How to Delegate Effectively in Nursing Key Principles

Now a day How to Delegate Effectively in Nursing Key Principles. Registered nurses (RNs) assign or delegate tasks based on the patient’s needs and condition, the risk of harm, the stability of their condition, the complexity of the task, the predictability of the outcome, the qualifications and skills of the delegated staff, and the context of the other patient.

Delegate Effectively in Nursing and Key Principles In Nursing

In nursing, effective delegation is essential for efficient teamwork and high-quality patient care. It involves delegating tasks to other healthcare professionals while ensuring patient safety and optimal outcomes. Key principles include understanding the “Five Rights of Delegation,” clear communication, and ongoing supervision.

Delegating Effectively

Nurses at all levels and in all settings are required to assign and delegate tasks to and supervise other health-care workers. To do so effectively, nurses must develop skills in delegation, prioritization, and oversight of nursing care (American Association of Colleges of Nursing [AACN], 2008).

Florence Nightingale first talked about delegation in 1860: But again, to look to all these things yourself does not mean to do them yourself … But can you not insure that it is done when not done by yourself? Can you insure that it is not undone when your back is turned? … The former only implies that just what you can do with your own hands is done. The latter that what ought to be done is always done (Nightingale, 1860, p. 29).

Effective delegation is considered a core skill for professional nursing practice globally (American Nurses Association [ANA] and the National Council of State Boards of Nursing [NCSBN], 2006; International Council of Nurses [ICN], 2012). The ICN (2008) maintains that nurses are responsible for the delegation of nursing care and supervision of assistive personnel.

The ANA recognizes delegation as an important skill for nurses to deliver safe and effective care: The nurse “delegates according to the health, safety, and welfare of the healthcare consumer and considering the circumstance, person, task, direction or communication, supervision, evaluation, as well as the state nurse practice act regulations, institution, and regulatory entities while maintaining accountability for care” (ANA, 2015a, p. 61). Moreover, the ANA’s Code of Ethics for Nurses with Interpretive Statements states that “nurses are accountable and responsible for the assignment or delegation of nursing activities.

Such assignment or delegation must be consistent with state practice acts, organizational policy, and nursing standards of practice” (ANA, 2015b, p. 17). Delegation is essential to effective leadership and management as well as managerial productivity. As a management principle, delegation is necessary to obtaining desired outcomes through the work of nursing staff (NCSBN, 1997). Nurse leaders and managers must delegate many routine tasks to allow themselves time to handle more complex activities that require higher level of expertise.

In this post, the key principles of delegation are outlined, including what can be delegated and by whom. Next, the five rights of delegation are covered, followed by a breakdown of the delegation process. Knowledge, skills, and attitudes related to the following core competencies are included in this post: patient-centered care, teamwork and collaboration, and safety.

Key Principles of Delegation

Delegation requires problem-solving skills, critical thinking skills, and clinical judgment. Development of delegation skills begins early in a nurse’s academic career, but proficiency is achieved with education and experience. Indeed, delegation can be difficult for novice nurses because they are still acquiring foundational knowledge and skills, have limited experience, and are in the early stages of developing critical thinking skills (Duffy & McCoy, 2014).

Delegation is defined as “the act of transferring to a competent individual the authority to perform a selected nursing task in a selected situation, the process for doing the work” (NCSBN, 2005, p. 1). Additionally, the individual delegating the task retains accountability for the out come (ANA, 2015a, p. 86). Nurses delegate tasks based on patient needs, potential for harm, stability of a patient’s condition, complexity of the task, and predictability of the outcome. Also taken into consideration are the qualifications and skill level of the person to whom the task is delegated (ANA, 2012).

Nurses must be familiar with their state nurse practice acts to ensure that they delegate within legal parameters. Most state nurse practice acts prohibit nurses from delegating certain aspects of the nursing process to licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and unlicensed assistive personnel (UAPs). In addition, an individual cannot delegate a task that is not in his or her own scope of practice. Delegation is a management principle used to obtain the desired outcomes through the work of others (NCSBN, 1997). When delegation is used effectively, nurse leaders and managers can expand access to nursing care, promote safe and quality nursing care, and facilitate effective use of health-care resources.

In the delegation process, the delegator is the registered nurse (RN) who is delegating the task. The delegator must have the appropriate qualifications, education, and authority to delegate as determined by the state nurse practice act, other regulatory agencies, and organization policy and procedures. The delegate (also referred to as delegatee) is the person to whom the task is being delegated, and he or she must also have the appropriate education and skills to carry out the activity. RNs may delegate nursing activities to other RNs, LPNs or LVNs, and UAPs.

Accountability is defined by the NCSBN (1995) as “being responsible and answerable for actions or inactions of self or others in the context of delegation” (p. 2). In the process of delegation, an RN must comply with the state nurse practice act or regulating bodies and is accountable for the quality of nursing care provided. Nurses have a professional accountability and obligation not to abuse trust and to be able to justify professional actions (Royal College of Nursing, 2015).

Nurses are accountable for the decision to delegate and for the tasks delegated to others. In addition, “nurses are accountable for their professional practice and image as well as the outcomes of their own and delegated nursing care” (AACN, 2008, p. 9). The health-care organization is also accountable for delegation. Organizational accountability involves providing sufficient resources for nurses to provide nursing care effectively and safely, including the following (ANA and NCSBN, 2006, p. 3):

• Providing sufficient staffing with an appropriate staff mix
• Documenting competencies for all staff providing direct patient care and ensuring that RNs have access to the information
• Developing organizational policies on delegation with active participation of all nurses and acknowledging that delegation is a professional right and responsibility

Nurse leaders and managers are accountable for “establishing systems to assess, monitor, verify, communicate ongoing competence requirements in areas related to delegation” (ANA and NCSBN, 2006, p. 2). They set the expectations for appropriate delegation and ensure that RNs, LPNs or LVNs, and UAPs are aware of individual roles (Duffy & McCoy, 2014).

Additionally, nurse leaders and managers are accountable for providing a safe environment that supports the delegation process (ANA, 2015a). An RN has legitimate authority by virtue of his or her professional licensure to delegate specific tasks to other RNs or to a competent LPN, LVN, or UAP. In the delegation process, nurses have authority to make assessments, diagnose, plan nurse care, implement and evaluate nursing care, and exercise nursing judgment.

Authority is a “legal source of power; the right to act or command the actions of others and to have them followed” (Porter-O’Grady & Malloch, 2013, p. 432). A nurse must have the authority or the right to act or command the actions of others to carry out patient care activities safely. Authority is based on the state nurse practice act and should also be reflected in a nurse’s job description. The organization must give the nurse the authority to direct the work of others. Nurse leaders and managers have the authority to determine how staff resources will be distributed on the unit based on patient needs.

Responsibility is the obligation one has to accomplish work. Additionally, responsibility involves the individual’s obligation to perform competently at the person’s level of education. In the delegation process, the nurse is responsible to assess the situation, determine the competence of the delegate and appropriateness of delegation, supervise the delegate, evaluate the performance of the delegate, and man age the results (Porter-O’Grady & Malloch, 2013).

Delegates accept responsibility when they agree to perform tasks delegated to them (ANA, 2012; Weydt, 2010). The delegate is responsible for his or her own actions and for accepting only tasks for which he or she is qualified and providing feedback to the delegator as directed (Porter-O’Grady & Malloch, 2013). Supervision is provision of guidance or direction, oversight, evaluation, and follow-up (ANA and NCSBN, 2006, p. 1).

The nurse supervises the activities delegated by monitoring the delegate’s performance of the task or function and ensuring compliance with standards of practice and policies and procedures. Organizational policies and procedures must be in place to support the nurse delegating a task. In the event the activity is being done inappropriately, there must be policy in place to allow the nurse to assess the situation and take back control of the task if necessary (ANA and NCSBN, 2006). Nurses engaged in “supervision of patient care should not be construed as managerial supervisors on behalf of the employer under federal labor laws” (ANA and NCSBN, 2006, p. 1).

Assignment describes the distribution of work that each staff member is responsible for during a given time period (ANA and NCSBN, 2006; Duffy & McCoy, 2014). When making an assignment, a nurse designates an individual to be responsible for specific patients or selected responsibilities the individual is already authorized to take on through the nurse practice act (ANA and NCSBN, 2006; Porter-O’Grady & Malloch, 2013). During the assignment process, a transfer of responsibility and accountability for the activity occur. The nurse assigning tasks must ensure that the activity is within the individual’s scope of practice.

For example, the charge nurse of a unit typically makes the assignment of patient care for nurses on the shift. The charge nurse is accountable for his or her decisions related to the assignments but transfers the accountability for care to the assigned nurses. Prioritization is another important principle of delegation. Although nurses are accustomed to prioritizing nursing care, delegation also requires effective prioritization. Prioritization is deciding which patient needs or problems require immediate action and which are not urgent and can be addressed at a later time.

What Can and Cannot Be Delegated

Many state nurse practice acts, regulatory agency guidelines, and institutional policies specify nursing activities that may be delegated. Delegated tasks may involve monitoring patients, collecting specimens, reporting, providing care, and documenting data. The UAP may take vital signs, measure intake and output, and report the information to the nurse. The nurse interprets the reported information as part of the assessment and then makes clinical judgments and uses the data to establish a plan of care.

Tasks that should not be delegated include aspects of the nursing process (e.g., performing an assessment, formulating a nursing diagnosis, developing and updating a plan of care for a patient, and evaluating the patient’s progress toward achieving goals), as well as communicating with health-care providers, implementing orders from health-care providers, providing teaching to patient and/or family, evaluating patient status, and triage (ANA, 2015a; Anderson, Twibell, & Siela, 2006; Duffy & McCoy, 2014).

In general, any nursing activity that requires specialized nursing knowledge or nursing judgment cannot be delegated. Nursing judgment is defined as the educated, informed, and experienced process that a nurse uses to form an opinion and reach a clinical decision based on the analysis of available information (NCSBN, 2005). Further, nursing judgment includes conscious decision making and intuition.

Who Can and Cannot Delegate

As mentioned earlier, RNs may delegate to other RNs, LPNs or LVNs, and UAPs. In addition, LPNs or LVNs may delegate to a UAP if directed to do so by an RN. An LPN or LVN cannot assign or delegate to an RN. LPNs or LVNs can perform tasks that UAPs are not qualified to do. State nurse practice acts dictate the scope of practice for LPNs or LVNs, although the scope of practice varies from state to state.

Often the role of the LPN or LVN can be confusing for new nurses or those who have not worked with them before, so all nurses must be knowledgeable about the nurse practice act in their state. Monitoring patients’ health status and providing basic nursing care under the direction of an RN comprise the duties of LPNs or LVNs. Common tasks LPNs or LVNs can perform include those of the UAP in addition to updating initial assessments performed by the RN, reinforcing teaching, and monitoring patient status.

UAPs are health-care workers who provide low-risk care that does not require nursing knowledge or nursing judgment. UAPs typically assist patients with activities of daily living, such as bed making, bathing, and assisting with dressing, and they provide basic care under the supervision of an RN. Usually, UAPs do not hold a license; however, they may be certified.

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