3 Delegation and Assignment

How Care Is Distributed

Safe distribution of care begins by matching the patient’s needs with the work to be done, the team member’s authorized role and demonstrated competence, and the supervision available. Laws and regulations, facility policy, and the care setting determine what may be assigned or delegated. General guidance does not replace checking local requirements.

An Assignment distributes work a team member is already authorized and competent to perform. Delegation is a licensed nurse’s direction that another person carry out a specific activity or responsibility. Either way, the nurse must confirm that the work suits both the person and the patient.

A licensed-to-licensed transfer of patient-care responsibility is generally a handoff, not delegation. Delegation also does not permit the receiving person to pass the task to someone else.

Takeaway: First clarify whether the work is an assignment, a delegated activity, or a handoff; then check role, competence, and patient needs.

Roles and Responsibilities

Team roles differ according to jurisdiction, setting, education, and policy, so role descriptions are general patterns rather than universal permissions.

• A Registered nurse (RN) typically assesses patients, identifies nursing priorities, develops or updates the plan of care, coordinates complex nursing care, evaluates outcomes, and delegates when appropriate. Nursing judgment and critical decision-making cannot be delegated.

• A Licensed practical/vocational nurse (LPN/LVN) may provide care within the authorized scope of practice and their competence. The RN must not assign or delegate responsibilities the LPN/LVN is not legally authorized to perform.

• Unlicensed assistive personnel (UAP) may carry out trained, authorized routine tasks, such as assisting with hygiene or mobility or collecting specified measurements, when the patient and situation are suitable. UAP report observations; the licensed nurse interprets them and decides what they mean for care.

The nurse retains accountability for nursing decisions and the patient’s overall care. The person accepting a delegated task is responsible for carrying it out correctly, communicating concerns, and documenting as required.

Takeaway: A job title alone does not establish permission; verify both authorized scope and current competence.

Five Rights of Delegation

Use the Five Rights of Delegation before assigning a task to another person through delegation. All five checks matter together:

1. Right task: The activity is allowed by law and policy, fits the person’s role, and does not require nursing judgment.

2. Right circumstance: The patient’s condition and the situation make the activity appropriate. Reassess if the patient’s condition changes.

3. Right person: The person has current, demonstrated competence for the task and patient population.

4. Right directions and communication: Explain what to do, what to report, when to report it, and how to document. Confirm understanding and invite questions.

5. Right supervision and evaluation: Remain available to guide or intervene, follow up, and evaluate both the task and the patient’s response.

For example, an RN may ask a competent UAP to obtain routine vital signs for a stable patient and report them promptly. The RN should specify values or symptoms requiring immediate notification, interpret the results, and reassess the patient as needed. If the patient becomes short of breath or unstable, the task is no longer routine: the UAP should alert the RN, who reassesses and takes appropriate action.

Takeaway: Delegation must fit the task, circumstances, person, communication, and supervision—not just the team’s workload.

Supervision, Limits, and Safety

Delegation is not simply handing over a task. The nurse remains available, monitors progress at a level appropriate to the risk, responds to reports, checks whether the work was completed, and evaluates the patient’s response. The delegatee should accept only tasks they are trained and competent to perform, clarify unclear directions, report changes or difficulties promptly, and complete required documentation.

Do not delegate tasks that require assessment, interpretation, care planning, evaluation, independent clinical decision-making, or teaching that requires nursing judgment. Do not delegate merely because the unit is busy. Patient instability, unpredictable outcomes, high risk, unclear instructions, insufficient competence, or lack of necessary follow-up are reasons to retain or reassess the task. Exact limits, including medication-related duties, depend on applicable law and policy.

If the delegatee lacks competence or the nurse cannot provide needed supervision, do not delegate. When scope, competence, patient stability, or supervision is uncertain, pause and verify the requirements.

Takeaway: Safe delegation includes active follow-up. The nurse retains accountability for nursing judgment and overall care; the delegatee is responsible for competent performance of an accepted task and prompt communication of concerns.