118 unit 2 | Working Within the Organization
important that the RN discover why. Perhaps one
of the clients required more care than expected, or
the nursing assistant needed to do an errand off the
floor. Reevaluation of the assignment may be nec-
essary. When one RN works with another, then
supervision is not needed. This is a collaborative
relationship and includes consulting and giving
advice when needed.
Individuals who supervise others also delegate
tasks and activities. Chief nursing officers often
delegate tasks to associate directors. This may
include record reviews, unit reports, or client
acuities. Certain administrative tasks, such as staff
scheduling, may be delegated to another staff
member, such as an associate manager. The chief
nursing officer remains accountable for ensuring
the activities are completed.
Supervision sometimes entails more direct
evaluation of performance, such as performance
evaluations and discussions regarding individual
interactions with clients and other staff members.
Regardless of where you work, you cannot
assume that only those in the higher levels of the
organization delegate work to other people. You,
too, will be responsible at times for delegating some
of your work to other nurses, to technical person-
nel, or to another department. Decisions associated
with this responsibility often cause some difficulty
for new nurses. Knowing each person’s capabilities
and job description can help you decide which
personnel can assist with a task.
The Nursing Process and Delegation
Before deciding who should care for a particular
client, the nurse must assess each client’s particular
needs, set client-specific goals, and match the skills
of the person assigned with the tasks that need to
be accomplished (assessment). Thinking this
through before delegating helps prevent problems
later (plan). Next, the nurse assigns the tasks to the
appropriate person (implementation). The nurse
must then oversee the care and determine whether
client care needs have been met (evaluation).It is
also important for the nurse to allow time for feed-
back during the day. This enables all personnel to
see where they are and where they want to go.
Often, the nurse must first coordinate care for
groups of clients before being able to delegate tasks
to other personnel. The nurse also needs to consider
his or her own responsibilities. This includes assisting
other staff members with setting priorities, commu-
nicating clearly, clarifying instructions, and reassess-
ing the situation.
In 1995 the NCSBN published a paper address-
ing the issue of delegation. The NCSBN developed
a concept called the Five Rights of Delegation (see
Box 9-1), similar to the five rights regarding
medication administration. In 2006 the NCSBN,
along with the ANA, prepared a joint statement on
delegation that clarified the profession’s practice
guidelines and the legal requisites for delegation.
Before being able to delegate tasks and activities to
other individuals, however, the nurse must under-
stand the needs of each client.Coordinating Assignments
One of the most difficult tasks for new nurses to
master is coordinating daily activities. Often, you
have clients for whom you provide direct care, and
you must supervise the work of others, such as non-
nurse caregivers, LPNs, or vocational nurses.
Although care plans, critical (or clinical) pathways,
concept maps, and computer information sheets are
available to help identify client needs, these items
do not provide a mechanism for coordinating the
delivery of care. To do this, personalized work-
sheets can be developed that prioritize tasks to per-
form for each client. Using the worksheets helps
the nurse identify tasks that require the knowledge
and skill of an RN and those that can be carried out
by UAP.
On the worksheet, tasks are prioritized on the
basis of client need, not nursing convenience. For
example, an order states that a client is to receive
continuous tube feedings. Although it may be con-
venient for the nurse to fill the feeding container
with enough supplement to last 6 hours, it is not
good practice and not safe for the client. Instead,
the nurse should plan to check the tube feeding
every 2 hours.
As for Linda at the beginning of the chapter, a
worksheet can help her determine who can do
what. First, she needs to decide what particular
tasks she must do. These include receiving and
transcribing orders; contacting physicians with
information or requests; accessing laboratory
reports from the computer, reviewing them, and
giving them to the appropriate staff members; and
checking any new medication orders and placing
them in the medication administration records.
Another RN may be able to relieve the monitor