5 Rights of Delegation (2024)

Dec 15 2023 by Myrna B. Schnur, MSN, RN

Fundamental skills such as the ability to prioritize, multi-task, and delegate are essential for nurses to care for their patients safely and effectively. Over time, I learned how to prioritize and multi-task, but delegation proved to be very challenging for me for many reasons. First, I didn’t want to appear incapable of handling my assignment and I certainly didn’t want to burden anyone with my work. I needed to prove that I belonged in the intensive care unit and had to earn my position on the team. Second, I felt responsible for every aspect of my patient’s care and was afraid to relinquish control. Lastly, I didn’t necessarily feel empowered to delegate to any of the nursing assistants; they were my peers and I didn’t want to tell anyone what to do. I always felt that their tasks should be delegated by the charge nurse, or someone else in a leadership position. As I gained more experience, I grew more comfortable with delegation. However, nurses of all levels need to have a clear understanding of what they can delegate and who they can delegate to.

The National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) developed guidelines to standardize the delegation process for boards of nursing (BONs), health care employers, community-based settings, professional associations, nurse educators, nurse leaders, staff nurses, and delegated individuals (or delegatees).

What is nursing delegation?

According to the ANA (2019), nursing delegation can be summarized by the following:

The delegatee (person being delegated to) may complete a nursing activity, skill or procedure that is legally appropriate and allowed by the facility’s policies.
The delegatee has had education and training needed to perform the delegated task.
- The licensed nurse who delegates the task maintains overall accountability for the patient.
- The delegatee is responsible for the delegated activity or procedure.
Clinical reasoning, nursing judgement, and critical decision-making shouldn’t be delegated.
Nursing responsibilities can be delegated by someone who has the authority to delegate.
The delegated task must be within the delegator’s scope of practice under their state nurse practice act (NPA).

These guidelines apply to:

Advanced practice registered nurses (APRNs) when delegating to registered nurses (RNs), licensed practical nurses/vocational nurses (LPN/VNs), and unlicensed assistive personnel (UAP)
RNs when delegating to LPN/VNs, and UAP
LPN/VNs (as permitted by their state) when delegating to UAP

It is important to note that states have different laws, NPAs, and regulations about delegation. Clinicians are responsible for knowing what is legally permitted in their state.

What are the benefits of delegation?

According to the ANA (n.d.) there are many benefits of delegation in nursing such as:

Empowering employees
Decreasing burnout
Increasing commitment
Improving job satisfaction

Five rights of nursing delegation

The process of delegation includes “five rights” to remember. These are summarized in the table below.

Five Rights	Nursing Considerations (ANA, 2019; NCSBN, 2019; ANA, n.d.)
Right task	Delegate tasks that are legally appropriate and allowed by your facility’s policies.
Right circ*mstance	Assess the patient’s needs prior to delegating the task to ensure all resources and supervision are available. The patient’s medical condition must be stable. The delegatee must communicate any changes in condition to the licensed nurse who must then reassess if the delegation is still appropriate.
Right person	Ensure the delegatee has the skills and knowledge to perform the activity; identify the individual who is best able to complete the job.
Right direction and communication	Provide clear information on what the task involves, when it needs to be completed, documentation, patient limitations, and expected outcomes, and allow the delegatee to ask clarifying questions. The delegatee must agree to accept the delegated task and not make changes to the task without consulting the licensed nurse.
Right supervision and evaluation	Provide appropriate supervision for all tasks delegated and be ready to intervene when needed. Monitor the delegated activity, evaluate patient outcomes, and complete documentation when the activity is completed. The delegatee must communicate patient information to the licensed nurse. Offer advice and support, and provide feedback upon task completion.

Successful delegation requires effective communication, collaboration, competence and knowledge of the delegatee, and role clarity (NCSBN, 2019). Continue to work on your delegation skills and share your stories with us in the comments below.

References:

American Nurses Association. (2019). National Guidelines for Nursing Delegation.
https://www.nursingworld.org/~4962ca/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/nursing-practice/ana-ncsbn-joint-statement-on-delegation.pdf

American Nurses Association. (n.d.) Delegation in Nursing: How to Build a Stronger Team. https://www.nursingworld.org/resources/individual/nurse-managers/delegation-in-nursing/

Barrow, J. M., & Sharma, S. (2023). Five Rights of Nursing Delegation. InStatPearls. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK519519/

National Council of State Boards of Nursing. (2019).
https://www.ncsbn.org/nursing-regulation/practice/delegation.page

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