This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
Scenario
The RN starts a day shift on a medical-surgical unit with a licensed practical nurse (LPN) and a nursing assistant (NA). The patients below are illustrative, created for this assignment.
| Patient | Situation at 0700 |
|---|---|
| Mr. A, 68 | Day 1 after a hip replacement; newly confused, respiratory rate 26 |
| Ms. B, 45 | Type 2 diabetes, stable; scheduled insulin and a dressing change due |
| Mr. C, 80 | Stable after a stroke; needs help with hygiene, meals and turning every 2 hours |
| Ms. D, 52 | Going home today on warfarin; needs discharge teaching |
Setting priorities
Mr. A comes first. New confusion and a fast respiratory rate after surgery are a change in condition, and assessing an unstable patient and deciding what to do next takes nursing judgment. Ms. D comes next: her teaching has to be finished before she leaves, and it relies on the RN's assessment of what she understands. Ms. B and Mr. C are stable, with predictable needs, which makes parts of their care suitable to delegate.
The five rights of delegation
The National Guidelines for Nursing Delegation set out five rights (National Council of State Boards of Nursing [NCSBN] & American Nurses Association [ANA], 2019):
| Right | What it asks | Applied in this case |
|---|---|---|
| Right task | Is the activity in the delegatee's job description and the facility's policies? | The NA helps Mr. C with hygiene, meals and turning. The LPN gives Ms. B's insulin and changes her dressing, where the state's nurse practice act and facility policy allow it. |
| Right circumstance | Is the patient stable? | Ms. B and Mr. C are stable. Mr. A isn't, so the RN keeps his assessment and care. |
| Right person | Does the delegatee have the skills and knowledge? | The RN confirms that the NA is trained in safe transfers and the LPN in the dressing technique. |
| Right directions and communication | Are the instructions specific, with what to report and when? | "Turn Mr. C at 0800, 1000 and 1200 and tell me straight away if you see red skin over his heels or sacrum." "Tell me Ms. B's blood glucose before you give her lunchtime insulin." |
| Right supervision and evaluation | Does the RN follow up and evaluate outcomes? | The RN checks in with both at 1000, reviews their documentation and reassesses Ms. B if her glucose is out of range. |
What stays with the RN
The guidelines are clear that clinical reasoning, nursing judgment and critical decision making can't be delegated (NCSBN & ANA, 2019). Here that means the RN keeps Mr. A's assessment and escalation, Ms. D's discharge teaching and the evaluation of every patient's plan of care. The RN remains accountable for the patients even when tasks are delegated.
Why it matters
Care that no one clearly owns, or that no one checks on, can be missed. In a qualitative study on medical-surgical units, nursing staff named nine elements of care that were regularly missed, including ambulation, turning, patient teaching, discharge planning and surveillance (Kalisch, 2006). Specific directions and planned check-ins are how the RN makes sure Mr. C is turned on time and Ms. D goes home knowing how to take warfarin safely.
References
Kalisch, B. J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality, 21(4), 306–313. https://doi.org/10.1097/00001786-200610000-00006
National Council of State Boards of Nursing & American Nurses Association. (2019). National guidelines for nursing delegation. https://www.ncsbn.org/public-files/NGND-PosPaper_06.pdf
