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Posted: Nov 29, 2007 10:33 AM
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Defining Delegation
Every nurse is a manager. Nurses manage patient care, their own time and each other. Managing others is called “delegation” and is defined by the Nurse Practice Act of the state in which the nurse practices. The Nurse Practice Act specifies expectations related to authority, responsibility and accountability. Ignorance of these expectations is not an excuse. Patient outcomes are at stake and, perhaps, your own nursing license.
Delegation is defined as the “transfer of authority to a competent individual” (
www.ncsbn.org/314.htm). Your authority comes from the nurse’s scope of practice as provided by law in your state. The scope of practice differs for APN’s, RN’s and LVN/LPN’s, but at no time can you delegate authority you do not have. Likewise, no one can delegate to you any duty that is outside your scope of practice.
You are personally responsible for knowing what the Nurse Practice Act (NPA) for your state contains. The NPA is based on related rules, laws and standards and it is your responsibility to know which apply to your practice. Standards can be found online through various organizations, including the American Nurses Association (
www.nursingworld.org) and the Infusion Nurse Society (
www.INS1.org). Your first responsibility is to the patient. Before you delegate you must know that the patient will be cared for by a competent individual. Competency may also be defined by your NPA. It is not the responsibility of the unlicensed person to know what can or cannot be delegated.
Nurses are accountable to patients, employers, peers and the State Board of Nursing. Accountability means the nurse must answer for acts of commission or omission that fall within the nurse’s responsibility. Discipline is frequently tied to accountability and can take many forms, from mere documentation to license suspension or revocation. Delegation requires supervision. You are authorizing someone to provide nursing services but are
retaining accountability.
Unlicensed assistive personnel (UAP) are just that – Personnel without a license. Remember, a license delineates the scope of practice, so without a license the individual has no scope of practice. They have only a job description. UAP’s have many titles, including certified nursing assistant, patient care tech, and nursing extern. Nursing externs present a special challenge because they want to act like nurses, but do not yet have a license. They are UAP’s and cannot be assigned a patient or given any task that requires a licensed nurse. Almost having a license is not enough. Make assignments to Agency nurses and float RN’s as if they were LVN/LPN’s. Assign them
stable patients with
predictable outcomes as it is harder for them to do a full assessment and teaching that is specific to your nursing unit.
Assignments will “take into consideration client safety and which are commensurate with the educational preparation, experience, knowledge and physical and emotional ability of the persons to whom the assignments are made” (Standard 9, NPA,
www.bne.state.tx.us). Know your staff, but most of all know your patient needs. The benefit of effective delegation is positive patient outcomes.
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