Teaching Nurses How to Delegate Care

By Rose O. Sherman, EdD, RN, NEA- BCFAAN

Treat people as if they were what they ought to be, and you will help them become what they are capable of being – Goethe

Many health systems either are currently using or will be implementing team-based models of care in 2024. The transition from primary nursing to team nursing can be challenging as nurses need to learn new skills. One of those skills is delegating care to team members other than RNs. After almost three decades of not delegating care, few nurses today have the skill set. Ineffective delegation or the lack of follow-up for tasks delegated can result in errors or omissions of care.

As with any other new skill, delegation must be taught and practiced. RNs must know the roles and scope of practice for their team members. The National Council of State Boards of Nursing (NCSBN) has guidelines and a post-test for nurses that outlines specific expectations. Before delegating in any setting, nurses must understand the practice act or professional responsibilities that are part of their licensure.  In addition to this information, reviewing a healthcare agency’s policies regarding delegation is essential.

The following framework (NCSBN) can be useful in teaching delegation using case examples of patient situations.

Step One – Assessment and Planning Questions to Ask

Goal – Give the Right Task under the Right Circumstance to the Right Person

• What are the needs and condition of the patient?
• What level of clinical decision making and assessment is needed?
• What is the predictability of the patient’s response to care?
• What is the potential for adverse outcomes associated with the delegated performance of tasks and functions?
• What are the cognitive and technical abilities needed to perform the activity/function or task?
• Which team member has the scope of practice, skills, competencies and experience to perform the task needed?
• What is the context of the situation and the environment – was the patient just admitted, is it a high acuity environment?
• What level of interaction/communication is needed in the care of the patient and with whom?

Step Two – Communication Questions to Ask

Goal – Give the Right Direction

• How is the task to be accomplished?
• When and what information should be reported?
• What is the process for seeking clarification about delegated care?
• What are the communication expectations in emergency situations?

Step Three – Supervision Questions to Ask

Goal – Provide the Right Supervision

• What level of supervision and observation needs to be provided?
• What should be the frequency of monitoring and observing care?
• How will the completion of care be verified and documented?
• How will unexpected changes in a patient’s condition be managed?

Step Four – Observation and Feedback Questions to Ask

Goal – Assess the Effectiveness of Delegation

• Was the delegation successful?
• Is there a better way to meet the needs of the patient?
• Is there a need to adjust the plan of care?
• Were there learning moments for staff or the nurse who delegated care?
• Was appropriate feedback and follow-up provided?
• Was positive feedback given when appropriate?

Delegation is both a science and an art.  The science to delegation involves understanding professional responsibilities from a legal standpoint.  The art involves making sure that good communication takes place during the delegation process. Part of being a good leader is help professional nurses understand the need to develop their team members through delegation rather than demonstrating a lack of confidence in others or a need for control.

© emergingrnleader.com 2023

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