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Amy Jackson

on 15 April 2014

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Transcript of Delegation

What every nurse needs to know
Amy Jackson RN, BSN, CCRN
University of Indianapolis

What can I delegate?
The Five Rights of Delegation
Right Person
Right Task
Right Circumstance
Right Direction and Communication
Right Supervision and Evaluation
The RN supervises the delegation by monitoring the performance of the NAP.
Supervision is related to the RN's responsibility for client care.
RN's should give timely feedback on the performance of the NAP. This develops opportunities to enhance patient outcomes through education (ANA, 2006).
ANA Delegation Decision Tree
RN's can use the delegation decision tree to aid in determining if a task can be delegated.

At the end of the presentation the learner will be able to:
Discuss delegation.
Explain accountability and responsibility.
Identify the 5 rights of delegation
Evaluate which tasks can be delegated using the American Nurses Association (ANA) decision tree.
NAP's are those who are trained to function in a role to assist a licensed RN in providing patient care as delegated by the RN (ANA, 2006).
The NAP performs repetitive, low risk tasks for which they have been trained to perform (Potter, Deshields, Kuhrik, 2010).
Delegation is defined by the ANA (2006) as "the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome" (p.4).
What is delegation?
The principle for delegation is to gain productivity. However, this can only happen when the RN and NAP work together. The delegation process requires excellent judgement and open communication on the RN and the ability of the NAP to respond quickly and appropriately. Nursing leadership is responsible to monitor the delegation practices of RN's and NAP to ensure competency is maintained.
Effective communication is the cornerstone of effective delegation.
Communication must be intentional, clear, and concise (Potter, Deshields, & Kuhrik, 2010)
Shift report should start with the RN and NAP communicating on tasks, timelines for care, status of patients, and any pertinent information to effectively provide care (Potter, Deshields, Kuhrik, 2010).
The NAP should report to the RN any change in patient status or any change from shift report in a timely manner.
The RN needs to assess the skills and ability of the NAP to perform functions delegated to them.
Prezi was chosen as the format for this
presentation on delegation because its features allow for an exciting display.
Prezi is also easy to navigate and fun to use. Prezi allows the learner to watch a
presentation that flows freely from one
frame to the next without the one
dimensional feeling of Power point.

Youtube video:
Delegating Effectively:
Working Through and with
Assistive Personnel

Outlines the approach for
RN's to use during delegation.
The health care system is changing and the way health care is delivered also has to change. Delegation is a tool for the registered nurse (RN) to utilize in the effort to achieve better patient outcomes. Delegation is a skill that needs to be practiced for the RN to become proficient. The act of delegation can be intimidating especially for new graduates who may have not been taught how to delegate in nursing school. The National Council of State Boards of Nursing developed the five rights of delegation that a RN can utilized to ensure appropriate delegation.

The ANA (2005) defines accountability as "the state of being responsible or answerable. Nurses, as members of a knowledge-based health profession and as licensed health care professionals, must answer to patients, nursing
employers, the board of nursing and the civil and criminal court system when the quality of patient care provided is compromised or when allegations of unprofessional, unethical, illegal, unacceptable or inappropriate nursing conduct, actions or responses arise" (p.4).
The Indiana Nurse Practice Act establishes legal parameters for delegation (American Nurses Association, 2006).

Indiana Nurse Practice Act

848 IAC 2-2-2 Responsibility as a member of the nursing profession:

(8) Delegate and supervise only those nursing measures which the nurse knows, or should know, that another person is prepared, qualified, or licensed to perform.
(9) Retain professional accountability for nursing care when delegating nursing intervention.
(Indiana State Board of Nursing, 2013, p.41-42)


Defined by the Merriam- Webster dictionary as a duty or task that you are required or expected to do.

When an RN delegates a task to a non-licensed assistive personnel (NAP), the RN is still accountable for the task but the NAP assumes responsibility.

Elements of care are often missed by RN's who are busy providing critical aspects of patient care or who are short staffed. "The most often missed elements are: ambulation, turning, feeding, hygiene, and intake/output documentation" (Bittner & Gravlin, 2009, p.143). These tasks can be delegated to a NAP for improved patient outcomes.
What circumstances would the RN need to perform the task their self?
Overbearing family that may not want a NAP providing care
Consider the NAP's skill level
Patient teaching
Confused/combative patient
The RN cannot delegate any part of the nursing process.
Any task that is delegated must not require an assessment
or teaching which are only RN responsibilities.
In 2013, IU Health began educating all of their NAPS in "Advanced Skills" which are peripheral IV starts, drawing peripheral blood cultures, in/out caths, urine cultures from a foley catheter, priming the feeding pumps, and applying the leads of a 12 lead EKG.

Refer to the ANA decision tree to determine if the task can be delegated.
The Right Task
Tasks that are routinely delegated are: vital signs, blood glucose, weights, intake/output, feeding, ambulating, transport, bathing, activities of daily living, answering call lights, toileting, and stocking rooms (Bittner & Gravlin, 2009).
In Summary
The delegation process can be difficult and must be practiced. All parties involved must be dedicated to the best patient outcomes and work together to achieve those outcomes. The five rights of delegation can be used as a guide for proper delegation. The five rights include the right person, the right task, the right circumstance, the right supervision/evaluation, and the right direction/communication. It is imperative RN's utilize the five rights because the RN is held accountable for all care that is delegated even though the NAP assumes responsibility for the task.
American Nurses Association, (2005). Principles of delegation. Retrieved from www.indiananurses.org/education/

Bittner, N. P., & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice.
The Journal of
Nursing Administration
, 39(3), 142-146. doi: 10.1097/NNA.0b013e31819894b7

Indiana State Board of Nursing, (2013). Compilation of the Indiana code and Indiana administrative code. Retrieved
from website: www.in.gov/Pla/files/ISBN_2013_Edition.pdf

Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered nurses and nursing assistive
Journal of Nursing Management
, 18, 157-165. doi: 10.1111/j.1365-2834.2010.01062.x

Responsibility. (n.d). In Merriam-Webster dictionary online. Retrieved from www.merriam-webster.com/

American Nurses Association, (2006). Joint statement on delegation: American Nurses Association and the National Council of
State Boards of Nursing. (2006). Retrieved from https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf
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