Delegation is the process for a nurse to direct another person to perform nursing tasks and activities (American Nurses Association [ANA] & National Council of State Boards of Nursing [NCSBN], 2019). Delegation involves the transfer of responsibility for the performance of an activity to another individual while retaining accountability for the outcome. Used appropriately, delegation can result in safe and effective nursing care and contribute to improved patient care outcomes (Barrow & Sharma, 2021). Delegation allows the registered nurse (RN) to attend to more complex patient care needs, develops the skills of assistive personnel, and promotes cost containment for the health care organization (ANA & NCSBN, 2019). The decision to delegate is based upon the RN's judgment concerning the condition of the patient, the competence of all members of the nursing team, and the degree of supervision that will be required of the RN if a task is delegated (ANA & NCSBN, 2019).

In delegating, the RN must ensure appropriate assessment, planning, implementation, and evaluation. Decision making about delegation is a continuous process. These guidelines provide a quick reference for the delegation decision-making information found in each skill.

Criteria to be considered by the RN when deciding to delegate care activities (ANA & NCSBN, 2019) include:

1. The State Nursing Practice Act must permit delegation and outline the authorized task(s) to be delegated or authorize the RN to decide delegation.
2. The person delegating has the appropriate qualifications: appropriate education, skills, and experience as well as current competency.
3. The person receiving the delegation must have the appropriate qualifications: appropriate education, training, skills, and experience as well as evidence of current competency.

In addition, according to the ANA and NCSBN (2019), the delegated task(s) must not involve critical decision making or nursing judgment.

Delegation is a multistep, continuous process.

1. The RN must be fully aware of the parameters for delegation as outlined in their state's Nurse Practice Act as well as the employing organization's policies and procedures regarding delegation (Daley, 2013).
2. The RN must assess the situation, identifying the needs of the patient, considering the circumstances and setting, as well as the competence of the person to whom the task is being delegated (delegatee). The RN may proceed with delegation if patient needs, circumstances, and available resources indicate patient safety will be maintained with delegated care.
3. The RN plans for and clearly communicates the specific task(s) to be delegated. The RN may proceed with delegation if the nature of the task, competence of the person receiving the delegation, and patient implications indicate patient safety will be maintained with delegated care.
4. The RN maintains overall accountability for the patient. The delegatee bears the responsibility for the delegated activity, skill, or procedure (ANA & NCSBN, 2019). The RN may proceed with delegation if the RN and person receiving the delegation accept the accountability for their respective roles in the delegated patient care.
5. The RN supervises performance of the delegated task(s), providing directions and clear expectations of how the task(s) is to be performed. The RN monitors performance, intervenes if necessary, and ensures the appropriate documentation.
6. The RN must evaluate the entire delegation process, evaluating the patient, the performance of the task(s), and obtain and provide feedback.
7. The RN must reassess and adjust the overall plan of care, as needed.

The Five Rights of Delegation provide a resource to facilitate decisions about delegation. The ANA and NCSBN (2019) identify the Five Rights of Delegation as follows:

• Right Task: One that falls within the delegatee's job description or is included as part of the established written policies and procedures of the practice setting.
• Right Circumstances: The health condition of the patient must be stable. Changes in the patient's condition require the delegatee to communicate this to the RN, and the RN must reassess the situation and the appropriateness of the delegation.
• Right Person: The delegatee possesses the appropriate skills and knowledge to perform the activity.
• Right Direction/Communication: Each delegation situation should be specific to the patient, the licensed nurse, and the delegatee. A clear, concise description of the task, including its objective, limits, and expectations should be provided.
• Right Supervision/Evaluation: This includes appropriate monitoring, evaluation, intervention, as needed, and feedback.

Nursing care or tasks that should never be delegated except to another RN include:

• Initial and ongoing nursing assessment of the patient and their nursing care needs
• Determination of the nursing diagnosis, nursing care plan, evaluation of the patient's progress in relation to the care plan, and evaluation of the nursing care delivered to the patient
• Supervision and education of nursing personnel; patient teaching that requires an assessment of the patient and their education needs
• Any other nursing interventions that require professional nursing knowledge, judgment, and/or skill

Using skills, knowledge, and professional judgment, the RN determines appropriate nursing practice based on the state practice act and professional scope of practice, the standards and code of ethics, and the organization's policies and procedures related to delegation (ANA & NCSBN, 2019).

The Decision Tree for Delegation by Registered Nurses distributed by the American Nurses Association and the National Council of State Boards of Nursing can assist nurses with delegation decisions. The Decision Tree for Delegation can be found at https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf