Guidelines to Effective Nursing Delegation
Delegation is defined as to entrust to another or to assign responsibility. A key part of the definition is contained in the word "entrust". For delegation to occur, trust must be present. The trust that the RN has in the other staff member will determine what and how much he or she is willing to delegate. Also, those who delegate must also have trust in their own decision-making ability.
Delegation is a legal and management concept, an art and a skill, and a decision-making process. Delegation is never absolute; the delegator retains final accountability for the delegation decision-making process, and for the results of the delegation. It is essential to remember that scope of practice for any provider of nursing care should be built on a foundation of beginning, entry level practice. RNs and LPNs should ideally concentrate on performance of entry-level skills during the first 6-12 months of practice. It is during this time period that the nurse often learns the essential skills of time human resource management, and is able to better fine-tune skills and develop confidence in his/her nursing abilities.
The RN has significant responsibility as a supervisor of delegated or assigned activities. Each person involved in this process is accountable for his or her own actions or inaction and is potentially liable if competent and safe care is not provided. Certainly, the educational preparation and demonstrated ability of the person who will perform the designated act must be evaluated by the RN making the decision to delegate tasks to others. Inappropriate delegation may be specifically stated as grounds for disciplinary action by your Board of Nursing.
The decision to delegate essentially involves the use of the nursing process, i.e., appropriate assessment of the circumstances (staff available and patient acuity), planning, implementation, and evaluation by the delegator. It is up to the RN to make a professional judgment based upon the information available to him/her in each specific situation.
General guidelines in terms of delegation include the following:
1. Delegation of acts beyond those taught in the basic educational program for the LPN should be based upon a conscious decision of the RN. The decision to delegate should not be automatic nor should it be based solely on length of experience. It cannot be assumed that because someone has been a nurse for X number of years that he/she is competent in a task.
2. Records of any educational activities, inservices, etc. which provide additional information beyond entry level must be maintained by the employer and the employee. Records should contain an outline of the education content and documentation which indicates that the staff member achieved the educational objectives and demonstrated the desired skills.
3. Practice must be limited to those activities addressed in the written policies and procedures of the agency. It is important for the employer to have in its job descriptions and policies functions that the LPN or unlicensed person will be expected to perform.