):20-4. [PubMed: 25239017]

3. Siegel EO, Young HM. Communication between nurses and unlicensed assistive personnel in nursing homes: explicit expectations. J Gerontol Nurs. 2010 Dec;36(12):32-7. [PubMed: 20669856]

4. Bittner NP, Gravlin G. Critical thinking, delegation, and missed care in nursing practice. J Nurs Adm. 2009 Mar;39(3):142-6. [PubMed: 19590471]

5. Gravlin G, Phoenix Bittner N. Nurses' and nursing assistants' reports of missed care and delegation. J Nurs Adm. 2010 Jul-Aug;40(7-8):329-35. [PubMed: 20661063]

6. Weydt AP. Defining, analyzing, and quantifying work complexity. Creat Nurs. 2009;15(1):7-13. [PubMed: 19343844]

7. Hopkins U, Itty AS, Nazario H, Pinon M, Slyer J, Singleton J. The effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction: a systematic review. JBI Libr Syst Rev. 2012;10(15):895-934. [PubMed: 27820462]

8. Kalisch BJ. The impact of RN-UAP relationships on quality and safety. Nurs Manage. 2011 Sep;42(9):16-22. [PubMed: 21873843]

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