Delegation and Supervision
Key Takeaways
- The five rights of delegation: right task, right circumstance, right person, right direction and communication, right supervision and evaluation
- The nurse who delegates a task retains accountability for it — delegation transfers the doing, never the responsibility
- A CNA should refuse a delegated task that is outside scope, unsafe for the resident, or one the CNA is not trained or comfortable performing
- After completing a delegated task, report what was done and any problems or changes observed — the task is not finished until it is reported
- All CNA work must stay consistent with the resident's care plan; report mismatches to the nurse instead of improvising
Delegation and Supervision
Quick Answer: Delegation is the process by which a licensed nurse assigns a task to a CNA. Safe delegation follows the five rights — right task, right circumstance, right person, right direction and communication, and right supervision and evaluation. The nurse who delegates keeps accountability; the CNA accepts responsibility for doing the task correctly and reporting the result.
Delegation is the formal transfer of a task from a licensed nurse to a nursing assistant. Nearly everything a CNA does on a shift arrives through delegation, so the Montana knowledge exam treats it as core Role and Responsibility material. Two ideas anchor the whole topic: the nurse decides what may be delegated using the five rights, and the CNA decides whether to accept based on training, scope, and resident safety.
The Five Rights of Delegation
The five rights of delegation are the nurse's checklist — and the exam's favorite delegation question:
| Right | What it means |
|---|---|
| Right task | The task is delegable — within CNA scope, allowed by state rules and facility policy, and does not require nursing judgment. Bathing, vital signs on a stable resident, and transfers are delegable; assessments and medication administration are not. |
| Right circumstance | The resident's condition is stable and the setting is appropriate. A task routine for a stable resident may be wrong for one whose condition is changing. |
| Right person | The specific CNA has the training, competency, and (if required) demonstrated skill check-off for that task. |
| Right direction and communication | The nurse gives clear, specific instructions: what to do, for whom, any limits ("walk 50 feet, stop if dizzy"), what to watch for, and when to report back. |
| Right supervision and evaluation | The nurse monitors the work, is available for questions, follows up on the outcome, and evaluates performance. |
A memory aid worth keeping: Task, Circumstance, Person, Direction, Supervision. Exam distractors typically substitute "right equipment" or "right documentation" — those are not among the five rights.
The Nurse Retains Accountability
Delegation transfers the doing of a task, never the accountability for it. The delegating nurse remains accountable for the decision to delegate and for the overall nursing care of the resident. The CNA accepts responsibility for performing the task correctly, within scope, and for reporting the outcome. This split matters on the exam: if a delegated task harms a resident, the nurse's judgment in delegating is examined — but the CNA who knowingly accepted an unsafe or out-of-scope task also bears responsibility. "The nurse told me to" is not a defense for doing something you knew was wrong.
Accepting and Refusing Delegated Tasks
Before accepting a delegated task, run your own quick check:
- Is it within my scope under Montana rules and facility policy?
- Am I trained and competent to do it — have I done it before or been checked off?
- Is the resident's condition stable and appropriate for this task right now?
- Do I have the right instructions, equipment, and time to do it safely?
- Is a nurse available to supervise and answer questions?
If any answer is no, you have the right and the duty to refuse. Refuse professionally: state the specific reason ("I haven't been trained on that lift" — not "I don't want to"), and offer what you can do. Then the nurse reassigns the task, trains you, or does it personally. Accepting a task you are unqualified for endangers the resident; refusing for a legitimate reason protects everyone and is never insubordination.
Reporting Completion and Problems
A delegated task is not complete until it is reported back. Reporting closes the loop of the fifth right — supervision and evaluation. Report:
- That the task was done and when
- Anything you observed while doing it — skin redness, shortness of breath, pain, refusal, unusual behavior
- Anything you could not complete — the resident refused a bath, the blood pressure cuff would not fit
- Anything abnormal or urgent, which you report immediately, not at end of shift
Some findings can never wait: chest pain, trouble breathing, unresponsiveness, a fall, bleeding, or a sudden change in condition. Stop, stay with the resident or get help per training, and notify the nurse right away.
Working Within the Care Plan
The care plan is the nurse-written, team-developed roadmap for each resident: diet order, activity level, transfer method, fluid restrictions, fall precautions, and individualized approaches. Delegated tasks must be carried out as the care plan specifies. If the care plan says two-person transfer, do not attempt it alone to save time. If it says nectar-thick liquids, do not give thin water. When reality does not match the care plan — the resident now needs more help than it says — do not improvise your own upgrade or downgrade. Report the mismatch to the nurse so the plan can be updated. Following the care plan exactly, and reporting when it no longer fits, is how a CNA practices safely inside the delegation system.
Which of the following is NOT one of the five rights of delegation?
After delegating a task to a CNA, who retains accountability for that task?
While performing a delegated task, a CNA notices the resident has become short of breath and is complaining of chest pressure. What should the CNA do?