Registered nurses (RNs) are responsible for many patients in their care. In any nursing unit, the registered nurses take care of the patients. Countless times, there are many patients who need extensive and delicate care at the same time, so how can one individual take care of everything? The answer is that they can’t, and RNs need their teams to accomplish all the care, administrative, communication, and educational tasks, and they need the best team to do it. This is where RN delegation comes in.
Delegating is one of the most complicated leadership qualities because it involves not only telling others what they are going to do but letting go of responsibility, even for a short time, and they have to trust that someone else can do tasks just as well as they can. To achieve this goal, and because the responsibility for all these tasks remains with them as the head of the team, they need to have trained those they are in charge of well, and they need to have enough hands, confidence in their team members, and clarity in their instructions. Although the feeling that others will not carry out tasks as well as they themselves would may still be present, delegating is the art of getting others to do tasks as well or better than the charge nurse would do them.
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What Is Nursing Delegation?
According to the ANA’s (American Nursing Association’s) Principles for Delegation for registered nurses, nursing delegation is the assignment of patient care activities and/or tasks to nursing personnel who are present to assist, without the registered nurse losing responsibility for the assignment; in other words, the registered nurse retains full responsibility for the patient at all times. This is why the document also describes that tasks requiring nursing judgments should not be delegated.
Nursing delegation is a vital part of nursing, as its absence means being unable to complete many patient care tasks, which is detrimental to everyone in the healthcare facility where the RN works.
What Are the 5 Rights of Delegation?
There are five rights of delegation in nursing. To safely assign care tasks, these five rights of delegation involve assigning the right person to the right task or job in the right circumstances. The RN delegating the tasks or jobs must communicate in the right way what needs to be done and must correctly monitor and evaluate that these tasks have been done properly. In summary, we are talking about the following:
- The Right Person
- The Right Task or Job
- The Right Circumstance
- The Right Directions and Communication
- The Right Supervision and Evaluation
When the five rights of the delegation are combined, the nursing delegation is successful—at least in all the steps that a registered nurse must take.
Who Does an RN Delegate Tasks To?
Registered nurses can and should delegate patient care tasks to the rest of the nursing professionals or healthcare teams that they are in charge of supervising. Generally, this involves both certified nursing assistants (CNAs) and licensed practical nurses (LPNs), although sometimes it may be other healthcare professionals as well.
The task that RNs delegate should always be within the capability of those who will be in charge of the task—the right person for the task—and at the time of delegation, it should be clear what the task is through the right directions and communication for that person. Through practice, delegating will become easier, and the people RNs supervise will also learn what their responsibilities are and what to do when they must fulfill a delegated function.
What Do I Do When a Task I Delegate Is Not Complete?
When a task has not been completed after being delegated, the RNs should offer constructive criticism to the staff member to whom they delegated the task. It is a very stressful situation to delegate and trust someone and then discover that a task will not be completed in time, so the RNs will need to take responsibility for this task, and often this involves either completing it themselves, taking responsibility for the fact that it could not be completed and covering the need in some other way, or facing the consequences of it not being done properly. For this reason, it is also important to use words of praise when tasks are performed correctly and on time, and always make sure that those who are performing the tasks have all the necessary tools, knowledge, and motivation.
There are many ways to approach the motivation needed when RNs delegate. As mentioned previously, praise, when tasks are completed correctly, might be one. Also, RNs can motivate their teams by clearly defining the desired outcome—for example, by communicating that if the patient has good nutrition, they can have better mood and strength for their day, CNAs will be able to feed the patients in their care more attentively and lovingly.
Allowing for failure and being patient will especially help RNs achieve greater and greater task delegation by building self-esteem and skills in their staff. Having clear rules from the beginning and demonstrating authority without forgetting to offer praise when tasks are well done are also important for effective delegation.
What Should an RN Know about Delegation?
RNs can delegate elements of care but cannot delegate the nursing process—neither can they assume that their team has the knowledge and tools necessary to do this process. That is why RNs should be aware of the skills present in their team while also taking into account that they should not delegate in the following cases:
- When the assignment is not within the team member’s scope of practice—in other words, when they do not have sufficient knowledge.
- When the healthcare facility in which RNs work does not allow them to delegate certain tasks.
- When the RNs cannot supervise the delegated task.
- When there are no clear rules, steps, or sufficient protocols for this task—in other words, when it is not clear what needs to be done and the RN must make the decisions as a nurse in this regard.
- When a patient’s life is at risk in any way, for example, when the patient needs specific care that only an RN can provide.
- When there are not enough nursing professionals in the team to delegate tasks to.
It is important to take into account all these aspects and delegate only when there are no associated risks, to be able to delegate without problems that put the integrity of the healthcare facility, the patient, and the RNs in charge at risk.
However, it is also important to know that when there are tasks to delegate, and the staff is trained to do so, it is the responsibility of the RNs to delegate the tasks and supervise them promptly.
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Who Is Responsible for Nursing Care and Treatments?
Registered nurses should know that they are responsible for creating a plan of care specific to each patient’s needs. Nursing care and treatment is a formal process that involves the following components:
- Assessment
- Diagnosis
- Expected outcomes
- Interventions
- Evaluation
When delegating, RNs must keep in mind that all outcomes that come from nursing care are their responsibility.
Often being able to delegate depends a lot on the workspace that the RNs have. This is why it is important to always have sufficient nursing staff in healthcare facilities. This situation has been worsening over time due to the large nursing shortages that have existed in recent years, but this shortage can be solved through PRN (pro re nata) hiring (also called per diem nursing jobs). Healthcare facilities that need extra nurses can cover their needs by hiring highly qualified people for delegation duties at their facilities simply by posting the shifts they have available and quickly filling these shifts without major problems.
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