116 unit 2 | Working Within the Organization
Linda is a new graduate and has just f inished her
orientation. She works from 7 p.m. to 7 a.m. on a
busy, monitored neuroscience unit. The client census
is 48, making this a full unit. Although there is an
associate nurse manager for the shift, Linda is the
charge nurse. Her responsibilities include receiving
and transcribing orders, contacting physicians with
any information or requests, accessing laboratory
reports from the computer, reviewing them and giv-
ing them to the appropriate staff members, checking
any new medication orders and placing them in the
appropriate medication administration records,
relieving the monitor technician for dinner and
breaks, and assigning staff to dinner and breaks.
When Linda comes to work, she discovers that one
registered nurse (RN) called in sick. She has two
RNs and three unlicensed assistive personnel (UAP)
for staff. She panics and wants to refuse to take
report. After a discussion with the charge nurse from
the previous shift, she realizes that not taking report
is not an option. She sits down to evaluate the acu-
ity of the clients and the capabilities of her staff.Introduction to Delegation
Delegation is not a new concept. In her Notes on
Nursing, Florence Nightingale (1859) clearly
stated: “Don’t imagine that if you, who are in
charge, don’t look to all these things yourself, those
under you will be more careful than you are....” She
continued by directing, “But then again to look to
all these things yourself does not mean to do them
yourself. If you do it, it is by so much the better
certainly than if it were not done at all. But can you
not insure that it is done when not done by your-
self? Can you insure that it is not undone when
your back is turned? This is what being in charge
means. And a very important meaning it is, too.
The former only implies that just what you can do
with your own hands is done. The latter that what
ought to be done is always done. Head in charge
must see to house hygiene, not do it herself ” (p. 17).
Definition of Delegation
By definition, delegation is the reassigning of
responsibility for the performance of a job from
one person to another (American Nurses
Association [ANA], 1996). RNs maintain account-
ability for supervising those to whom tasks are del-
egated (ANA, 2005). Although the responsibility
for the task is transferred, the accountability for the
process or outcome of the task remains with the
delegator, or the person delegating the activity.
Nightingale referred to this delegation responsibil-
ity when she inferred that the “head in charge” does
not necessarily carry out the task but still sees that
it is completed.
An assignment is not the same as delegation.
In an assignment, power is not transferred.
Assignments refer to practical or routine functions
that are part of a job description or client needs.
For example, the team leader assigns three clients
to the licensed practical nurse (LPN). That is part
of the job description for the LPN. However, giv-
ing medications to all the clients on the team is a
delegated responsibility.
According to the ANA, specific overlying prin-
ciples remain firm regarding delegation. These
include the following:■The nursing profession delineates the scope of
nursing practice.
■The nursing profession identifies and supervises
the necessary education, training, and use of
ancillary roles concerned with the delivery of
direct client care.
■The RN assumes responsibility and accountabil-
ity for the provision of nursing practice.
■The RN directs care and determines the
appropriate utilization of any ancillary personnel
involved in providing direct client care.
■The RN accepts assistance from ancillary nurs-
ing personnel in delivering nursing care for the
client (ANA, 2005, p. 6).Nurse-related principles are also designated by the
ANA. These are important when considering what
tasks may be delegated and to whom. These princi-
ples are:■The RN has the duty to be accountable for
personal actions related to the nursing process.
■The RN considers the knowledge and skills of
any ancillary personnel to whom aspects of care
are delegated.
■The decision to delegate or assign is based on
the RN’s judgment regarding the following: the
condition of the client; the competence of the
members of the nursing team; the amount of
supervision that will be required of the RN if a
task is delegated.
■The RN uses critical thinking and professional
judgment when following the Five Rights of