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Delegation affects nurses who are dealing with the harsh reality of financial constraint in the health care sector. When traditional nursing tasks are delegated to other health care workers, nurses are concerned about patient safety, quality of care and their own responsibility.
1. What is delegation?
Delegation occurs when either the employer or the nurse transfers authority to a health care worker in a selected situation to do work traditionally performed by a nurse.
Legislation defines the practice of nursing in very broad terms. The essence of nursing practice is the application of the nursing process, which provides the foundation for nursing diagnosis, outcome identification, and care planning. Nurses should not delegate these responsibilities. For example, an unlicensed worker may measure vital signs but the nurse analyzes the data for comprehensive assessment, nursing diagnosis, and planning care.
2. Who is responsible for what?
Responsibility for delegation is shared between the employer, the nurse and the other health care worker.
a) The employer is legally responsible for hiring appropriate staff and for establishing written policies and procedures on delegation, including who the delegator is (facility or nurse), workers to whom authority has been or can be delegated, the process for delegation, and guidelines for care. Differences in roles of nurses and other health care workers must be reflected in policies. The employer is also responsible for: providing adequate education, training, and assessment of the competence of health care workers; establishing and maintaining quality control measures to ensure competent care; ensuring adequate supervision of health care workers; and prohibiting delegation when no suitably qualified health care worker is available.
b) The nurse is responsible for knowing the work approved for delegation by the employer and the circumstances under which work may be delegated. She is also responsible for making an appropriate decision to delegate and for adequately supervising health care workers.
In order to determine whether a decision to delegate is appropriate, the nurse must take into account the employer’s policies; patient needs; complexity of health problems; the health care worker’s job description, knowledge base, and demonstrated competency; the knowledge needed to deliver the care required; the predictability of the anticipated outcome and specific risk factors.
Because the nurse is responsible for evaluating nursing care by monitoring patient outcomes, she must supervise workers to whom she has delegated. Supervision entails initial direction, periodic inspection and corrective action when needed.
c) The health care worker is responsible for having sufficient knowledge, skill, and judgment to accept delegation. The health care worker is also responsible for: following policies and procedures; performing tasks and giving care safely, effectively and ethically; documenting the care given; reporting observations and patient information to the nurse supervising the patient’s care; and refusing to accept delegation of those acts for which she is not competent.
3. How can I delegate responsibly?
You can delegate responsibly by:
- Knowing your unit’s job descriptions and delegation policies
- Knowing each worker’s qualifications and competencies
- Developing nursing care plans
- Determining which interventions, if any, can be safely delegated and to whom
- Ensuring the worker is available: is someone using her disproportionately or inappropriately?
- Being specific by providing detail on who, what, where, when, and how. Include when and how to report outcomes and ask for assistance, e.g., “Tell me if Mr. Jones’ blood pressure is higher than 160/100” provides a reportable parameter, in contrast to “Check Mr. Jones’ BP”
- Indicating priorities
- Checking comprehension
- Ensuring the patient knows who his nurse is and who his health care worker is
- Supervising either directly or indirectly based on patient’s condition, nature of delegated tasks, resources available and worker’s competence
- Intervening if necessary
- Continuing to do ongoing nursing assessments, care plan development, and evaluation of intervention’s effectiveness
- Remembering that the working relationships in your team rely on communication, respect, and positive reinforcement
If in doubt about the appropriateness of delegation, you may wish to consult your professional/territorial practice advisor. If you have a concern about legal issues, contact a member of our legal counsel, who is a lawyer, at CNPS at no charge (1-800-267-3390). CNPS is for you.
As knowledgeable professionals, nurses must continue to advocate for safe and ethical practice environments while striving to acquire new skills, such as supervising others, to practice competently.
CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
N.B. In this document, the feminine pronoun includes the masculine and vice versa.
Vol. 9, No. 2, December 2000
THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.