2 Delegation and Nursing Accountability
Learn how nurses distinguish delegation from assignment, apply the Five Rights of Delegation, and maintain safe supervision and accountability.
and scope
authorizes another qualified person to perform a specific activity, but it does not transfer the nurse’s clinical judgment or authority. The delegatee is responsible for performing the accepted activity correctly, reporting concerns, and documenting it as required.
An distributes work that is already within a team member’s authorized role and scope. Exact definitions and rules can vary by jurisdiction. A handoff of a patient’s care between licensed nurses is a transfer of care, not .
Legal and professional boundaries
is determined by applicable nurse practice acts and regulations, the individual’s licensure, education and demonstrated competence, and employer policy. Requirements differ among states and settings, so nurses must check their jurisdiction’s rules and workplace policies before delegating. Employer policy cannot authorize practice prohibited by law.
A licensed nurse must not delegate an activity that requires nursing assessment, clinical reasoning, judgment, or critical decision-making.
The
Before delegating, consider all five rights. Together, they guide decisions about whether a task, situation, and person are appropriate, and what communication and oversight are needed.
Right task: The activity is legally permitted, allowed by workplace policy, and appropriate to delegate.
Right circumstance: The patient’s condition and the situation are sufficiently stable and predictable, and suitable resources are available. Reassess if the condition changes.
Right person: The delegatee has the training, competence, and time required to perform the activity safely.
Right directions and communication: Give clear, patient-specific instructions about what to do, when to do it, what to report, and how to document. Confirm the delegatee understands and accepts the task.
Right supervision and evaluation: Provide the oversight the situation requires, remain available to intervene, follow up, and evaluate the patient’s response and the completed activity.
Prioritizing decisions
Prioritize care according to urgency, patient acuity, risk of deterioration, and time sensitivity. First determine which needs require nursing judgment and which routine activities may be safely performed by another team member. Match the patient’s needs with the delegatee’s authorized role and competence, while considering workload and the supervision available.
If the patient is unstable, the task is unfamiliar or complex, or safe supervision is unavailable, the nurse should retain the activity or seek appropriate assistance rather than delegate it.
For example, when permitted by law and policy, a trained assistive personnel member may obtain routine vital signs for a stable patient. The nurse specifies when to report results and which symptoms or readings require immediate notification. If the patient becomes short of breath or the results are concerning, the delegatee reports promptly; the nurse reassesses and determines the next steps. Collecting data does not authorize the delegatee to interpret them or change the plan of care.
Supervision in practice
Supervision is an active process, not simply giving an instruction. The nurse communicates expectations, remains available for questions, monitors progress as appropriate, responds to changes, and checks that the activity and documentation are complete.
The delegatee should accept only work they are competent and authorized to perform, follow directions, promptly report concerns, and not pass the delegated task to someone else. Either person should raise concerns if the task cannot be completed safely.
and documentation
is shared but distinct. The licensed nurse remains accountable for the decision, appropriate supervision, and overall nursing care. The delegatee is responsible for carrying out the accepted activity safely and accurately.
Document care and relevant communication according to policy. Report errors, unexpected findings, or changes in the patient’s condition promptly. Safe matches a permitted task and suitable patient situation with a competent person, clear communication, and appropriate supervision, while following applicable nurse practice acts, regulations, and employer policies.