DELEGATION

BY:
Meilati Suryani, S.Kp.,M.Kep
INTRODUCTION
Nurses are accountable for supervising those to
whom they have delegated tasks. Nurses often
delegate nursing tasks to other team members, and
they are accountable for the decision to delegate
and for the adequacy of nursing care to the
patient, provided the person to whom the task was
delegated performed the task as instructed and
delegated by the delegating. Nurse retains
accountability for the outcome of delegation.
DEFINITION
The transfer of responsibility for the performance of
a task from one individual to another while
retaining accountability for the outcome. Example:
the RN, in delegating a task to an assistive
individual, transfers the responsibility for the
performance of the task but retains professional
accountability for the overall care.
Delegation is the reassigning of responsibility for
the performance of a job from one person to
another (ANA,1996)
DEFINISI
Delegasi adalah penyelesaian suatu pekaryaan
melalui orang lain atau pelimpahan suatu tugas
kepada seseorang atau kelompok dalam
menyelesaikan tujuan organisasi (Marquis dan
Huston, 1998)
 DIRECT DELEGATION: Verbal direction by the RN
delegator regarding an activity or task in a spesific
nursing care situation
INDIRECT DELEGATION: An approved listing of
activities or tasks that have been established in
policies and procedures of the health care institution
or facility
CASE
Mrs Rankin was admitted to the unit from the neurological
itensive care unit. She suffered a grade II subarachoid
hemorrhage 2 weeks ago and has a left hemiparesis. She also
has difficulty with swallowing. She is still receiving tube
feedings through a gastrotomy tube, however she has been
advanced to a pureed diet. She needs assistance with personal
care, toileting and feeding. Although a physical therapies
comes twice a day to get her up to gait trainning, the physician
wants he in a chair as much as possible
 Assesing this situation, the RN might may consider assigning a
licensed practical nurse (LPN) to this client
The LPN capable of managing the tube feeding, assiting with
bathing, perform range of motion exercises to all the clients
extremities and assess her skin for breakdown, transferring
from the bed to the chair
The RN may not assign an individual to perform a task or
activity not specified in his or her job description or within the
scope practice such as allowing a nursing assistant to
administer medications or perform certain types of dressing
changes
SUPERVISION
The active process of directing, guiding and
influencing the outcome of an individuals
performance of a task.
Supervision is generally categorized as on-site (the
RN being physically present or immediately
available while the task is being performed) or off-
site (the RN has the ability to provide direction
through various means of written and verbal
communications).
Principle
The RN may delegate elements of care but does
not delegate the nursing process itself.
The RN has the duty to answer for personal actions
relating to the nursing process.
The RN takes into account the knowledge and skills
of any individual to whom the RN may delegate
elements of care.
 The decision of whether or not to delegate or assign
is based upon the RNs judgment concerning the
condition of the patient, the competence of all
members of the nursing team and the degree of
supervision that will be required of the RN if a task
is delegated. The RN delegates only those tasks for
which she or he believes the other health care
worker has the knowledge and skill to perform,
taking into consideration training, cultural
competence, experience and facility/agency
policies and procedures.
 The RN uses critical thinking and professional
judgment when following The Five Rights of
Delegation:
1. Right task
2. Right circumstances
3. Right person
4. Right directions and communication
5. Right supervision and evaluation (NCSBN 1995).
The Need for Delegation

The Nursing Shortage

Health Care Reform

Increased Need for Nursing Services

Demographic Trend
The Need for Delegation
Health care institution often use UAPs to perform
certain client tasks
UAPs: Unlicensed Assistive Personnel are individual
who are trained to function in an assistive role to the
registered nurse in the provision of patient/client care
activities as delegated by and under the supervision
of the RN
When a task is delegated to an UAP person, the
professional nurse remains personally responsible for
the outcomes of these activities
 As the use of LPNs or client care extenders increases
the nurse focus moves toward diagnosing client care
needs and carrying out complex intervention
Non nursing function such as performing clerical
receptionist duties, taking trips or running errands
off the unit, making beds, collecting trays, ordering
supplies, however should not be carried out by the
highest paid and most educated member of the
team
Elements essential for effective
delegation
1. Emphasis on professional nursing practice
2. Definition of delegation, based on the nurse
practice act and regulations
3. Review of specific sections of the law and
regulations regarding delegation, identification of
disciplinary actions related to inappropriate
delegation
4. Emphasis on tasks/functions that cannot be
delegated nor routinely delegated
5. Focus on RN judgment for task analysis and
decision to delegate
6. Determination of the degree of supervision
required for delegation
7. Identification of guidelines for lowering risk related
to delegation
8. Development of feedback mechanisms to ensure
that task is completed and to receive updated data
to evaluate the outcome.
 The RN assesses the patient and the person to whom
the task will be delegated (delegatee) before
delegating a task:
Will the patient receive quality nursing care if the
task is delegated? Should the task be delegated?
How much supervision will the person doing the task
require?
 Is the person to whom the task is being delegated
competent to do the task? Is she or he functionally
able to perform the task based on other
assignments? Can the person perform the task
without adverse patient occurrence?
 The RN communicates clearly the task being
delegated, in a concise manner, for a specific
patient. Communication includes both written and
oral components. The RN has the responsibility for
clinical supervision of the person doing the task. If
the RN identifies that the task to be delegated
requires too much supervision, then the task should
not be delegated. The RN monitors the patient and
evaluates the outcome of the delegated task and
anticipates a potential change of plan based on
clinical judgment.
 The RN does not delegate the nursing process.
However, selected components of the nursing
process may be delegated as follows:
Component Can it be delegated?

Assessment No, input is solicited

Diagnosis No
Planning No, input is solicited
Intervention Yes, with supervision
Evaluation No, input is solicited
 the ANA has specified tasks that RNs may not
delegate because they are specific to the discipline
of professional nursing, these activities include:
Initial nursing assessment and follow up assessment if nursing
judgment is indicated
Decisions and judgments about client outcomes
Determination and approval of a client
Interventions that require professional nursing knowledge,
decision or skill
Decisions and judgments necessary for the evaluation of
client care
 COMPONENT OF THE DELEGATION DECISION
MAKING GRID

Level of client acuity

Level of unlicensed nurse capability
Possibility of injury
Number of times the skill has been performed by
the unlicensed assistive personnel
Level of decision-making needed for the activity
Clients ability for self care
 DELEGATION DECISION MAKING GRID

..\DELEGATION DECISION GRID.doc

 Scoring the components help the nurse evaluate the
situations, the client needs, and the health care
personnel available to meet the needs
A low score on the grid indicates that the activity
may be safely delegated to personnel other than
RN and a high score indicates that delegation may
not be advisable
Task Related Concerns
Abilities
Priorities
Efficiency
Appropriateness
Barriers to Delegation
Experience issues
Licensure issues
Quality of care issues
Assigning Work to OthersThis is diffiuclt
for several reason
Some nurses think they must do every thing themselves
Some nurses disturb subordinates to do things
correctly
Some nurses think that if they delegate all the
technical tasks, they will not reinforce their learning
Some nurses are more comfortable with the technical
aspects of client care than with the more complex
issues of client teaching and discharge planning
THANK YOU