Within the realm of nursing there are Five Rights of Delegation which allow licensed nurses to delegate tasks to other nurses or to unlicensed assistive personnel as long as this criteria is met and the patient’s safety and well-being is not jeopardized.
The Five Rights of Delegation are:
- Right Task
- Right Circumstances
- Right Person
- Right Directions/Communication
- Right Supervision/Evaluation
The Nurse Practice Act (NPA) allows for licensed nurses, namely RNs, to delegate tasks to LPNs, CNAs, and UAPs as long as certain criteria is met. First of all the nurse delegating the task must realize that s/he remains responsible for the task and the outcomes.
The Right Task
The RN must determine that the task is one that can be safely delegated in the first place. This includes such factors such as possessing the skills and knowledge of how to perform the task and how to evaluate the success or failure of the task. The tasks must have a predictable outcome, a minimal potential risk, and a standard, unchanging procedure.
The task must fall within the scope of practice and job description of the person to whom it is being delegated and they must have demonstrated competency in performing said task. The organizational policies and procedures of the facility must not prohibit the delegated person from performing said task.
Typically tasks which can be delegated frequently recur in the day-to-day care of patients on the unit. The tasks are not complex, and do not require critical thinking or application of the nursing process.
The Right Circumstances
The patient must be stable and the outcome predictable. The decision to delegate must be based on the nursing process and a careful analysis of the patient’s needs and circumstances prior to delegating. The person to whom the task is delegated must perform the task within their own scope of practice and job description. They are assisting the licensed nurse with the task, not replacing the nurse. If at anytime the patient’s condition changes, the nurse must reassess the situation and may rescind the delegation.
The Right Person
The licensed nurse delegating the task must ensure that the delegatee possesses and has demonstrated the knowledge base and appropriate skills and resources to perform the task and provide adequate supervision and evaluation to ensure the patient’s safety and appropriate outcome.
The Right Directions/Communication
The licensed nurse is responsible to ensure that the delegatee has the previously documented appropriate skills and knowledge base. The nurse is also expected to communicate to the delegatee specific instructions for this task. Each instance of delegation is to be specific to the patient, the nurse and the delegatee.
The nurse needs to clearly communicate the specifics and expectations of the task such as any data to be collected, the method for collecting it and the time frame for reporting results to the nurse. Any possible complications need to be communicated along with time frames for reporting them to the nurse. Further all outcomes must be reported to the nurse and the time frame needs to be pre-defined. The delegatee must agree to accept the delegated responsibility and understands the terms of the assignment.
It must be clear to the delegatee that s/he is not to make decisions or modifications to the care without first consulting with the nurse. This would be overstepping their scope of practice.
The Right Supervision/Evaluation
The nurse remains responsible for the tasks and the outcomes. The nurse is responsible to follow up and receive report on the task and outcomes if the delegatee has not done so. The nurse is responsible to ensure compliance with standards of care, and the policies and procedures of the organization. S/he is to intervene if necessary. After careful evaluation of the outcomes, the nurse also needs to ensure appropriate documentation is provided.
After the fact, the nurse needs to evaluate the patient, the outcomes, and make any necessary modifications to the plan of care. The nurse should also provide feedback to the delegatee and thank them for the assistance.
In some states, LPNs can delegate to CNAs and UAPs. However, unlicensed personnel such as CNAs and UAPs may not delegate. Anyone to whom a task has been delegated may not reassign the task to anyone else.
Resources:
National Council of State Boards of Nursing
©2009 by UltimateNurse.com All Rights Reserved. By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book. She is also the owner/author of TheNursingSite.com.
