chapter 9 | Delegation of Client Care 121others” (p. 1). In 2005, the ANA defined delegation
as “the transfer of responsibility for the performance
of an activity from one individual to another while
retaining accountability for the outcome” (p. 4). To
delegate tasks safely, nurses must delegate appropri-
ately and supervise adequately.
In 1997 the NCSBN developed a Delegation
Decision-Making Grid. This grid is a tool to help
nurses delegate appropriately. It provides a scoring
instrument for seven categories that the nurse
should consider when making delegation decisions.
The categories for the grid are listed in Box 9-2.
Scoring the components helps the nurse evalu-
ate the situations, the client needs, and the health-
care personnel available to meet the needs. A low
score on the grid indicates that the activity may be
safely delegated to personnel other than the RN,
and a high score indicates that delegation may not
be advisable. Figure 9.2 shows the Delegation
Decision-Making Grid. The grid is also available
on the NCSBN Web site at ncsbn.com
Nurses who delegate tasks to UAP should eval-
uate the activities being considered for delegation
(Keeney, Hasson, & McKenna, 2005). The
American Association of Critical Care Nurses
(AACN) (1990) recommended considering five
factors, which are listed in Box 9-3, in making a
decision to delegate.
It is the responsibility of the RN to be well
acquainted with the state’s nurse practice act and
regulations issued by the state board of nursing
regarding UAP (ANA, 2005). State laws and regu-
lations supersede any publications or opinions set
forth by professional organizations. As stated earlier,
the NCSBN provides criteria to assist nurses
with delegation.
LPNs are trained to perform specific tasks, such
as basic medication administration, dressing
changes, and personal hygiene tasks. In some states,
the LPN, with additional training, may start and
monitor intravenous (IV ) infusions and administer
certain medications.Criteria for Delegation
The purpose of delegation is not to assign tasks to
others that you do not want to do yourself. When
you delegate to others effectively, the result is you
have more time to perform the tasks that only a
professional nurse is permitted to do.
In delegating, the nurse must consider both the
abilityof the person to whom the task is delegated
and the fairnessof the task to the individual and
the team (Tappen, Weiss, & Whitehead, 2004). In
other words, both the task aspectsof delegation
(Is this a complex task? Is it a professional respon-
sibility? Can this person do it safely?) and the
interpersonal aspects(Does the person have time to
do this? Is the work evenly distributed?) must be
considered.
The ANA (2005) has specified tasks that RNs
may not delegate because they are specific to the
discipline of professional nursing. These activities
include (Boysen & Fischer, 2000):
■Initial nursing and follow-up assessments if
nursing judgment is indicated
■Decisions and judgments about client outcomes
■Determination and approval of a client plan of
care
■Interventions that require professional nursing
knowledge, decisions, or skills
■Decisions and judgments necessary for the
evaluation of client careTask-Related Concerns
The primary task-related concern in delegating
work is whether the person assigned to do the task
has the ability to complete it. Team priorities and
efficiency are also important considerations.Abilities
To make appropriate assignments, the nurse needs
to know the knowledge and skill level, legal defi-
nitions, role expectations, and job description
for each member of the team. It is equally impor-
tant to be aware of the different skill levels ofbox 9-2
Seven Components of the Delegation
Decision-Making Grid- Level of client acuity
- Level of unlicensed assistive personnel capability
- Level of licensed nurse capability
- Possibility for injury
- Number of times the skill has been performed by the
unlicensed assistive personnel - Level of decision making needed for the activity
- Client’s ability for self-care
Adapted from the National Council of State Boards of Nursing. Delegation
Decision-Making Grid.National State Boards of Nursing, Inc., 1997
(ncsbn.org).