chapter 9 | Delegation of Client Care 117Delegation delineated by the National Council
of State Boards of Nursing (NCSBN) (Box 9-1).
■The RN recognizes that a relational aspect exists
between delegation and communication.
Communication needs to be culturally appropri-
ate, and the individual receiving the communi-
cation should be treated with respect.
■Chief nursing officers are responsible for
creating systems to assess, monitor, verify, and
communicate continuous competence require-
ments in areas related to delegation.
■RNs monitor organizational policies, procedures,
and job descriptions to ensure they are in
compliance with the nurse practice act, consult-
ing with the state board of nursing as needed
(ANA, 2005, p. 6).
Delegation may be direct or indirect.Direct delega-
tionis usually “verbal direction by the RN delegator
regarding an activity or task in a specific nursing
care situation” (ANA, 1996, p. 15). In this case, the
RN decides which staff member is capable of per-
forming the specific task or activity.Indirect delega-
tion is “an approved listing of activities or tasks that
have been established in policies and procedures of
the health care institution or facility” (ANA, 1996,
p. 15). The ANA also differentiated the delegation
of a task from the assignment of a task. Although
the terms are often used interchangeably, according
to the ANA (1996), assignment is the “downward
or lateral transfer of both the responsibility and the
accountability of an activity from one person to
another.” When one RN “delegates” to another RN,
that RN, based on knowledge and skill, may be
responsible and accountable. UAP may also be
assigned, rather than “delegated,” a task. For exam-
ple, UAP have the knowledge and skills required for
some routine tasks (Ellis & Hartley, 2004).
The recent changes occurring in the health-care
environment continue to modify the scope of nurs-
ing practice and the activities delegated to UAP. A
main concern in almost all health-care settings is
that UAP are performing inappropriate functions
that belong within the legal realm of nursing
(ANA, 2002).
Permitted tasks vary from institution to institu-
tion. For example, a certified nursing assistant
(CNA) performs specific activities designated by the
job description approved by the particular health-
care institution. Although the institution delineates
tasks and activities, this does not mean that the RN
cannot decide to assign other personnel in specific
situations. Take the following example:
Ms. Ross was admitted to the neurological unit
from the neuroscience intensive care unit. She suf-
fered a grade II subarachnoid hemorrhage 2 weeks
ago and has a left hemiparesis. She has diff iculty
with swallowing and receives tube feedings through
a percutaneous endoscopic gastrostomy (PEG) tube;
however, she has been advanced to a pureed diet.
She needs assistance with personal care, toileting,
and feeding. A physical therapist comes twice a day
to get her up for gait training; otherwise, the physi-
cian wants her in a chair as much as possible.
Assessing this situation, the RN might consider
assigning an LPN to this client. The swallowing
problems place the client at risk for aspiration,
which means that feeding may present a problem.
There is a potential for injury. The LPN is capable
of managing the PEG tube feeding. While assist-
ing with bathing, the LPN can perform range-
of-motion exercises to all the client’s extremities
and assess her skin for breakdown. The LPN also
knows the appropriate way to assist the client in
transferring from the bed to the chair. The RN may
not assign an individual to perform a task or activ-
ity not specified in that person’s job description
or within the scope of practice, such as allowing
a nursing assistant to administer medications or
perform certain types of dressing changes.Supervision
Do not confuse delegation with supervision.
Supervision is more direct and requires directly
overseeing the work or performance of others.
Supervision includes checking with individuals
throughout the day to see what activities have been
completed and what may still need to be finished.
For example, a nursing assistant has been assigned
to take all the vital signs on the unit and give the
morning baths to eight clients. Three hours into
the morning, she is far behind. At this point, it isbox 9-1
The Five Rights of Delegation
1.Right task
2.Right circumstances
3.Right person
4.Right direction/communication
5.Right supervision/evaluation