Nursing Delegation

Nursing Delegation

Nursing Delegation: Leaders’ Guidance and Support Can Help Nurses Avoid Liability

A reader asked me about nursing delegation of duties and why it can be such a dilemma for nurses during their breaks.

It’s natural for a charge nurse to question his or her work situation when the employer requires a 30-minute unpaid lunch. The policy allows the nurse to leave the premises for the break, but the nurse must delegate his or her assignment to another nurse. And if the lunch break is not taken, the nurse faces a write up. This situation is a quandary for nurses because there are often no other nurses on the unit who can take over patient care.

Delegation in nursing has always been a liability concern for nurses. And the scarcity of licensed nurse colleagues or assistive personnel to whom a nurse can delegate makes matters very difficult.

These Guidelines Can Help

The American Nurses Association and the National Council of State Boards of Nursing issued a joint position statement, the National Guidelines for Nursing Delegation, to help “standardize the nursing delegation process based on research findings and evidence.”

The guidelines discuss nurses’ roles and responsibilities in delegating such as:

  • Nurses are responsible for knowing about what their state nurse practice act and regulations say about delegation.
  • A licensed nurse is responsible for making sure any delegated assignment is carried out completely and correctly. This means that the delegator is accountable for the delegation.
  • The Five Rights of Delegation must be adhered to.
  • Clinical reasoning, nursing judgment, or critical decision making cannot be delegated.

Some of the employer/nursing leader responsibilities include:

  • Policies and procedures specific to delegation and delegated responsibilities must be developed within the healthcare institution.
  • Nurse leaders who are responsible for overseeing delegation must be identified by the employer. This nurse leader identifies which nursing duties may be delegated, to whom, and under what circumstances.

Some of the licensed nurse responsibilities include:

  • Determining when and what to delegate.
  • Following up with the delegatee and the patient after a delegation activity is completed.
  • Communicating to the delegatee the information about the patient and his or her care requirements.

Who Bears the Responsibility?

As the guidelines indicate, policies and procedures should be in place to help nursing staff make appropriate delegation decisions.

The CNO or other nurse leaders in the RN’s facility need to be informed of the choice this RN (and probably others in the facility) face on a regular basis so that guidance is provided by established policies and procedures within that facility.

In addition to informing the CNO or other nurse leaders of the difficulty in delegating patient care when no qualified staff member is on duty at the time, the “punishment factor”— the write-up — needs to be eliminated.

In most instances, RNs will choose to forgo the break rather than place their patients at risk of harm from a colleague that is not competent to provide the care needed during the break. This is a wise decision from a potential liability perspective, but not helpful in the long run.

The risk manager also needs to be informed of the dilemma RNs face. Because risk management is intended to reduce the risk of financial loss to the facility, the risk manager needs to be involved to resolve any issues with nursing delegation so the facility does not face a lawsuit because of negligent delegation and negligent care.

As the guidelines say, “delegation should be assigned based on the nurse’s judgment regarding the patient’s condition, competence of the nursing team, and the degree of supervision required of that nurse.” But it takes the whole team to make sure every obstacle to proper delegation has been removed.

Be sure you understand your role in delegating care by reading your facility’s policy, the national guidelines, your professional organization’s position paper on delegation, and your state nurse practice act and rules. Then, incorporate those principles into your practice when you delegate to others on your nursing staff.

Take these courses related to delegating duties:

Protect Yourself
(1 contact hr)

Nurses have an obligation to keep abreast of current issues surrounding the regulation of the practice of nursing, not only in their respective states, but also across the nation, especially when their nursing practice crosses state borders. Because the practice of nursing is a right granted by a state to protect those who need nursing care, nurses have a duty to patients to practice in a safe, competent and responsible manner. This requires a nurse licensee to practice in conformity with their state’s statute and regulations. This course outlines information about nurse practice acts and how they affect nursing practice.

Delegating to Unlicensed Assistive Personnel
(1 contact hr)

The skill and art of delegation for effective use of unlicensed assistive personnel (UAP) is a critical nursing competency, yet many nurses remain uncomfortable with delegation. This educational activity will address the role of delegation in providing quality care in a collaborative environment and will provide strategies for effective delegation.

Lines of Communication
(1 contact hr)

From taking an order over the telephone to handing off a patient to another department, all healthcare professionals face situations every day involving potential communication problems. This module discusses the importance of clear, accurate, and timely communication, both oral and written, in providing safe and effective care to patients. It reviews unacceptable medical abbreviations, acronyms and symbols, handoff communication, and timely and accurate reporting of critical test results.