Nursing Research Paper on EBP Assignment #1

Nursing Delegation
About the Guideline
• The goal of this guideline is to standardize the nursing delegation process based on current
evidence and is applicable to all levels of nursing licensure.
o Advanced practice registered nurse (APRN) delegating to registered nurse (RN), licensed
practical nurse/vocational nurse (LPN/VN), or assistive personnel (AP)
o RN delegating to LPN/VN or AP
o LPN/VN delegating to AP (as allowed by state or jurisdiction)
• The guideline was endorsed by the National Council of State Boards of Nursing (NCSBN) and the
American Nurses Association (ANA).
Background
• The ability to delegate, assign, and supervise are essential skills for all licensed nurses.
• Since laws and regulations about delegation vary in states, all licensed nurses are responsible to
know what’s permitted in their jurisdiction.
• Delegation should be assigned based on the nurse’s judgment regarding the patient’s condition,
the competence of the nursing team, and degree of supervision required of that nurse.
Key Recommendations
Definitions
• Accountability: “To be answerable to oneself and others for one’s own choices, decisions and
actions as measured against a standard…” (American Nurses Association, 2015, p. 41).
• Delegated responsibility: A nursing activity, skill, or procedure that is transferred from a licensed
nurse to a delegatee.
• Delegatee: One who is delegated a nursing responsibility. A delegatee may be an RN, LPN/VN or
AP.
• Delegator: One who delegates a nursing responsibility. A delegator may be an APRN, RN, or
LPN/VN.
• Assignment: The routine care, activities, and procedures that are within the authorized scope of
practice of the RN or LPN/VN or part of the routine functions of the AP.
• Licensed Nurse: A licensed nurse includes APRNs, RNs, and LPN/VNs. In some
states/jurisdictions, LPN/VNs may be allowed to delegate.
• Assistive Personnel (AP): Any assistive personnel trained to function in a supportive role,
regardless of title, to whom a nursing responsibility may be delegated. This includes but is not
limited to certified nursing assistants or aides (CNAs), patient care technicians, certified
medication aids (CMAs), and home health aides.
Important Notes
• A licensed nurse is responsible for ensuring any delegated assignment is carried out completely
and correctly; this delegating nurse maintains accountability for the patient.
• The delegatee bears the responsibility for the delegated activity.
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• Any activity that will involve clinical reasoning, nursing judgment or critical decision making can’t
be delegated.
• The delegated responsibility must be within the delegator’s scope of practice and within the
parameters of the delegatee’s authorized scope of practice under the Nurse Practice Act (NPA).
Five Rights of Delegation
1. Right task
o The activity is within the delegatee job description.
o The activity is included as part of the established written policies and procedures.
2. Right circumstance
o The patient’s health condition is stable.
o The delegatee must notify the licensed nurse if the patient’s condition changes; the
licensed nurse will then reassess the situation and determine if the delegation is
appropriate.
3. Right person
o The delegatee has the appropriate skills and knowledge to provide care.
o This is determined by the licensed nurse, the employer, and the delegatee.
4. Right directions and communication
o Specific instructions should be given for the delegated activity to the delegatee.
o Clarifying questions should be answered.
o Data collection, reporting, and time frame should be determined and agreed upon.
o Decisions or modifications can’t be made without consulting with the delegator.
5. Right supervision and evaluation
o Monitoring, follow up and evaluation are the responsibility of the delegator.
o Completion of documentation must also be confirmed.
Seven Employer/Nurse Leader Responsibilities
1. A nurse leader responsible for oversight of delegated responsibilities for the facility must be
identified by the employer.
o The nurse leader assesses the needs of the facility, understands the type of knowledge
and skill needed to perform specific nursing responsibilities, and is accountable to
maintain a safe environment for patients.
o The nurse leader needs to be aware of the knowledge, skill level, and limitations of the
licensed nurses and AP.
2. The designated nurse leader responsible for delegation determines which nursing
responsibilities may be delegated, to whom, and under what circumstances. He or she must be
familiar with the NPA for the state/jurisdiction.
3. Policies and procedures specific to the delegation and delegated responsibilities must be developed.
4. Information about what responsibilities can be delegated must be communicated. Licensed
nurses must be aware of the competence level of staff and expectations for delegation in order
to make informed decisions about delegation.
5. Knowledge and competency on how to perform a delegated responsibility must be
demonstrated and periodically evaluated.
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6. The delegation process must periodically be evaluated; patient safety should always be the
priority.
7. Promoting a positive culture and work environment for delegation must be emphasized; this
cultivates effective communication and collaboration.
Five Licensed Nurse Responsibilities
Delegation is at the nurse’s discretion, with consideration of the particular patient situation. The
licensed nurse maintains accountability for the patient, while the delegatee is responsible for the
delegated activity. If it’s not appropriate to delegate a certain responsibility, the delegating nurse should
perform the activity.
1. The licensed nurse must determine when and what to delegate.
2. The licensed nurse must communicate information about the patient and their care
requirements.
3. The licensed nurse must be available for guidance and questions, including assisting with the
delegated responsibility, if necessary.
4. The licensed nurse must follow up with the delegatee and the patient after the delegated
activity is completed.
5. The licensed nurse must provide feedback about the delegation process and any issues related
to the competency of a specific responsibility or judgment and decision-making to the nurse leader.
Four Delegatee Responsibilities
1. The delegatee must accept only responsibilities that they are appropriately trained and
educated to perform; he or she should feel comfortable with the activity given the specific
circumstances and the patient’s condition.
2. The delegatee has a responsibility to maintain competency.
3. The delegate is responsible for asking questions and communicating any concerns.
4. The delegatee is accountable for carrying out the activity correctly and completing timely and
accurate documentation.
Reference:
National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA). 2019. National Guidelines for
Nursing Delegation. Retrieved from https://www.ncsbn.org/NGND-PosPaper_06.pdf

Link to Practice Guideline:
https://www.ncsbn.org/NGND-PosPaper_0