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chapter 9 | Delegation of Client Care 121 CikguOnline
others” (p. 1). In 2005, the ANA defined delegation LPNs are trained to perform specific tasks, such
as “the transfer of responsibility for the performance as basic medication administration, dressing
of an activity from one individual to another while changes, and personal hygiene tasks. In some states,
retaining accountability for the outcome” (p. 4). To the LPN, with additional training, may start and
delegate tasks safely, nurses must delegate appropri- monitor intravenous (IV) infusions and administer
ately and supervise adequately. certain medications.
In 1997 the NCSBN developed a Delegation
Decision-Making Grid. This grid is a tool to help Criteria for Delegation
nurses delegate appropriately. It provides a scoring
instrument for seven categories that the nurse The purpose of delegation is not to assign tasks to
should consider when making delegation decisions. others that you do not want to do yourself. When
The categories for the grid are listed in Box 9-2. you delegate to others effectively, the result is you
Scoring the components helps the nurse evalu- have more time to perform the tasks that only a
ate the situations, the client needs, and the health- professional nurse is permitted to do.
care personnel available to meet the needs. A low In delegating, the nurse must consider both the
score on the grid indicates that the activity may be ability of the person to whom the task is delegated
safely delegated to personnel other than the RN, and the fairness of the task to the individual and
and a high score indicates that delegation may not the team (Tappen, Weiss, & Whitehead, 2004). In
be advisable. Figure 9.2 shows the Delegation other words, both the task aspects of delegation
Decision-Making Grid. The grid is also available (Is this a complex task? Is it a professional respon-
on the NCSBN Web site at ncsbn.com sibility? Can this person do it safely?) and the
Nurses who delegate tasks to UAP should eval- interpersonal aspects (Does the person have time to
uate the activities being considered for delegation do this? Is the work evenly distributed?) must be
(Keeney, Hasson, & McKenna, 2005). The considered.
American Association of Critical Care Nurses The ANA (2005) has specified tasks that RNs
(AACN) (1990) recommended considering five may not delegate because they are specific to the
factors, which are listed in Box 9-3, in making a discipline of professional nursing. These activities
decision to delegate. include (Boysen & Fischer, 2000):
It is the responsibility of the RN to be well
■ Initial nursing and follow-up assessments if
acquainted with the state’s nurse practice act and
nursing judgment is indicated
regulations issued by the state board of nursing
■ Decisions and judgments about client outcomes
regarding UAP (ANA, 2005). State laws and regu-
■ Determination and approval of a client plan of
lations supersede any publications or opinions set
care
forth by professional organizations. As stated earlier,
■ Interventions that require professional nursing
the NCSBN provides criteria to assist nurses
knowledge, decisions, or skills
with delegation.
■ Decisions and judgments necessary for the
evaluation of client care
box 9-2 Task-Related Concerns
Seven Components of the Delegation The primary task-related concern in delegating
Decision-Making Grid
work is whether the person assigned to do the task
• Level of client acuity
has the ability to complete it. Team priorities and
• Level of unlicensed assistive personnel capability
• Level of licensed nurse capability efficiency are also important considerations.
• Possibility for injury
Abilities
• Number of times the skill has been performed by the
unlicensed assistive personnel To make appropriate assignments, the nurse needs
• Level of decision making needed for the activity
to know the knowledge and skill level, legal defi-
• Client’s ability for self-care
nitions, role expectations, and job description
Adapted from the National Council of State Boards of Nursing. Delegation
Decision-Making Grid. National State Boards of Nursing, Inc., 1997 for each member of the team. It is equally impor-
(ncsbn.org). tant to be aware of the different skill levels of