1 Management of Care Foundations

Organizing safe, person-centered care

Management of care brings together ongoing assessment, clinical judgment, and coordination to meet each patient’s needs. Nurses set priorities, organize people and resources, communicate changes, and check whether care achieved its intended results.

The plan should respond to the individual patient, including their preferences and practical barriers. For example, preparing for discharge may involve confirming the medication plan, communicating follow-up needs, and checking that the patient knows whom to contact with questions.

Responsibility and legal boundaries

Accountability means being answerable for professional decisions and actions. Nurses are expected to practice competently, follow applicable laws and policies, communicate concerns, document care accurately, and act when patient safety may be at risk.

A nurse’s scope of practice depends on their license, education, demonstrated competence, applicable state laws and regulations, and practice setting. Requirements can differ by jurisdiction and by nursing role, so verify local rules instead of assuming a task is allowed everywhere. If a request is outside your authority or competence, clarify it and seek appropriate guidance before proceeding.

Making assignments and delegating tasks

An assignment distributes work a person is authorized and competent to perform within their role. Delegation transfers authority to perform a specific task when law and policy permit it. The details of these responsibilities can vary by jurisdiction and setting.

Before delegating, use the five rights of delegation as a safety check:

1. Right task: The task is permitted and appropriate to delegate.

2. Right circumstance: The patient’s condition and situation make delegation safe.

3. Right person: The person accepting the task is authorized, trained, and competent.

4. Right direction and communication: Instructions, limits, expected results, and reporting requirements are clear.

5. Right supervision and evaluation: The nurse remains available, follows up, and evaluates the result.

Routine tasks for a stable patient may be appropriate to delegate when permitted and when the person is qualified. Assessment, clinical judgment, care planning, evaluation, and patient teaching generally require nursing judgment and should not be transferred to unlicensed assistive personnel. The RN must interpret relevant findings and respond appropriately. Apply state law, organizational policy, and the needs of the individual patient.

Coordinating care and responding to change

Match care needs to staff authorization, competence, and available support. Consider the patient’s stability, the complexity and predictability of care, and the likelihood of a change in condition. A routine task that is safe for a stable patient may not be safe to delegate when the patient is deteriorating or requires ongoing assessment.

During handoffs or changes in responsibility, communicate the patient’s condition, current plan, risks, pending tasks, and when concerns should be reported. Confirm or read back critical instructions when appropriate. If a patient’s condition worsens, reassess, intervene within scope, notify the appropriate clinician, and escalate unresolved safety concerns through the chain of command. Document objective findings, actions, notifications, and responses according to policy.

Takeaway: Safe care depends on matching responsibilities to patient needs and staff qualifications, while maintaining clear communication, supervision, and follow-up.

• Care coordination