Annotated Bibliographies for Capstone Project

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NUR 470 Delegation Assignment

Name: Betsy Emmons Date: October 30, 2011

Differentiate between delegation, accountability, authority, and responsibility. Give clinical example of each.

Effective delegation is one of the most challenging and difficult RN responsibilities. American Nurses Association (ANA) and National Council of State Board of Nursing (NCSBN) share the definition of delegation as; “the process for a nurse to direct another person to perform nursing tasks and activities.” For instance, a registered nurse can delegate tasks to an unlicensed staff member such as; transfer a patient from bed to chair and measure intake and output. The RN can assign an LPN to a patient with colostomy that needs irrigation. Delegation is when the nurse transfers their authority but not their responsibility. It allows the nurse to request another team member to perform a specific nursing task, but the RN is always responsible for the manner in which it was delivered. The duties of a registered nurse may be given to a licensed practical nurse or certified nursing assistant but the RN must always be in compliance with state licensure and training laws and certifications. Delegation is one of the most complex nursing skills and requires good clinical judgment and final accountability for patient care. The skill required of an RN is to understand what patients and families need and then to appoint the appropriate care givers in the plan of care in order to accomplish desired patient outcomes. The RN tries to maximize the available resources for the patient while also managing clinical and financial outcomes. Nurses make careful decision about delegation, taking into consideration the skill level of the UAP, the risk/difficulty of the duty, and the patient’s condition (as mentioned). The nurse must be clear to UAP about the expectations, time frames, and any limitations prior to the delegation. The 2001, ANA Code of Ethics says that delegation relies on the RN’s judgment and competence of all team members, and the degree of supervision needed for the particular task. The licensed nurse may assign and/or delegate nursing care activities to other licensed nurses or unlicensed assistive personnel (UAP) based upon their own license level, assessment of the client’s status, clinical competence of available licensed and unlicensed personnel, and the variables in each practice setting. Before assigning/delegating nursing activities to staff, the licensed nurse needs access to information about the RN-validated competencies for each individual. Accountability of delegation is when the nurse accounts for themselves and for others regarding their actions. (ANA Code of Ethics, 2001). When a nurse is accountable they are legally liable and held responsible for all actions or inactions of self and others within setting. To assure accountability the nurse not only accepts responsibility for performance of the task, but they also verify that the delegate accepts accountability for carrying out the task correctly. The nurse must know state regulation and specific job description regarding what tasks the nursing assistant and licensed practical nurse are able to perform in order to uphold accountability. An example of this would be when the LPN is assigned to auscultate and observe a patient’s abdomen to gather data regarding distention. The RN analyzes and synthesizes the data to develop care planning based on nursing diagnosis. The RN is accountable for the total assessment of a patient and the plan of care for specific outcomes.RNs assure appropriate accountability by verifying that the receiving person accepts the delegation and accompanying responsibility (NCSBN and ANA, 2006). The acceptable use of the authority to delegate should be consistent with the nursing process; appropriate assessment, planning, implementation, and evaluation. The nursing process and decision to delegate must be based on cautious analysis of the patient’s...
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