Delegation and Supervision
Delegation questions test the five rights of delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. The RN retains accountability for the outcome even when tasks are delegated.
The nurse must distinguish delegation (transferring a task to an assistive person) from assignment (distributing work among staff with similar scopes) and from teaching (a professional function that is not delegated). Tasks suitable for unlicensed assistive personnel (UAP) are routine, predictable, and do not require nursing judgment-vital signs on a stable patient, hygiene, ambulation, intake and output. Tasks that require assessment, teaching, evaluation, or clinical judgment stay with the RN or LPN per state rules.
Supervision means providing clear instructions, confirming understanding, monitoring performance, and evaluating outcomes. The nurse must be available for questions and must intervene if the delegatee is not competent.
Traps in questions:
- Delegating assessment, teaching, or evaluation to UAP.
- Delegating to a person who lacks training for the task, even if the task is generally delegable.
- Assuming the RN is no longer accountable after delegating.
- Forgetting to verify the delegatee's competence and the patient's stability.
Worked example: An RN may delegate obtaining vital signs on a stable postoperative patient to a UAP, but not interpreting an abnormal value or deciding to call the provider-those require nursing judgment and remain with the RN.
Rule of thumb: If the task needs nursing judgment, it is not delegable; if it is routine and the patient is stable, it may be.