Effective Nursing Delegation Guidelines for Safe Patient Care

1. Chapter 3 Delegation of Nursing Tasks

2. Delegation • Allows the transfer of responsibility to another person to complete a task or activity while the initial person retains the accountability for the outcome • The person that is entrusted the delegated task must be qualified, competent and able to perform the task

3. Unlicensed Assistive Personnel (UAP) Also known as: • Non-credentialed assistive personnel • Nursing assistant (NA) • Certified nursing assistant (CNA) • Patient care associate (PCA) • Nursing technician • Unit technician

4. RN is responsible for all patient care • The UAP cannot practice nursing • UAP must be directed, supervised and evaluated by the RN • Licensed practical nurse (LPN / LVN) works under direction and supervision of the RN. Their limitations of practice are governed by their state board regulations

5. Direct Patient Care Activities • Grooming • Feeding • Hygiene care • Vital signs • Ambulation • Electrocardiogram • Measuring Blood sugar levels

6. Indirect Patient Care Activities • Restocking supplies • Transporting patients • Clerical activities

7. The Five Rights of Delegation The National Council of State Boards of Nursing (1997) has defined the Five Rights of Delegation, as follows: • Right task • Right circumstance • Right person • Right direction / communication • Right supervision

8. Should You Accept a Delegated Assignment? • Is it consistent with your defined scope of practice? • Is there a valid order? Is it in accordance with the agency policies and procedures? • Is the act supported by research data or a position statement? • Are you competent to perform it safely? • Is the act to be performed with the acceptable “standards of care”? Would another nurse with similar education and clinical skills perform similarly? • Are you prepared to assume accountability for the provision of safe care?

9. Factors to Consider • Your state’s nurse practice act • Hospital policies and procedures • Job descriptions • Staff competencies • Clinical situation • Professional standards • Patient needs

10. What can be delegated? • Non-invasive non-sterile treatments such as emptying Foley catheters and providing hot/cold soaks • Vital signs, height, weight, capillary blood sugar results • Bathing, toileting, feeding, assistance with ambulation • Socialization activities

11. What cannot be delegated? • Patient assessments • Planning and evaluation of nursing care • Development of a plan of care • Health teaching and health counseling (unless it is reinforcement of previously taught material)

12. Obstacles to Delegation • Lack of training for nurses on how to delegate • Personal qualities, such as poor communication or interpersonal skills • Lack of resources • Insecure delegator • Unwilling to delegate • Nurse unwillingness to trust others

13. Levels of Clinical Experience • Novice • Advanced beginner • Competent nurse • Proficient nurse • Expert

14. Priority Setting • Identify your priorities • Interact differently with others in order to maintain control over your time, energy and priorities • Identify a time when you will be able to manage a task, set a realistic timeline • Understand the scope, intended outcome and deadline of assignments before accepting the assignment • Ask for help when needed • Delegate where you can – you cannot do it all!!!

15. Set Realistic Goals • Be SMART • Specific • Measurable • Attainable • Relevant • Time bound