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Delegation is a term that means assigning certain authority or responsibility to a person to carry out that task but the person delegating still maintains the responsibility of the delegated task (Wikipedia, 2010). In the nursing world, delegation is a skill that requires knowledge of what a registered nurse (RN) can delegate and who they can delegate to. It is a competency both recognized by the American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN). Delegation is a complex skill that is best learned through working with other RN's. In order for an RN to delegate, he or she must know their "states nurse practice acts, institutions policies and procedures, and the institutions job description for assistive personnel" (Potter and Perry, 2005, p. 379).
In order for the RN to delegate a task to a nursing assistive personnel (NAP) or another RN, he or she must know the five rights of delegation which includes the right task, right circumstance, right person, right directions and communications, and right supervision and evaluation (ANA, 2009).
A right task is delegated when the task being delegated is within the NAP or another RN's scope of practice. The person being delegated to that task must require very little supervision and must be competent at the assigned task. A nurse can assign the NAP to take vital signs from another patient of his or her but not assign him or her to discontinue an IV. If a nurse is in the middle of an important task (i.e, start another IV from a patient whose IV line had infiltrated), she can ask or assign another RN, if that RN is not busy with her own task, to give her other patients their scheduled medications.
For a task to be completed in the appropriate time and manner, it must be done under the right circumstances. The delegating RN must look at the overall scenario to see if the delegated task is right for the patient setting and that resources are readily available. A patient's condition can change quickly in an acute care setting. An RN with good critical thinking skills can make good clinical decisions based on the client's condition and be able to delegate a task to the NAP.
For a good patient outcome, an RN must know who he or she can delegate a task to. Knowing who to delegate a task can make the workflow much smoother. An NAP with very little experience might need constant supervision compare to an NAP who has worked in the facility for years and knows what can be delegated to him or her. Although an inexperienced NAP must need supervision, he or she must not be deprived of clinical experience and that once enough clinical experience, within his or her scope of practice, is achieved, he or she can be a big help to maintain good workflow.
Giving the right direction and maintaining good communication with the NAP or other RN's is a big key in maintaining a good work relationship between the RN and the NAP. Communication is a two way process and that it must be proper and appropriate (ANA, 2009). The delegating RN must let the NAP know what he or she expects of them in doing a delegated task. Giving the NAP a clear and complete direction can make the job flow much smoother and manageable. The RN must also let the NAP know that if he or she has any question regarding the delegated task, that the RN will be readily available for him or her as a resource, guide, and support if she has any question (NCSBN, 2005, p.09).
Having supervised the NAP by the delegating RN makes sure that the NAP is complying with the practice, policies, and procedures of the working institution and within the NAP's scope of practice. The RN can determine how often he or she can assign the NAP based on patient needs on the nursing unit and supervise the NAP based on the NAP's experience with the task. In supervising the NAP, the RN must make sure that the delegated task is completed on time so that other RN's on the unit may utilize the NAP if needed. If the delegated task is not completed on time, the RN must intervene so that in can meet the facility's expectation and completed on time (NCSBN, 2005, p.10). Also, if there is an unexpected change in the patient's condition while the NAP is performing his or her task, the RN must intervene to assess and check what could be causing the patients change in condition.
Knowing who to delegate and what can be delegated can result in good patient outcomes. Delegation is a skill that requires critical thinking and experience. In order for the RN to delegate, he or she must know the five rights of delegation, their state nurse practice acts, and the working facilities policies and procedures on delegation (ANA, 2009). In turn, this helps assure the public and patients that good, safe, up-to-date knowledge on nursing procedures, policies, and standards keep the RN's and NAP's competent on what they do to provide care. In some of the patient's and public's view, the RN's are the one taking care of them but some don't realize that without the NAP's, the RN would not be able to provide the needed time and care they need. RN's are highly encouraged to seek help or assistance if they have any questions regarding delegation. This can help the RN's obtain the information they need to provide safe and effective care for the patients and result in good patient outcomes. This also helps them build a good working relationship with the NAP's and that the NAP's are more willing to do the required task without having to ask them the next time. And thus, this frees the RN to tend to his or her more complex patient and in return, have good patient outcomes.