1.8 Delegation and Supervision
Delegation
Nurses may assign or delegate client care to other members of the nursing team based on federal regulations and their scope of practice as defined by that state’s Nurse Practice Act (NPA). RNs may assign or delegate client care to other RNs, LPN/VNs, and/or UAP. LPNs may delegate care to other LPN/VNs or UAP.
When making assignments and delegating tasks to nursing team members, it is essential for nurses to keep in mind specific tasks that can and cannot be delegated to other nursing team members based on federal and/or state regulations. For example, in Wisconsin the NPA states, “In the supervision and direction of delegated acts, an RN shall do all of the following:
(a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.
(b) Provide direction and assistance to those supervised.
(c) Observe and monitor the activities of those supervised.
(d) Evaluate the effectiveness of acts performed under supervision.”
Examples of tasks that generally cannot be delegated are described in Table 1.8a.
Table 1.8a. Examples of Tasks Outside the Scope of Practice of Nursing Team Members
| Nursing Team Member | Tasks That Cannot Be Delegated
|
|---|---|
| LPN/VN |
|
| Unlicensed Assistive Personnel (UAP) |
|
There has been significant national debate over the difference between “assignment” and “delegation” over the past few decades. In 2019 the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) published updated joint National Guidelines on Nursing Delegation.[2] These guidelines apply to all levels of nursing licensure (advanced practice registered nurses [APRN], registered nurses [RN], and licensed practical/vocational nurses [LPN/VN]) when delegating when there is no specific guidance provided by the state’s Nurse Practice Act (NPA).[3] It is important to note that states have different laws and rules/regulations regarding delegation, so it is the responsibility of all licensed nurses to know what is permitted in their jurisdiction.
The National Guidelines on Nursing Delegation defines a delegatee as an RN, LPN/VN, or UAP who is delegated a nursing responsibility by either an APRN, RN, or LPN/VN, is competent to perform the task, and verbally accepts the responsibility.[4] Delegation is allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role and not routinely performed, but the individual has obtained additional training and validated their competence to perform the delegated responsibility.[5] However, the licensed nurse still maintains accountability for overall client care. Accountability is defined as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard. Therefore, if a nurse does not feel it is appropriate to delegate a certain responsibility to a delegatee, the delegating nurse sho