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Who can the RN Delegate to? The 5 Rights of Delegation in Nursing


Delegation is a critical skill for registered nurses (RNs) as they collaborate with other healthcare team members to provide comprehensive patient care. Effective delegation should be based on patient needs, appropriate task allocation, and maintaining positive relationships within the healthcare team. For example, delegating the task of collecting a urine specimen to an LPN so that the RN can focus on administering IV pain medication to another patient prevents delays in patient care and optimizes the skills, time, and expertise of both the RN and LPN. On the other hand, If an RN has the time to assist a patient to the bathroom and simply delegates the task to a CNA because they don't want to do it, it may create strained relationships within the team. It's important to foster a collaborative and respectful environment, where all team members are willing to support one another as needed.

 
 

It is essential to understand the principles and guidelines governing delegation to ensure safe and efficient care delivery. Use the five rights of delegation to help you stay within your legal scope of practice. NEVER delegate clinical reasoning, clinical judgment, or critical decision making to an assistive personnel.


1. Right Task

The first right of delegation emphasizes the importance of selecting the appropriate task for delegation. Delegate TASKS, not PATIENTS. RNs should delegate tasks that are within the scope of practice of the individual to whom the task is assigned.


The RN is allowed to delegate certain tasks to a Licensed Practical Nurse (LPN) based on their scope of practice and the specific regulations and guidelines of the healthcare setting. The exact tasks that can be delegated may vary depending on factors such as state nursing regulations, facility policies, and the individual competencies of the LPN. However, some common tasks that an RN may delegate to an LPN include:

  • Medication Administration: RNs often delegate the administration of oral medications and topical medications. In most states the RN may NOT delegate IV medication administration.

  • Vital Sign Monitoring: LPNs can measure and document vital signs such as temperature, blood pressure, pulse rate, and respiratory rate.

  • Wound Care: Depending on the complexity and severity of the wound, an RN may delegate wound dressing changes, wound assessments, and basic wound care to an LPN.

  • Basic Patient Care: LPNs are often delegated tasks related to basic patient care, such as assisting with activities of daily living (ADLs), hygiene care, and feeding.

  • Collecting Specimens: The collection of routine specimens, such as urine or stool samples, can be delegated to an LPN.

  • Basic Monitoring and Documentation: LPNs can assist with monitoring and documenting basic patient observations, such as intake and output measurements and recording fluid balance. The LPN may NOT complete an initial patient assessment.

  • Reporting and Communication: RNs may delegate the task of reporting and communicating relevant patient information to the LPN, such as changes in patient condition or significant events. The RN is usually responsible for initial patient education.

Some common tasks that an RN may delegate to assistive personnel (AP) such as Certified Nursing Assistants (CNAs) or Nursing Assistants (NAs) include:

  • Activities of Daily Living (ADLs): This includes assisting with bathing, dressing, grooming, toileting, and feeding of patients.

  • Vital Sign Measurement: Assistive personnel can measure and document basic vital signs under the direction and supervision of the RN.

  • Ambulation and Transfers: Assistive personnel can assist patients with mobility, including transferring from bed to chair, walking with assistance, and using assistive devices like walkers or canes.

  • Patient Transport: Assistive personnel can transport patients within the healthcare facility, such as to and from diagnostic procedures or to different units.

  • Bed Making and Environmental Safety: Assistive personnel can assist with keeping patient rooms clean and safe, including making beds, maintaining cleanliness, and ensuring the availability of necessary supplies.

  • Specimen Collection: The collection of routine specimens, such as urine or stool samples, can be delegated to assistive personnel in most states

  • Non-Sterile Dressing Changes: Assistive personnel can often be delegated the task of changing simple, non-sterile dressings under the direction and supervision of the RN.

It is important for the RN to provide clear instructions, communicate effectively, and supervise the tasks delegated. The RN retains accountability for the overall care provided to the patient, even when tasks are delegated. Collaboration, ongoing communication, and regular feedback are crucial to ensure safe and effective patient care. Again, know your state practice act's first.


2. Right Circumstance

RNs need to evaluate the stability and complexity of the patient's condition before delegating a task. The patient needs to be STABLE in order to delegate tasks. Tasks that are routine, well-defined, and predictable are more suitable for delegation. Conversely, complex or critical tasks should be retained by the RN to ensure the highest level of patient safety and care. When delegating, the RN should specify when and which information should be reported.


3. Right Person

Selecting the right person for delegation is vital to ensure patient safety and quality care. The individual to whom a task is delegated should possess the necessary knowledge, skills, and abilities to perform the task competently. This is not just the responsibility of the nurse, but also the employer and the delgatee. All parties should ensure they delegatee has the knowledge and skills required before agreeing to the delegation.


4. Right Direction/Communication

Clear and concise communication is essential in delegation. The RN should provide explicit instructions and guidelines to the delegatee. This includes providing information about the patient's condition, the desired outcomes, specific instructions for performing the task, and any potential risks or precautions. Ongoing communication and feedback channels should be established to address questions, concerns, or changes in the patient's condition. The delegatee is responsible for asking questions if necessary. The RN should always request help with please and end with thank you and feedback.


5. Right Supervision/Evaluation

The final right of delegation involves appropriate supervision and evaluation. The RN retains accountability for the overall care provided to the patient, even when tasks are delegated. Regular monitoring, evaluation, and feedback are necessary to ensure that the delegated task is performed correctly and achieves the desired outcomes. The RN should be readily available for consultation and intervention when appropriate.


Delegation is a crucial aspect of nursing practice that can improve efficiency and enhance patient care. By adhering to the five rights of delegation, RNs can effectively assign tasks to competent individuals while maintaining overall accountability for patient safety and quality outcomes. It is imperative for RNs to have a thorough understanding of legal and regulatory frameworks, scope of practice, and the capabilities of the individuals to whom tasks are delegated. Through effective delegation, RNs can optimize their roles, foster collaboration, and ultimately enhance patient care delivery.

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