Nurses often work in acute work environments where patients’ lives are on the line. Therefore, it is absolutely essential for a nurse to learn how to prioritize and make decisions quickly and effectively. This is a skill that some new nurses struggle with. Understanding which tasks to delegate to LPN/LVNs (licensed practical nurses), CNA (certified nursing assistants), UAPs (unlicensed assistive personnel) can help reduce nurse burnout and improve patient’s quality of care.
What is Delegation?
According to the the American Nurses Association and the National Council of State Boards of Nursing, delegation refers to “the process by which a nurse directs another person to perform nursing tasks and activities. ” Additionally, delegation involves two people: the delegator and the delegate. The delegator is a registered nurse who assigns a task to another person referred to as the delegate.
What are the Components of Delegation?
Responsibility
You have a responsibility and a professional duty to perform your tasks dependably and reliably.
Authority
It refers to the ability to perform your duties within your scope of practice. Authority derives from nurse practice acts, organizational policies, and job descriptions.
Accountability
Accountability means that you are legally liable for your actions when it comes to patient care. Even though you assign the task to the delegate, you are responsible for the task’s completion. As a registered nurse, you are accountable for the outcome of the delegated task as per the state’s nurse practice act provisions.
What are the 5 Rights of Delegation?
American Nurses’ Association provides five rights of task delegation to assist you in making safe decisions for your clients.
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Right task
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Right circumstance
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Right person
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Right supervision
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Right direction and communication
Let’s learn it through an example.
Julie is a newly graduated registered nurse who has recently joined a well-reputed acute care hospital. Currently, she has completed her orientation phase and now started her post-preceptor practice in a busy medical-surgical department. Yesterday she was on her night shift, and it was so busy. She had several tasks to do all at once, which included changing bed linens and a patient’s dress who just vomited, administering pain medication to a patient with a pain score of 9 out of 10, and assessing an intravenous line with possible infiltration. Julie also had to conduct hourly rounds and her documentation was also behind. Using the five rights of task delegation Julie assigned some of the tasks at hand to her coworkers.
Now let’s see how Julie should effectively delegate the task using each of the 5 rights of delegation.
Right tasks
First and foremost, Julie needs to identify which tasks are right to delegate, she should consider the following;
- What tasks are legally appropriate to delegate?
- Can I delegate the tasks as per my organization’s policies?
To answer these questions correctly, Julie would need to be familiar with the organizational and standard guidelines. Always remember, as a registered nurse, you have the duty to perform assessments, planning, and evaluation, and you should not delegate these tasks to anyone who is not a registered nurse.
Right Circumstances
After identifying the right tasks for delegation, here are some more factors for right circumstances that Julie should consider for delegation.
- Is there appropriate equipment available to complete this task?
- Does the delegate have appropriate supervision to perform the task?
- Is the environment favorable in this case to do the task?
To effectively answer these questions, Julie must assess her clients thoroughly. This is because there are patients with unpredictable and unstable conditions who do not qualify for task delegation. For example, you may find it appropriate that a UAP feeds a client who requires feeding assistance. However, if the client is at high risk of aspiration, delegating this task to a UAP is unsafe.
Right Person
If Julia has correctly identified the right task and circumstance, the next right of delegation is “right person.” The essential thing that Julia needs to identify here is whether the delegate has the required knowledge and experience of doing the task with safety and efficiency. With this, she also needs to know the delegate’s job description, credentials, and previous training.
It might be possible that Julie or any other delegator is unaware of the delegate’s job description and qualifications. Thus she needs to consider the following questions before delegating the task;
- Did the delegate receive training to do the task?
- Has the delegate performed this task on the patient before?
- Has the delegate completed the task without supervision?
- What problems did the delegate encounter while performing the task in the past?
Right Supervision
Nurse practice acts require RNs to provide appropriate supervision for all delegated tasks. In our case, Julie must ensure that she provides feedback to the delegate after the task is done. Besides, Julie is also responsible for evaluating the outcome of the task with the client. Note that as an RN, you are accountable for the evaluation and the overall outcome of your patients.
Right Direction and Communication
Finally, all delegators must provide the right and clear direction and communication to the delegate. You must communicate the performance expectations precisely and directly.
In the above case, Julie should never assume that the delegate knows what to do and how to do the task, even for the routine tasks. Instead, she should ensure that her delegate understands assigned tasks, directions, expectations, and limitations before doing it. Moreover, delegates should also comprehend what, when, and how to report back once the task is done. It is always effective to set deadlines for the delegated tasks if they are time-sensitive.
Result of the case study
Julie appropriately delegated the tasks and took care of her patients’ needs using the five rights of delegation. She delegated the linen changing to a trained UAP, and she entrusted her hourly rounds to her shift-charge nurse. Julie handled the client with the possibly infiltrated intravenous site first. After discovering that the site is infiltrated, she immediately removed the intravenous line, elevated the affected arm, and applied warm compression. She then delegated new intravenous line maintenance to an intravenous-certified coworker for the patient with infiltrated peripheral line. Meanwhile, she handled the task of pain medication administration to the person who complained of severe pain. Also, Julie was able to complete all her documentation by the end of the shift.
Clinical Significance of Delegation
The first question that might come to your mind is that if delegation is so challenging and legally charged, why should you delegate? Well, the answer for this is due to fiscal constraints, the nursing shortage, and patient care complexity that have led to the formation of an environment where delegation is needed.
For instance, you are on your shift, and due to an avoidable circumstance, most of your staff is absent. Due to a staffing crunch, you are taking care of 6 patients instead of 4 that you do on normal days. Similarly, there are 4 call lights that need to be attended to at a time. One patient needs a bed bath; the second patient needs a cup of tea, the third patient has developed a medication reaction, the fourth patient needs toilet assistance. In this case, the best approach would be to delegate the tasks and provide your service to the most critical patient. Such as dealing with medication reactions immediately. If appropriately used, delegation can significantly improve patient care outcomes.
Nursing Pearls
- Always remember that improper delegation can cause serious harm to your patient and expose you to legal action.
- Always keep in mind that patient safety must always be your priority.
- Think before you do; it means that before delegating any task, always keep in mind whether it is safe for the patient? Does the delegate understand what he has to do? Is he or she credentialed to do so?
- Use direct, honest, close-loop communication to ensure that your message is well understood and safe task performance. For example, instead of saying ” Please provide toilet assistance,” say, “Please take the patient (name or room number) to the bathroom within the next 10 minutes. Always set deadlines for your delegated tasks.
- Most of the time, the issue occurs when the tasks are delegated to UAPs. This is due to unclear delegation directions, lack of accountability and follow-through, and the failure of the registered nurse to obtain the agreement of the unlicensed assistive personnel.
When to not delegate a task?
Avoid delegating tasks that:
- Require a degree of risk and decision making that is unfair to the delegate
- Require your personal expertise
- Require your personal leadership
- Have legal restrictions
Examples of the task that should NOT be delegated to a UAP?
- Assessment, Planning, and Evaluation tasks.
- Medication administration
- Patient education and teaching
- Complex care tasks such as invasive procedures, reporting laboratory findings, receiving medications from the pharmacy, drug dose calculations.
- Complex documentation such as documenting nursing assessment findings. Critical lab results, Hand-offs, code documentation, medication documentation, etc.
Avoid delegating to the wrong person by using this mnemonic to remember “OH-CAST.”
- People who are already Overloaded.
- People who have other important, High-priority tasks requiring their attention.
- People who have not successfully Completed similar tasks.
- People who lack the Skills to complete the task successfully.
- People who lack the Time to complete the task successfully.