What minimum communication must take place when a task is being delegated

Delegation is a decision-making process that requires skillful nurse judgment. The decision to delegate should incorporate critical thinking and sound clinical decision making. The process outlined by the NCSBN (2005) starts with a preparation phase and then has a 4-step process phase. The steps are (1) assess and plan, (2) communication, (3) surveillance and supervision, and (4) evaluation and feedback.

In most cases, it is recommended that the nurse delegator and the delegate agree on the task, circumstances, and time frame and then arrange for feedback in which the delegate reports or the delegator evaluates progress toward completion of the task. One way to make certain that both delegator and delegate understand what the task is and how to complete it effectively is to follow up a verbal directive with written instructions so that each person can refer to them later. Figure 9-2 displays a sample delegation tracking form that can be generated by NAP to give to the nurse. As a vehicle for clear communication and verification of expectations and consensus, this form can be modified to be specific to each unit. The task should specify a time frame in which the entire task is to be completed. The decision to delegate needs to be consistent with the nursing process. Thus the nurse needs to ensure appropriate assessment, nursing diagnosis, planning, implementation, and evaluation in a continuous process.

Decisions to delegate need to be carefully and thoroughly evaluated. A reasonable first decision rule is to be able to delegate the care of clients whose care requirements are routine and standard. Because care is complex and variable, the competency of the delegate is critical. Once it is assessed that the person to be delegated to has the minimum competencies required for safe care and if the outcomes of care are relatively predictable, delegation is considered safe. If the client’s reaction to illness and hospitalization is not threatening to his or her mental health or sense of self, it also is relatively safe to assume that this care can be delegated to NAP. For example, a client experiencing an acute episode of hypertension would require the RN as opposed to NAP to monitor the vital signs.

In making a decision to delegate nursing tasks, the following five factors can be assessed (American Association of Critical Care Nurses [AACN], 2004):

The over-arching determinant for the decision to delegate is the legal scope of delegation as set forth in the state’s nurse practice act. With the qualifications of both the delegator and the delegate as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation. This includes supervision of the performance of the entire task, any necessary intervention, and evaluation of the task performance and the delegation itself.

The joint ANA and NCSBN (2006) statement identified nine principles of delegation specific to the RN, including the following:

The decision of whether to delegate or assign is based on the RN’s judgment concerning the condition of the patient, the competence of all members of the nursing team, and the degree of supervision that will be required of the RN if an element of care is delegated.

The RN uses critical thinking and professional judgment when following The Five Rights of Delegation promulgated by the NCSBN (1995) as follows:

When determining the right task (element of care) to delegate, the nurse determines whether the element of care falls within the guidelines of established agency policies and procedures, the ANA Code of Ethics, and legal regulations for practice. The nurse then must consider whether the element of care can be delegated to any other staff members.

The right circumstance to perform the element of care indicates the delegate has the available resources, equipment, safe environment, and supervision to complete the task correctly.

The right person has the education and competency to perform the element of care. The right delegate, then, is legally acceptable to complete the element of care.

The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions.

The right supervision of an element of care includes appropriate monitoring, intervention, evaluation, and feedback as deemed necessary. A process should be in place for the delegate to report to the RN both that the task was completed and the client’s response.

In addition to the five rights, the following three organizational principles are to be considered:

The five rights can quickly help analyze whether a delegation decision will most likely result in a safe outcome. To facilitate the delegation process in a way that will ensure the client’s personal health needs are addressed and the nurse’s professional goals are achieved, effective communication techniques must be used (Marthaler, 2003). Box 9-1 outlines a personal checklist for the delegator to use for self-evaluation.

The 5 Right-answers host with Delegation-baton

The 5 rights of delegation serve to guide appropriate transfer of responsibility for the performance of an activity or task to another person. These "rights" are defined as having the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation.

5 KEY FACTS