Leadership, Delegation, and Team Communication
The Leadership, Delegation, and Team Communication domain tests safe delegation, assignment decisions, conflict management, and structured communication. The exam focuses on what the RN may delegate and how the RN follows up.
Core rules and concepts
- Delegation has five rights: the right task, circumstance, person, direction and communication, and supervision and evaluation.
- The RN cannot delegate the nursing process: assessment, nursing diagnosis, planning, evaluation, teaching, or tasks requiring nursing judgment. These remain RN accountabilities.
- Unlicensed assistive personnel may perform tasks such as vital signs on stable patients, activities of daily living, ambulation, and intake and output within their training and state rules.
- Assignment differs from delegation: assignment is distributing work based on scope and competency; delegation transfers authority for a specific task. The RN remains accountable for follow-up.
- Use SBAR for handoffs, CUS (concerned, uncomfortable, safety issue) to stop an unsafe action, and the chain of command when an order is unsafe or unresolved.
- A just culture encourages speaking up and reporting; incivility and intimidation are patient safety threats.
Worked example
A UAP has a free moment. The nurse delegates vital signs and ambulation for a stable patient, specifying which patient, what to report, and when to return. She does not delegate the new admission assessment or discharge teaching to the UAP. She verifies understanding and follows up on the results. Reasoning: the task is within UAP scope, the patient is stable, directions are clear, and the RN retains accountability for assessment and teaching.
Traps that cost marks
- Delegating teaching, initial assessment, or evaluation to unlicensed staff.
- Delegating without clear directions or follow-up.
- Confusing assignment with delegation.
- Avoiding the chain of command because the provider seems busy or intimidating.