8.5 Delegation, Assignments, Documentation, and Reporting Boundaries

Delegation in Washington and the Five Rights

Quick Answer: Delegation is when a registered nurse (RN) transfers a specific task for a specific client to a qualified nurse aide. In Washington, the RN delegator uses the nursing process, judges that the task is appropriate, gives clear directions, supervises, and obtains the client's written consent. The aide may accept or refuse, and must refuse anything outside training or scope. The RN keeps accountability for the delegation decision.

Delegation is not the same as an everyday assignment (the routine tasks already within your role, like ADLs). Delegation hands you a nursing task that normally requires a license, under specific conditions. The framework tested is the Five Rights of Delegation:

If any of the five is missing — unclear directions, an unstable client, a task you were never trained for — the safe answer is to clarify or decline and notify the nurse, not to proceed and hope.

What May Be Delegated, and What May Not

Washington's Board of Nursing allows an RN delegator, especially in community-based and in-home settings, to delegate certain nursing tasks to a qualified NAC after assessing the client and obtaining written consent under the informed-consent statute (chapter 7.70 RCW). The aide may consent to or refuse any delegated task and must keep refusing tasks beyond training.

Commonly delegable tasks (when conditions are met):

• Medication administration/assistance (with the required Washington endorsement/training)
• Blood glucose monitoring
• Non-sterile dressing changes
• Ostomy care and gastrostomy (tube) feedings for a stable client
• Simple urinary catheter care in some delegated arrangements

Never delegated to a nurse aide:

• The initial nursing assessment and any reassessment requiring nursing judgment
• Sterile procedures and complex/open-wound care
• Evaluating client responses that require clinical interpretation
• Anything requiring independent nursing judgment about the plan of care

The principle: a nurse may delegate a task, but never the assessment, judgment, or accountability. Even when a task is delegated, the aide still reports outcomes and changes back to the delegating nurse, who remains responsible for the overall care.

Reporting Boundaries and Honest Documentation

Clear reporting is what keeps delegation and assignments safe. The nurse aide is the eyes and ears of the team, so the exam tests what and when to report and how to document.

Report promptly to the nurse:

• Any change in condition — new pain, confusion, breathing change, fever, fall, bleeding, skin breakdown.
• A resident's refusal of care or of a delegated task.
• Incomplete care — tasks you could not finish and why.
• Safety concerns — broken equipment, unsafe staffing, unclear orders.
• Errors, including your own.

Documentation rules (record = legal document):

1. Chart factually, objectively, and on time — do not pre-chart.
2. Record only care you actually performed and observations you actually made.
3. Do not document another person's work unless facility policy specifically allows it.
4. Correct errors per policy (line through, initial, date); never erase or use correction fluid.
5. Use only approved abbreviations and the approved record.

When directions are incomplete, conflicting, unsafe, or outside your training, the boundary rule is simple: ask the nurse before acting. Guessing on an unclear order or accepting an out-of-scope task to be "helpful" is how harm and liability occur. Clarifying is always the professional choice.

Assignment vs. Delegation, and Accepting Tasks Safely

Keeping the assignment-versus-delegation distinction straight prevents the most common boundary errors:

• An assignment is routine work already within the NAC role (ADLs, vital signs, repositioning). You are expected to perform it and report results.
• A delegation transfers a nursing task that normally needs a license, only under the Five Rights and (in Washington community settings) written client consent.

In both cases the aide may need to refuse or seek clarification when a task is unsafe or beyond training. Refusing appropriately is professional, not insubordinate. The correct way to decline is factual and respectful: "I haven't been trained on that and it's outside my scope — I want the resident to be safe, so I'll get the nurse."

A safe-acceptance checklist before doing a delegated or unclear task:

1. Is the task legally allowed for an NAC and within facility policy?
2. Am I trained and competent for this specific task and resident?
3. Are the directions clear, with limits and what to report?
4. Is the client stable enough (right circumstances)?
5. Will a nurse supervise and be available if something goes wrong?

If every box is checked, accept and perform the task carefully, then report the outcome. If any box is unchecked, stop and consult the nurse. This disciplined approach protects the resident, the aide, and the delegating nurse who retains accountability.