Key Takeaways
- Delegation is the transfer of responsibility for a task while the RN retains accountability for the outcome
- The RN can never delegate assessment, evaluation, nursing judgment, or teaching that requires professional interpretation
- Supervision must match the task and delegatee: stable patients with competent staff require less frequent oversight
- Assignment differs from delegation: assignment is transferring authority for an entire work situation to another licensed person
- The delegating RN is accountable even when the delegatee performs the task incorrectly
Assignment, Delegation, and Supervision
Delegation is the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. This is a high-stakes area on the NCLEX because improper delegation leads to patient harm.
Delegation vs. Assignment
| Term | Definition | Example |
|---|---|---|
| Delegation | Transferring a specific task to someone in your authority | RN delegates vital signs to UAP |
| Assignment | Transferring authority for entire work situation | Charge nurse assigns RN to patient load |
Key Distinction: The RN delegates to UAPs and LPNs. The charge nurse (or nurse manager) assigns patients to RNs.
The Delegation Decision-Making Process
Before delegating, the RN must assess:
- Patient factors - Is the patient stable? Predictable?
- Task factors - Is this within delegatee's scope? Is it routine?
- Delegatee factors - Is this person competent? Available?
- Circumstance factors - Is supervision available? What's the setting?
What the RN Can NEVER Delegate
Mnemonic: EAT - Evaluate, Assess, Teach
| Function | Rationale |
|---|---|
| Evaluation | Requires nursing judgment to interpret outcomes |
| Assessment | Initial, comprehensive, and change-in-condition assessments require RN |
| Teaching | Initial teaching and teaching requiring professional interpretation |
Additional Non-Delegable Functions:
- Nursing diagnosis
- Care planning
- Interventions requiring nursing judgment
- Any task requiring assessment during performance
Supervision Requirements
Supervision must be matched to the task, delegatee, and patient:
| Factor | Less Supervision Needed | More Supervision Needed |
|---|---|---|
| Patient | Stable, predictable | Unstable, complex, changing |
| Task | Routine, low-risk | Complex, high-risk |
| Delegatee | Experienced, demonstrated competency | New, unfamiliar with task |
| Setting | Adequate staff ratios | Short-staffed, high acuity |
Types of Supervision
| Type | Description | When Used |
|---|---|---|
| Direct | RN present or immediately available | Complex tasks, new delegatees |
| Indirect | RN available by phone, checks periodically | Routine tasks, experienced delegatees |
Accountability in Delegation
| Role | Accountability |
|---|---|
| Delegating RN | Accountable for the decision to delegate and outcome of care |
| Delegatee (UAP/LPN) | Accountable for own actions and completing the task correctly |
| Supervising RN | Accountable for adequate supervision and follow-up |
Key Point: The RN remains accountable for patient outcomes even when tasks are delegated appropriately. If a patient is harmed, the delegating nurse shares responsibility.
Safe Delegation Process
| Step | Action |
|---|---|
| 1 | Assess the patient, task, and delegatee |
| 2 | Plan what, when, and how to delegate |
| 3 | Communicate clear, specific instructions |
| 4 | Supervise at appropriate level |
| 5 | Evaluate outcomes and provide feedback |
Communication Requirements
Effective delegation requires specific instructions:
| Vague (Unacceptable) | Specific (Acceptable) |
|---|---|
| "Check vitals" | "Measure vital signs at 0800, 1200, 1600" |
| "Report high BP" | "Report systolic BP > 160 or diastolic > 90" |
| "Watch the patient" | "Check on the patient every 30 minutes and report any changes in breathing" |
Barriers to Effective Delegation
| Barrier | Solution |
|---|---|
| Fear of liability | Understand that proper delegation reduces risk |
| Lack of trust | Verify competency, start with simpler tasks |
| Poor communication | Use specific, clear instructions |
| Time constraints | Recognize that delegation saves time long-term |
On the NCLEX
Delegation questions are extremely common. They test:
- Which tasks can be delegated to which personnel
- When to delegate vs. perform tasks personally
- Appropriate supervision levels
- Understanding of scope of practice
Exam Tip: When answering delegation questions, first identify the patient's stability. Unstable patients require RN assessment and intervention.
A patient's condition changes suddenly, requiring immediate assessment. The RN is busy with another patient. The RN should:
The RN delegates vital signs measurement to a UAP. The UAP reports that the patient's blood pressure is 88/52 mmHg. The RN should:
Which instruction demonstrates appropriate delegation communication?