6.3 Delegation, Interprofessional Collaboration & Communication

The Principles of Delegation

Delegation is a critical skill for Registered Nurses (RNs), allowing them to manage time effectively and focus on complex patient care needs. By definition, delegation is the transfer of responsibility for the performance of an activity or task to a competent individual, while the delegator (the RN) retains accountability for the outcome.

It is imperative to understand that an RN can delegate tasks, but they can never delegate the nursing process (assessment, diagnosis, planning, and evaluation) or nursing judgment.

The Five Rights of Delegation

The National Council of State Boards of Nursing (NCSBN) outlines the Five Rights of Delegation, which must be strictly followed to ensure safe and legal practice:

Scope of Practice Guidelines

Understanding what can and cannot be delegated is paramount for the licensing exam. While specific regulations vary by jurisdiction, general principles apply:

Registered Nurse (RN):

• Performs initial comprehensive assessments.
• Develops the nursing care plan.
• Provides initial and complex patient education.
• Cares for unstable or acutely ill patients.
• Administers IV push medications and manages central lines.
• Interprets clinical data and makes nursing judgments.

Licensed Practical Nurse / Practical Nurse (LPN/PN):

• Cares for stable patients with predictable outcomes.
• Performs focused or reassessments (after the RN's initial assessment).
• Administers oral, intramuscular, and subcutaneous medications.
• Can reinforce teaching previously provided by the RN.
• Performs routine sterile procedures (e.g., Foley catheter insertion, simple wound care).
• Cannot administer IV push medications or initiate blood transfusions (in most jurisdictions).

Unlicensed Assistive Personnel (UAP/CNA):

• Performs basic Activities of Daily Living (ADLs): bathing, grooming, dressing, toileting.
• Ambulates, positions, and turns stable patients.
• Obtains routine vital signs and blood glucose checks on stable patients.
• Measures Intake and Output (I&O).
• Cannot perform assessments, teaching, or administer medications.

Interprofessional Collaboration

Modern healthcare relies heavily on interprofessional collaboration, where multiple health workers from different professional backgrounds work together with patients, families, and communities to deliver the highest quality of care. This approach breaks down silos and leverages the unique expertise of each discipline.

Effective collaboration requires:

• Mutual Respect and Trust: Valuing the contributions of all team members, from physicians to social workers to dietitians.
• Shared Decision-Making: Engaging in collaborative problem-solving, ensuring that the patient's voice is central to the care plan.
• Role Clarity: Understanding one's own scope of practice and the scopes of other team members.
• Open Communication: Cultivating an environment where any team member feels empowered to speak up about safety concerns.

Structured Communication: The SBAR Framework

Communication failures are a leading root cause of sentinel events in healthcare. To mitigate this risk, standardized communication tools like the SBAR framework are essential, particularly during handoffs or when communicating critical information to physicians.

SBAR stands for:

• Situation: What is occurring right now? Identify yourself, the unit, the patient, and briefly state the immediate problem. (e.g., "Dr. Smith, this is Nurse Jones calling from Unit 4 regarding Mr. Davis in room 402. He has suddenly developed severe, crushing chest pain.")
• Background: What is the relevant clinical history leading up to this point? Include admitting diagnosis, date of admission, significant medical history, and relevant baseline data. (e.g., "Mr. Davis was admitted two days ago with pneumonia. He has a history of hypertension and stable angina.")
• Assessment: What do you think the problem is? Provide the current vital signs, pertinent assessment findings, and any recent lab or diagnostic results. (e.g., "His current vital signs are BP 160/90, HR 110, RR 24, SpO2 92% on 2L oxygen. He is diaphoretic and rates the pain as 9/10.")
• Recommendation: What do you suggest needs to be done? Or, what do you need from the provider? (e.g., "I recommend that you come evaluate the patient immediately. Should I initiate the chest pain protocol and obtain a stat ECG while we wait?")

By utilizing SBAR, nurses ensure that communication is concise, focused, and actionable, thereby significantly enhancing patient safety and interprofessional teamwork.