Many charge nurses find it difficult to delegate tasks to other members of their health care team. When done well, delegation can be a very effective management tool. It frees professional nurses to attend to more complex client needs, develop the skills of nursing assistive personnel and promote cost containment for the organization. Ineffective delegation or a lack of follow-up supervision for tasks delegated can result in errors or omissions of care. Effective delegation begins with a clear understanding of your professional responsibilities as a Registered Nurse.
Know your State Nursing Practice Act
Most states provide specific guidance about the delegation of nursing care in their professional practice acts and nursing administrative rules/regulations. The National Council of State Boards of Nursing describes delegation as the transfer of authority by a qualified nurse to a competent individual for the purpose of completing selected tasks or activities. The assignment should be based on the assessment of the patient’s needs and the scope of practice/skills of the individual to whom care is delegated.
The delegation can be to another RN, a Licensed Practical Nurse or Unlicensed Assistive Personnel. Follow-up guidance and supervision of care delegated is expected. In most states, activities that include the use of the nursing process or judgment/skills of the professional nurse (nursing assessment, diagnosis, plan of care, reassessment and evaluation of patient outcomes) can only be delegated to a Registered Nurse.
Steps in Delegation
Step One – Assessment and Planning
Goal – the Right Task, Under the Right Circumstances to the Right Person
- What are the needs and condition of the patient?
- What level of clinical decision making and assessment is needed?
- What is the predictability of the patient’s response to care?
- What is the potential for adverse outcomes associated with the performance of tasks and functions?
- What are the cognitive and technical abilities needed to perform the activity/function/task?
- Which team member has the scope of practice, skills, competencies and experience to perform the tasks needed?
- What is the context of the situation and the environment – was the patient just admitted or did they have recent surgery, is it a high acuity environment such as an intensive care unit or ER?
- What level of interaction/communication is needed in the care of the patient and with whom?
Step Two – Communication
Goal – the Right Direction
- How is the task to be accomplished?
- When and what information is to be reported?
- What is the process for seeking clarification about delegated care?
- What are the communication expectations in emergency situations?
Step Three – Supervision and Surveillance
Goal – the Right Supervision
- What level of supervision and observation does the charge nurse need to provide?
- What will be the frequency of monitoring and observing care?
- How will the completion of care be verified and documented?
- How will unexpected changes in a patient’s condition be managed?
Step Four – Observation and Feedback
Goal – Assessment of the Effectiveness of Delegation
- Was the delegation successful?
- Is there a better way to meet the needs of the patient?
- Is there a need to adjust the plan of care?
- Were there learning moments for staff or charge nurse?
- Was appropriate feedback and follow-up provided by the charge nurse?
During their shift of responsibility, charge nurses manage people, patient flow, use of equipment, and unit communication to ensure that the patients and staff get the support that they need. In order to manage all of these responsibilities, charge nurses must be able to effectively delegate and supervise care. The delegation of nursing care is both an art and a science. The science to delegation involves understanding licensure responsibilities from a legal standpoint and the policies of agencies where nurses work. The art of delegation involves effective communication with members of the health care team.