Delegation is the transfer of responsibility for the performance of an activity from one individual to another, while the delegating nurse retains accountability for the outcome. The RN does not delegate the responsibility — only the task. The legal framework for delegation is established by state Nurse Practice Acts (NPAs), which vary by jurisdiction.
The National Council of State Boards of Nursing (NCSBN) framework for delegation is built on five rights — a systematic checklist that nurses apply before delegating any task:
| Right | What the RN Must Verify | Clinical Application |
|---|---|---|
| Right Task | Is this a task that CAN be delegated based on facility policy, the state NPA, and the specific patient situation? | Routine vital signs = delegatable. Initial nursing assessment = NOT delegatable. Even a delegatable task may not be appropriate if the patient's condition is complex or unstable. |
| Right Circumstance | Is the patient's condition stable enough for this task to be performed by someone other than the RN? | Taking routine vitals on a stable post-op patient = appropriate. Taking vitals on a patient in hypertensive crisis who needs immediate RN interpretation = not appropriate to delegate. |
| Right Person | Does this specific UAP or LPN have the training, competency, and scope of practice to perform this task safely? | The RN must know what the delegatee is actually competent to do — not assume based on job title alone. New UAP orientation status matters. Scope of practice for LPNs varies by state. |
| Right Direction/Communication | Has the RN provided clear, specific instructions — what to do, how to do it, what to report, when to report? | "Take Mr. Johnson's vital signs every 2 hours and report to me immediately if his systolic BP is above 160 or below 90, or if his pulse is above 100." Not: "Keep an eye on Mr. Johnson." |
| Right Supervision/Evaluation | Is the RN providing appropriate oversight, monitoring results, and following up on delegated tasks? | The RN doesn't walk away after delegating. The RN checks back, reviews reported values, acts on findings, and remains accountable for patient outcomes. Delegation is not abandonment. |
Delegation flows downward through the clinical hierarchy — from RN to LPN/LVN, and from RN to UAP (unlicensed assistive personnel, including CNAs, patient care technicians, and nurse aides). The scope of what can be delegated differs at each level.
LPNs/LVNs are licensed healthcare providers with defined scopes of practice under their state's NPA. LPNs can typically perform a wider range of tasks than UAPs — including medication administration (oral, subcutaneous, intramuscular) in most states, wound care, catheter care, and in some states IV medication administration for stable patients. However:
UAPs are unlicensed — they have training but no independent license and no scope of independent clinical judgment. UAPs perform tasks that require technique but do not require nursing assessment or clinical judgment. The fundamental principle: UAPs can perform tasks, but cannot assess patients, make nursing judgments, or administer medications (with narrow exceptions like applying prescribed topical products in some states).
| Task Category | Delegatable to UAP? | Delegatable to LPN? | Notes |
|---|---|---|---|
| Vital signs (stable patient) | Yes | Yes | RN interprets and acts on findings; UAP reports |
| Routine bathing and hygiene | Yes | Yes | UAP core responsibility |
| Ambulation (stable patient) | Yes | Yes | Must be stable, appropriate functional status, and UAP must be competent in safe patient handling |
| Intake and output measurement | Yes | Yes | UAP measures and records; RN interprets and acts |
| Foley catheter care (routine) | Yes | Yes | NOT catheter insertion or removal — that typically requires RN or LPN depending on state |
| Fingerstick glucose (in some states) | Yes (state-dependent) | Yes | Varies widely by state NPA and facility policy; insulin administration remains RN/LPN scope |
| Oral medication administration | No | Yes (most states) | Medication administration is outside UAP scope in virtually all states |
| IV medication administration | No | State-dependent | LPN IV scope varies by state; commonly limited to stable, non-high-alert medications |
| Initial nursing assessment | No | No | The nursing assessment is the foundational RN function; cannot be delegated; LPN may contribute data collection but RN synthesizes and documents the assessment |
| Nursing care plan development | No | No | Planning is the RN's professional responsibility |
| Patient education | No | Limited | Initial teaching and complex education is RN function; LPN may reinforce teaching already initiated by RN |
| Discharge planning | No | Limited | Discharge assessment and planning are RN responsibilities |
The nursing functions that can never be delegated to UAP and that are exclusively RN scope can be remembered through the five core professional nursing functions: Assessment, Analysis/Nursing Diagnosis, Planning, Implementation of complex nursing interventions, and Evaluation. The "ADPIE" nursing process is RN professional territory.
Practically, this means: the RN cannot delegate the initial patient assessment, the development of the nursing diagnosis, the construction of the care plan, the administration of high-alert medications, complex wound assessment, teaching new complex concepts, or evaluation of whether nursing interventions achieved the desired patient outcomes.
Which patient should the RN see first? — Before asking what to delegate, NCLEX often asks what the RN should handle directly. Unstable, newly changed, or post-procedure patients always get RN attention first. The rule: airway first, then the patient with the most acute need, then assess whether routine tasks can be delegated.
Which task is appropriate to delegate to the UAP? — Apply the Five Rights. The classic correct answers: vital signs on a stable patient, routine hygiene care, ambulating a patient who is stable and cleared by the RN, and measuring intake and output. Classic wrong answers: any task requiring nursing assessment, medication administration, IV management, or patient education.
The "which task should the RN perform first" + delegation combination: A patient returning from cardiac catheterization — RN assesses (new procedure, assessment required). A patient with a hip replacement requesting help to the bathroom — delegate ambulation to UAP. A patient due for oral medications — RN or LPN per state scope. The scheduling logic flows from acuity, not convenience.
Delegation does not end when the task is assigned. The RN who delegates retains accountability for patient outcomes and must supervise the delegatee's performance appropriately. This includes:
Following up to confirm the task was completed. Reviewing reported findings and acting on abnormal values promptly. Re-assessing the patient if findings suggest clinical change. Providing feedback to the delegatee if the task was performed incorrectly or if reporting was incomplete. Intervening directly if the delegatee is clearly not performing the task safely.
The RN cannot use "I delegated it" as a defense when a patient is harmed because the RN failed to supervise a delegated task appropriately. The nursing license is on the line at all times.
Related guides: Nursing ethics | Nursing advocacy | How to succeed in nursing school | Therapeutic communication
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