In order to delegate effectively as a Registered Nurse you need to make sure you assign the
right task to the right person under the right circumstances. You also need to be sure to
provide right direction, communication, supervision and evaluation throughout the process of delegation.
The Joint Statement on Delegation from the American Nurses Association and the NCSBN
states that nurses need to use critical thinking and professional judgement when delegating
a task to ensure that these five rights of delegation are followed.
In this video I will explain the 5 rights of delegation. Understanding these rights
will help you delegate appropriately in real life and on the NCLEX. Throughout this video
I will give you some tips to help you remember what to delegate so you can pass the NCLEX.
The right Task. Before delegating a task you need to be sure
that it the right task to be delegated. In order to delegate a task it needs to be within
your scope of practice. It also needs to be within the caregiver’s scope of practice
and job description. Organizational policies and standards, laws and practice guidelines
in your jurisdiction, professional standards and codes of ethics should all be taken into
consideration when tasks that can be delegated are identified.
When you delegate a task the task needs to be identified for a specific client at a specific
time to promote desired outcomes for that client. Client needs need to be met when the
delegation occurs.
RNs should never delegate the nursing process. I explain the roles of members of the health
care team in another video, but in short remember that you cannot share your TEAACUP. I have
doubled up the A in this acronym but it still works because you really don’t want to share
your TEAACUP!
T stands for teaching. RNs need to do the primary teaching because it is such an important
part of health promotion and disease prevention.
E stands for evaluation. Others can collect data for you but the RN needs to interpret
it, formulate the nursing diagnoses and judge client progress towards meeting goals in the care plan.
A stands for assessments. Assessments need to be done by the RN.
LPNs can do routine assessments but RNs need to complete initial assessments on new patents,
regular follow up assessments or assess when there is an emergency or a change in patient condition.
The second A stands for advanced interventions. That is things like administering IV medications
where specialised knowledge or skill is required.
C stands for collaboration. RNs need to be the ones to work with physicians or others
on the health care team to resolve client issues.
U stands for unstable patients. RNs need to be the ones to care for unstable patients.
Never delegate care of an unstable patient to an LPN or UAP.
P stands for planning. RNs need to be the ones to identify client goals and develop care plans.
The right Circumstances Delegation must occur under the right circumstances.
Client needs must be assessed. A task like positioning a client may be appropriate to
delegate to a UAP in many circumstances, but it is right in your current circumstances?
It is your job to assess each client’s goals and needs. It is also important to consider
if safe care can be delivered using the resources available.
You need to consider the competency of your assistive personnel and how much supervision
is needed for the task. You need to balance the needs of the client with the competency
of the care providers available. Be sure that assistive personnel can be appropriately monitored
and guided. Do you have the skills and knowledge to safely delegate the task?
The right Person It is critical that you are sure that the
person you are asking to perform a task is competent to perform that task. You need to
assess if they have the knowledge and skill that is needed to perform the task being delegated.
Consider any certifications or licenses they may have as well as training or documented knowledge.
Have you seen them demonstrate their competence in performing this task?
Have you seen them doing skills?
If their competence is not already assessed or documented, you may need to teach them
what to do or go with them to assess that they know what they are doing with a specific
client or task.
You also need to consider how stable your client is and how predictable the outcome is.
UAPs and LPNs cannot be assigned to unstable patients. The outcome of the task they are
doing needs to be predictable.
The right Direction and Communication
When you delegate you need to be sure that you have provided clear directions. You must
be sure that a specific person was told to help a specific client. The way that delegation
decisions are communicated will depend on where you are working. It may be done verbally
or in writing. Typically agencies have set up processes for communicating and dividing
client workload.
The American Association of Critical-Care Nurses handbook outlines the 4Cs criteria
for the right direction. Are your initial directions Clear, Concise, Complete and Correct?
You must clearly direct assistive personnel during delegation. The activity that you are
asking them to complete must be concisely described - that way you don’t confuse anyone.
You need to be sure to provide them with complete information about the activity including what
objectives you need met. You also need to communicate the correct limits and expectations
for the activity.
In certain situations more specific communication may be needed. For example, if you are working
in long term care and you are monitoring a client’s bowel movements more closely than
normal you may need to ask the UAP to report verbally to you if the process normally just
involves written documentation. In these situations you need to let the UAP know that you need
to be told within a certain time frame that is different from normal.
The assistive personnel should feel comfortable letting you know that the need help or that
they don’t know how to do something. Feedback should be ongoing and reciprocal. Be open
to feedback that can help you improve. Assistive personnel should be involved in
the flow of information and recognised for their efforts. A simple “thank you” can
help to promote an environment for open communication.
When problems arise get them involved in brainstorming potential solutions.
The right Supervision and Evaluation.
Once a task is delegated your job isn’t over. You need to monitor the completion of
the task since you are still accountable for ensuring safe client care.
An RN or other licensed nurses needs to supervise certain nursing activities. After clear directions
and expectations are given there is a need for ongoing monitoring and feedback. You can
give the person you are working with feedback about how they are performing the activity
and they can give you feedback about how you are delegating and communicating.
Make sure you respond to questions and help in problem-solving as needed.
Whenever needed you should intervene to promote safe client care and learning for the assistive
personnel. As long as you approach it in a professional and caring way people should
be open to your feedback.
Be sure you document delegation activities using the methods appropriate in your setting.
Do not forget to evaluate how things went. Evaluation is an important step in the delegation
process. Both the client and how the task or activity was performed should be evaluated.
Evaluation enables quality improvement and professional growth for you and the people
you are working with. Are staff reporting when the tasks are completed and how the client
responded? Are you providing appropriate teaching and guidance?
Are issues or problems being reported properly?
If you like acronyms you can use DEPICTS to remember the important components of the 5
rights of delegation. Everyone refers to it as 5 rights but there are more than 5 things
to remember! I just changed “Communication” to “Interpersonal communication” so that
I could fit all these important elements into one word.
When you follow the 5 rights of delegation you will be able to delegate properly in real
life and on the NCLEX.
Thank you for watching. Please comment below to let me know if you found this video helpful.
Also, let me know if you need more information about something to help you pass the NCLEX.
I am working on a playlist now that will help you study for and pass the NCLEX.
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