Before We Start
What delegation means — and why it matters
Delegation is the transfer of responsibility for performing a nursing task to another person while retaining accountability for the outcome. The key word is accountability — when you delegate a task, you are not transferring responsibility. You are sharing it. The RN remains accountable for the task even after delegation.
Delegation is a clinical skill that requires judgment — assessing the patient, the task, and the person to whom you're delegating. Getting it wrong puts patients at risk and puts your license in jeopardy. Getting it right allows you to provide safe, efficient care to more patients.
💡 The Three Levels of Nursing Personnel
RN (Registered Nurse) — full scope of practice, including assessment, diagnosis, planning, teaching, evaluation, and complex interventions. The RN is ultimately accountable for all patient care.
LPN/LVN (Licensed Practical/Vocational Nurse) — works under the supervision of an RN or physician. Can perform many nursing tasks but has a more limited scope, particularly around assessment and care planning.
UAP (Unlicensed Assistive Personnel) — includes CNAs, patient care technicians, orderlies, and similar roles. Perform tasks under the direction and supervision of licensed nursing staff. No independent clinical judgment.
The Five Rights of Delegation
The framework for every delegation decision
1 — Right Task
Is this task appropriate to delegate at all?
Some tasks can never be delegated by the RN — they are exclusively within the RN scope of practice. Others are routinely delegable to the appropriate personnel.
Tasks the RN can NEVER delegate:
• Initial nursing assessment
• Nursing diagnosis
• Care planning
• Patient teaching and education
• Evaluation of patient outcomes
• Tasks requiring nursing judgment or interpretation
• Care of unstable patients
Tasks routinely delegable to LPN: Routine medication administration (oral, topical, some SQ), wound care, catheter insertion (in some states), data collection, reinforcing (not initiating) teaching.
Tasks routinely delegable to UAP: Vital signs (stable patients), ADLs (bathing, dressing, feeding), ambulation assistance, I&O measurement, specimen collection, bed making.
💊 NEVER delegate assessment, teaching, care planning, or evaluation — these are always RN responsibilities. You can delegate DATA COLLECTION (asking the patient their pain score) but not ASSESSMENT (interpreting what the pain score means clinically).
2 — Right Circumstance
Is this patient stable enough for delegation?
Patient stability is the most important circumstance to assess. Tasks that are safe to delegate for stable patients may be unsafe to delegate for unstable ones.
Consider:
• Is the patient's condition predictable? (Stable patients = more delegable)
• Is the patient's condition complex? (Simple tasks on complex patients require more RN involvement)
• What is the potential for harm if something goes wrong? (High-risk tasks = less delegable)
• What is the expected outcome? (Predictable outcomes = more delegable)
Example: Vital signs on a stable post-op day 2 patient → appropriate to delegate to UAP. Vital signs on a patient in early sepsis every 15 minutes → the RN should be doing this assessment and interpreting the trends.
💊 Stable + simple + predictable = delegate. Unstable + complex + unpredictable = RN does it. When in doubt — do it yourself.
3 — Right Person
Is this person qualified and competent to perform this task?
Knowing the scope of practice of your team is not enough — you must also know whether the individual has the training and demonstrated competency for the specific task.
Scope of practice: Defined by the state nurse practice act. What LPNs and UAPs can legally do varies by state.
Individual competency: A UAP may have the legal authority to take vital signs but may not know how to use the specific equipment on your unit. You cannot assume competency — you must verify it.
Questions to ask yourself: Has this person been trained for this task? Have they demonstrated competency? Have I seen them perform it correctly? Are they comfortable with it?
💊 Don't assume — verify. "Have you taken a blood glucose reading before? Are you comfortable with our glucometer?" takes 10 seconds and prevents a competency error.
4 — Right Direction and Communication
Give clear, specific instructions — and confirm understanding
Clear delegation is not "go check on Mr. Smith." Clear delegation is specific about what to do, how to do it, when to do it, and what to report back.
Elements of clear direction:
• What task to perform (specific)
• On which patient
• When to perform it
• What specific parameters to report immediately (call me if BP <90 or HR >110)
• What documentation is required
After giving direction: "Does that make sense? Do you have any questions?" Confirm understanding without being condescending.
💊 "Can you get Mr. Chen's vitals every 30 minutes and let me know immediately if his systolic drops below 90 or his heart rate goes above 110? I'll be in room 4." — Specific, clear, with escalation parameters.
5 — Right Supervision
Follow up — delegation is not abandonment
After delegating, the RN remains responsible for the outcome. This requires active follow-up — not just waiting to hear if something went wrong.
Supervision responsibilities:
• Check in with the delegate periodically
• Review documented findings
• Evaluate whether the task was completed correctly
• Reassess the patient as clinically indicated
• Intervene immediately if the delegated task was performed incorrectly
Supervision is not micromanagement. It's professional accountability. You delegated — you're still responsible. Verify it was done right.
💊 "Check back with me after you've gotten his vitals" + actually following up when it doesn't happen = supervision. Delegation + never following up = negligence.
Quick Reference
Who can do what
RN — Full scope
Assessment · Nursing diagnosis · Care planning · Patient teaching · Evaluation · Complex interventions · Unstable patients · IV push medications · Blood transfusions · Care requiring clinical judgment
LPN/LVN — Under RN supervision
Stable patient care · Routine oral/topical/SQ medications · Wound dressing changes · Catheter care · Data collection · Reinforcing (not initiating) patient teaching · Some IV medications (varies by state)
UAP/CNA — Under RN direction
ADLs (bathing, dressing, grooming, feeding) · Vital signs (stable patients) · Ambulation assistance · Positioning · I&O measurement · Specimen collection · Bed making · Reporting observations to RN
NEVER delegate to UAP
Assessment · Teaching · Evaluation · Care planning · Medications · Unstable patients · Tasks requiring clinical judgment · IV care · Any task requiring a nursing license
🏥 Delegation Scenario — NCLEX-Style Prioritization
You are an RN with four patients and one UAP available to assist. Which tasks do you delegate and which do you perform yourself?
Task 1
Routine vital signs for Mr. Lee, post-op day 3, stable. → DELEGATE to UAP. Stable patient, routine task, predictable outcome. Tell UAP: "Take Mr. Lee's vitals every 4 hours. Report to me if systolic <90, HR >100, temp >38°C, or SpO₂ <93%."
Task 2
Discharge teaching for Mrs. Park, newly diagnosed with heart failure. → RN ONLY. Patient education is exclusively within RN scope. Cannot be delegated to LPN or UAP.
Task 3
Assist Mr. Johnson with morning bath and ambulation, stable. → DELEGATE to UAP. ADLs and ambulation assistance for stable patients are appropriate UAP tasks. Brief the UAP on fall precautions and what to report.
Task 4
Assess Ms. Garcia, who the night nurse reports "seems a little off" this morning. → RN ONLY. Assessment of a potentially changing patient condition is always the RN. "Seems a little off" is exactly the kind of ambiguous situation that requires a licensed nurse's judgment.
📌 NCLEX Application
Delegation is one of the most tested NCLEX management-of-care topics.
Key NCLEX rules:
• Never delegate assessment, teaching, evaluation, or care planning
• Never delegate care of unstable patients to UAP
• The RN remains accountable for all delegated tasks
• Tasks appropriate for stable patients may not be appropriate for the same patient when unstable
Classic NCLEX question pattern: "Which task should the nurse delegate to the UAP?" → Look for: stable patient + routine task + no clinical judgment required + predictable outcome
Another pattern: "Which patient should the RN see first?" → Unstable, newly admitted, post-procedure, or complex patients always go to the RN. Stable, routine, predictable patients can be managed with more delegation.
⚠️ The Trap — Delegating Because You're Busy
The most dangerous delegation decisions are made when a nurse is overwhelmed and simply needs help — not when the clinical situation calls for delegation.
"I don't have time to assess that new patient — can you go check on them?" directed at a UAP is delegation without clinical judgment. The UAP has no license, no assessment skills, and no ability to identify what they don't know about what they're seeing.
Busyness is not a clinical indication for delegation. The patient's stability, the complexity of the task, and the competency of the person are the clinical indications. When you're overwhelmed, the appropriate response is to communicate with your charge nurse, not to delegate tasks outside someone's scope of practice.
✓ Quick Self-Test — Delegate or Not?
Can the RN delegate each task to a UAP? Yes or No:
1. Obtain vital signs on a stable post-surgical patient
2. Perform a head-to-toe assessment on a newly admitted patient
3. Assist a patient with bathing and oral hygiene
4. Teach a diabetic patient how to self-administer insulin
5. Collect a urine specimen from a catheterized patient
6. Evaluate whether a patient's pain medication was effective
Answers:
1. Yes — routine vital signs, stable patient
2. No — assessment is RN scope only
3. Yes — ADLs are appropriate UAP tasks
4. No — patient teaching is RN scope only
5. Yes — specimen collection is appropriate for UAP
6. No — evaluation of patient outcomes is RN scope only