Delegation and supervision: Nursing

Nurse Kai works at a long-term care facility and is assigned to care for 10 clients on the evening shift. There are two unlicensed assistive personnel, or UAPs, also working this shift: Nursing Assistant Sarah and Nursing Assistant Jamal. One client needs to be bathed, another needs help eating his dinner, a third client needs his blood glucose checked every hour, and a fourth who needs a respiratory assessment every four hours to see if the client needs a PRN nebulizer treatment. Nurse Kai knows that it will be impossible to meet the needs of all his clients without help and so, Nurse Kai will use delegation skills to make sure all the tasks are completed.

Client-centered care means meeting all of the physical, mental, and emotional needs for each client. This can be a lot of work when you are caring for multiple clients. To help make sure all your client’s needs are met in a safe and timely manner, you will need to use delegation skills. Delegation is when the nurse assigns tasks to another individual while maintaining accountability for the activity. Being accountable means that you are answerable to others as well as yourself for the actions you do and the judgments you make. In delegation, you will remain accountable for a task even if you are not the one performing the task.

So, when Nurse Kai plans to delegate the task of blood glucose checks, he knows that even though he may not physically perform the task, he is responsible for making sure the task is completed safely. Delegation is an important tool for nurses because it helps maintain efficiency, enhances the care of clients, improves client safety, and even provides opportunities for staff training. Now, it is important to understand that different facilities will have their own guidelines for delegation, so it’s important to be familiar with your institutional practice guidelines before delegating care.

Okay, so there are two primary roles in delegation, the delegator and the delegatee. The delegator is the person who assigns tasks to another person. The delegatee is the person who accepts responsibility for the task. There are rules to who can be the delegator and who can be the delegatee in a professional relationship. So, as a nurse, it’s important to understand who you are allowed to delegate to, or accept tasks from. For example, while nurses can delegate a task to a UAP or a licensed practical nurse, or LPN, they cannot delegate a task to a nurse practitioner. However, the nurse practitioner is able to delegate to both the nurse and the UAP. Usually, roles with more extensive training will have greater delegation responsibilities.

When preparing to delegate a task, you should follow the five rights of delegation: Right Task, Right Circumstance, Right Person, Right Communication, and Right Supervision. First is the right task. Before you delegate, you must decide if the task is appropriate for delegation. There are two types of tasks that can be delegated: direct care activities and indirect care activities. Direct care activities involve client care and include things like feeding, bathing, vital signs, or testing blood sugars. On the other hand, indirect care activities include things that help support the team but do not involve client care such as restocking supply cabinets, or even clerical activities like answering the phone. There are also some things that should never be delegated. For example, nurses cannot delegate a task that involves clinical decision making or nursing judgment. This would include any task that can be considered part of the nursing process of assessment, diagnosis, planning, implementation, and evaluation. Additionally, nursing tasks like client education, interprofessional communication, or the documentation of assessments cannot be delegated.

Okay, so Nurse Kai begins by taking inventory of the tasks that could be appropriate for delegation, including bathing a client, assisting a client with eating their dinner, checking a client’s blood glucose level, and assessing a client’s respiratory status. He decides that the bathing, feeding, and glucose check are direct care activities and are appropriate for delegation, because they do not involve clinical decision making or nursing judgment. On the other hand, he knows that the respiratory assessment should not be delegated, because assessment involves clinical decision making and nursing judgment. The right circumstance is another important right. This requires you to assess if the situation is appropriate for task delegation. There are a couple of questions you can ask when evaluating the right circumstance.

First, “Are the appropriate resources available to the delegatee to achieve the task?” Resources can refer to staff or equipment needed to complete a task. As an example, it wouldn’t make sense to delegate transferring a client from bed to their chair if you know that three people are required in this circumstance to safely complete the task and only two are available. The second question you should ask yourself is, “Is the client condition favorable for task delegation?” This requires the nurse to assess the client to determine if there are any safety concerns or obstacles to performing care prior to delegating tasks. For example, if you were to delegate shaving a client’s beard to the Nursing Assistant, that would be an appropriate task.