Nursing Five Rights of Delegation


Article Author:
Jennifer Barrow


Article Editor:
Sandeep Sharma


Editors In Chief:
Susan Johnson
Alexandra Caley


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
7/30/2019 3:40:12 PM

Introduction

Many definitions for delegation exist in professional literature. One of the most commonly cited definitions of the word was jointly established by the American Nurses Association and the National Council of State Boards of Nursing. These groups describe delegation as the process for a nurse to direct another person to perform nursing tasks and activities. Delegation involves at least two individuals: the delegator, and the delegatee. The delegator is a registered nurse who distributes a portion of patient care to the delegatee.

Essential Components of Delegation

Responsibility

Based on individual states’ nurse practice acts, registered nurses have a professional duty to perform patient care tasks dependably and reliably.

Authority

Authority refers to an individual’s ability to complete duties within a specific role. This authority derives from nurse practice acts and organizational policies and job descriptions.

Accountability

Accountability within the nursing context refers to nursing professionals’ legal liability for their actions related to patient care. During delegation, delegators transfer responsibility and authority for completing a task to the delegatee; however, the delegator always maintains accountability for the task's completion. The registered nurse is always accountable for the overall outcome of delegated tasks based on each state's nurse practice act provisions.

Possible legal and ethical constraints arise regarding delegation in nursing. Therefore, the American Nurses Association developed the five rights of delegation to assist nurses in making safe decisions.

Five Rights of Delegation

  • Right task
  • Right circumstance
  • Right person
  • Right supervision
  • Right direction and communication[1]

Issues of Concern

Five Rights of Delegation Case Study Approach

Mark is a new graduate registered nurse who has recently completed nursing orientation. He is now on his second week of non-precepted practice on a busy medical-surgical unit. During the middle of his busy night shift, Mark has several tasks that need to be completed quickly. These tasks include a linen change for a patient who just vomited, an assessment of a possibly infiltrated intravenous line, and the administration of intravenous pain medication for a patient who rates her pain 10 out of 10. Mark also needs to make hourly rounds within the next few minutes, and he is very behind on his charting. He knows he must delegate some of the tasks to his coworkers. However, Mark is unsure what he can delegate and to whom. He decides to use the five rights of delegation to help with his delegation decisions.

Right tasks

First, Mark needs to determine which tasks are right to delegate. Some questions he may ask at this time would include (1) which tasks are legally appropriate to delegate and (2) can I delegate these tasks based on this organization’s policies and procedures? Correctly answering these questions will require familiarity with institutional and nurse practice act guidance. Generally, registered nurses are responsible for assessment, planning, and evaluation within the nursing process. These actions should not be delegated to someone who is not a registered nurse.[2]

Right circumstances

After determining the right tasks for delegation, Mark considers the right circumstances of delegation. In so doing, Mark may ask the following questions: (1) are appropriate equipment and resources available to perform the task, (2) does the delegatee have the right supervision to accomplish the task, and (3) is the environment favorable for delegation in this situation? To appropriately answer these questions, it is imperative that Mark completes an assessment on each client. Patients who are or may become unstable and cases with unpredictable outcomes are not good candidates for delegation. For example, it may be appropriate for unlicensed assistive personnel to feed patients requiring assistance with the activities of daily living. However, if a patient has a high risk for aspiration and a complicated specialty diet, delegation of feeding to unlicensed assistive personnel may not be safe.

Right person

If a task and circumstance are right for delegation, the next “right” of delegation is the right person. Mark needs to consider if the potential delegatees have the requisite knowledge and experience to complete delegated tasks safely, especially concerning the assessed patient acuity. Before delegating a task, the registered nurse must know the delegatee’s job description and previous training. Mark may be unsure about his potential delegatee’s qualifications. Therefore, he might ask the following questions before delegating a task: (1) have you received training to perform this task, (2) have you ever performed this task with a patient, (3) have you ever completed this task without supervision, and (4) what problems have you encountered in performing this task in the past?

Right supervision              

The right supervision must be available in all delegation situations. Nurse practice acts require the registered nurse to provide appropriate supervision for all delegated tasks. In the case study, Mark must be sure that the delegatee will provide feedback after the task is complete. Following task completion, Mark is responsible for evaluating the outcome of the task with the patient. Registered nurses are accountable for evaluation and the overall patient outcomes.

Right direction and communication                

Finally, the delegator must give the right direction and communication to the delegatee. All delegators must communicate performance expectations precisely and directly.[3] Mark should not assume that his delegatee knows what to do and how to do it, even for routine tasks. Mark must consider whether the delegatee understood the assigned task, directions, patient limitations, and expected outcomes before the delegatee assumes responsibility for it. The delegatee also must comprehend what, how, and when to report back after the delegated task is complete. Delegatees also need a deadline for task completion for time-sensitive tasks.[4]

Using the five rights of delegation, Mark appropriately took care of his patients’ needs. Mark delegated the linen change to trained unlicensed assistive personnel, and he entrusted his hourly rounds to his shift charge nurse. Mark opted to assess the patient with a possibly infiltrated intravenous site first. Upon finding the site infiltrated, he assessed his patient, removed the intravenous line, and placed a warm compress on the patient’s elevated extremity. He then administered another patient’s requested pain medications after delegating new intravenous catheter placement to an intravenous-certified coworker for the patient with the infiltration. Mark was able to complete all his documentation requirements by the end of his shift.

Clinical Significance

Reasons Delegation is Necessary for the Modern Health Care Environment

If delegation decisions are so challenging and legally charged, why should nurses delegate? Fiscal constraints, nursing shortages, and increases in patient care complexity have cultivated an environment in which delegation is necessary. If appropriately used, delegation can significantly improve patient care outcomes.

Improper Delegation

Improper delegation can negatively impact patient care while also potentially exposing the delegator to legal action.[5] All members of the health care team have valuable contributions to make toward safe, effective patient care.

Essentials of Communication

While employing the five rights of delegation in nursing practice, it is important to remember that the way the delegator asks the delegatee to perform a task can make a big difference. The delegator must use direct, honest, open, closed-loop communication to encourage teamwork and safe task performance.[6] Of the five rights of delegation, the right communication and direction are arguably the most important in ensuring good quality and safety outcomes.[7] Common delegation deficiencies for registered nurses occur when delegating tasks to unlicensed assistive personnel. These include unclear delegation directions from the registered nurse, a lack of retained accountability and follow-through, and the failure of the registered nurse to obtain the agreement of the unlicensed assistive personnel.[8]


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Nursing Five Rights of Delegation - Questions

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Which of the following applies to the five rights of delegation in caregiving?



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Which of the following is the term described by the National Council of State Boards of Nursing (NCSBN) as "being responsible and answerable for actions or inactions of self or others in the context of delegation"?



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Which of the following is the National Council of State Boards of Nursing (NCSBN) description of Unlicensed Assistive Personnel (UAP)?



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Which of the following is the National Council of State Boards of Nursing (NCSBN) definition of "right task"?



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Which one of the following five rights of delegation is the "clear, concise description of the task, including its objectives, limits, and expectations?"



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Which of the following does not apply to delegation?



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Which of the following is the assignment to a person or group on behalf of an individual, organization, or government?



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Which of the following is not true of delegation?



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Which is most true of delegation?



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Which self-limiting factor do some managers face when delegating tasks?



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Which of the following is the most important factor a manager must consider when delegating a task?



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Select the choice that best describes delegation according to the ANA:



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You are supervising a nurse's assistant in training. Which of the following may you delegate?



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Which of the following is the correct ANA definition for the term "Delegation of Care"?



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Which of the following are necessary when engaging in delegation?



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Which of the following was NOT included in the ANA's published "The Five Rights of Delegation" in 1997?



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An RN is trying to coordinate care with a nursing team that includes an LPN/LVN and a certified nursing assistant (CNA). Which of these patients should be assigned to the CNA?



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A registered nurse (RN) is in charge of a team with a licensed practical nurse (LPN), licensed vocational nurse (LVN), and unlicensed assistive personnel (UAP). Which of the following clients should be cared for by the RN?



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A patient has generalized weakness secondary to chemotherapy. Which of the following tasks can be done by a nursing assistant?



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Which task is appropriate for a licensed nurse to delegate to an unlicensed assistive personnel (UAP)?



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A registered nurse is assigning tasks to an LPN/LVN. Which of the following would be most appropriate?



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A registered nurse and an LPN/LVN are working together. Which of the following patients should be assigned to the LPN/LVN?



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Rounding on patients is an essential part of task delegation. After morning report, a nurse and nursing assistive personnel (NAP) approach the rooms of a young female who is one-hour postoperative and needs her vital signs measured, a male who has a fresh ileostomy and needs a pouch placed, a patient with a chest tube where the dressing is loose, and a patient requiring a condom catheter replacement who has no allergies. Which task would the nurse delegate to the NAP?



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An unlicensed assistive personnel (UAP), who is part of a team with a newly licensed nurse, has questions regarding safe delegation of tasks. Which tasks are not appropriate to delegate to a UAP?



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A nurse is rounding with an unlicensed assistive personnel (UAP) and discussing tasks that need to be divided up and completed. The delegation of tasks must be safe and appropriately carried out. What task meets the requirements to delegate to a UAP?



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A nursing instructor is educating a group of new nursing students on safe delegation practices. Tasks that can not be delegated to an unlicensed assistive personnel (UAP) and are a nursing responsibility include highly specialized skills or judgment involving complex or unstable patients as well as new post op patients. Which of the following is a highly specialized skill that can not be delegated to a UAP?



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A postoperative client has a near syncopal episode attempting to ambulate to the bathroom. Which of the following may the registered nurse (RN) delegate to the licensed practical nurse or licensed vocational nurse (LPN/LVN)? Select all that apply.



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The neonatology unit is short staffed, and an inexperienced pediatric nurse is temporarily floated to the unit. Which of the following clients can be safely assigned to this nurse? Select all that apply.



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A patient has returned from the operating room status post open gallbladder removal. Which of the following activities may be delegated from the registered nurse (RN) to the licensed practical/vocational nurse (LPN/LVN)? Select all that apply.



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Which of the following is within the Five Rights of Delegation for nursing from a registered nurse (RN) to a licensed practical nurse or licensed vocational nurse (LPN/LVN)? Select all that apply.



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A client is in the hospital and care is being provided by a team of a registered nurse (RN) and a licensed vocational or practical nurse (LVN/LPN). Which actions should only be performed by the RN? Select all that apply.



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A night shift nurse is in charge of six clients in an orthopedic unit. An unlicensed assistive personnel (UAP) is assisting with the client load. Which tasks delegated by the nurse to the UAP are appropriate and within their scope of practice? Select all that apply.



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A nurse is working in a busy emergency department. An unlicensed assistive personnel (UAP) has been assigned to assist in client care on the nurse's team. Which tasks cannot be delegated to the UAP? Select all that apply.



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The team leader, a registered nurse (RN), is working with a licensed practical nurse (LPN), licensed vocational nurse (LVN), and unlicensed assistive personnel (UAP) on a telemetry unit. The client load consists of a plethora of diagnoses and demographics. Regarding safe assignment and delegation tactics, which of the following are appropriate examples of dividing up the workload and care to the appropriate team member? Select all that apply.



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Delegation is part of time management and delivery of care. Unlicensed assistive personnel (UAP) are essential members of the healthcare team, often carrying out delegated tasks. Which tasks can be delegated safely to a UAP? Select all that apply.



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The Five Rights of Delegation incorporate certain safety principles. Knowing what tasks can be safely delegated by a registered nurse (RN) to a licensed practical or vocational nurse (LPN/LVN) is a part of the practice of delegation. Which of the following can be delegated to an LPN/LVN? Select all that apply.



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Which of the following duties can a nurse delegate to an unlicensed assistive personnel (UAP)? Select all that apply.



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A newly graduated registered nurse who has recently completed nursing orientation is now in their second week of practice without direct supervision from a preceptor. During the middle of a shift, the novice nurse has several tasks that need to be completed immediately, including a linen change for a client who just suffered an episode of urinary incontinence, assessment of a possibly infiltrated intravenous (IV) line, and administration of IV pain medication for a client who rates their pain level as 10/10 and is a day post-op. The novice nurse is way behind on charting and must make scheduled rounds. The nurse knows they must delegate some of the tasks to their coworkers, but is unsure about what and to whom the tasks can be delegated safely. How should the novice nurse proceed? Select all that apply.



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Nursing Five Rights of Delegation - References

References

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