Joint Statement on Nursing Delegation: ANA and NCSBN Guidelines | Study Guides, Projects, Research Nursing

Joint Statement on Delegation

American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

Introduction

There is more nursing to do than there are nurses to do it. Many nurses are stretched to the limit in the

current chaotic healthcare environment. Increasing numbers of people needing healthcare combined with

increasing complexity of therapies create a tremendous demand for nursing care. More than ever, nurses

need to work effectively with assistive personnel. The abilities to delegate, assign, and supervise are

critical competencies for the 21st century nurse.

In 2005, both the American Nurses Association and the National Council of State Boards of Nursing

adopted papers on delegation.1 Both papers presented the same message: delegation is an essential

nursing skill. This joint statement was developed to support the practicing nurse in using delegation safely

and effectively.

Terminology

Although there is considerable variation in the language used to talk about delegation, ANA and NCSBN

both defined delegation as the process for a nurse to direct another person to perform nursing tasks and

activities. NCSBN describes this as the nurse transferring authority while ANA calls this a transfer of

responsibility. Both mean that a registered nurse (RN) can direct another individual to do something that

that person would not normally be allowed to do. Both papers stress that the nurse retains accountability

for the delegation.

Both papers define assignment as the distribution of work that each staff member is responsible for

during a given work period. The NCSBN uses the verb “assign” to describe those situations when a nurse

directs an individual to do something the individual is already authorized to do, e.g., when an RN directs

another RN to assess a patient, the second RN is already authorized to assess patients in the RN scope

of practice.

Both papers consider supervision2 to be the provision of guidance and oversight of a delegated nursing

task. ANA refers to on-site supervision and NCSBN refers to direct supervision, but both have to do with

the physical presence and immediate availability of the supervising nurse. The ANA refers to off-site

supervision, and NCSBN refers to indirect supervision. Both have to do with availability of the supervising

nurse through various means of written and verbal communication.

1 ANA and NCSBN have different constituencies. The constituency of ANA is state nursing associations and member

RNs. The constituency of NCSBN is state boards of nursing and all licensed nursing. Although for the purpose of

collaboration, this joint paper refers to registered nurse practice, NCSBN acknowledges that in many states LPN/VNs

have limited authority to delegate.

2 ANA defines supervision to be the active process of directing, guiding, and influencing the outcome of an individual’s

performance of a task. Similarly, NCSBN defines supervision as the provision of guidance or direction, oversight,

evaluation and follow-up by the licensed nurse for the accomplishment of a delegated nursing task by assistive

personnel. Individuals engaging in supervision of patient care should not be construed to be managerial supervisors

on behalf of the employer under federal labor law.

ANA • 8515 Georgia Avenue, Suite 400 • Silver Spring Maryland 20910-3492 • 301.628.6500 • Fax 301.628.5001 • www.nursingworld.org

NCSBN • 111 E. Wacker Drive, Suite 2900 • Chicago, Illinois 60601-4277 • 312.525.3600 • Fax 301.279.1032 • www.ncsbn.org

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American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

Introduction

There is more nursing to do than there are nurses to do it. Many nurses are stretched to the limit in the

current chaotic healthcare environment. Increasing numbers of people needing healthcare combined with

increasing complexity of therapies create a tremendous demand for nursing care. More than ever, nurses

need to work effectively with assistive personnel. The abilities to delegate, assign, and supervise are

critical competencies for the 21

century nurse.

In 2005, both the American Nurses Association and the National Council of State Boards of Nursing

adopted papers on delegation.

Both papers presented the same message: delegation is an essential

nursing skill. This joint statement was developed to support the practicing nurse in using delegation safely

and effectively.

Terminology

Although there is considerable variation in the language used to talk about delegation, ANA and NCSBN

both defined delegation as the process for a nurse to direct another person to perform nursing tasks and

activities. NCSBN describes this as the nurse transferring authority while ANA calls this a transfer of

responsibility. Both mean that a registered nurse (RN) can direct another individual to do something that

that person would not normally be allowed to do. Both papers stress that the nurse retains accountability

for the delegation.

Both papers define assignment as the distribution of work that each staff member is responsible for

during a given work period. The NCSBN uses the verb “assign” to describe those situations when a nurse

directs an individual to do something the individual is already authorized to do, e.g., when an RN directs

another RN to assess a patient, the second RN is already authorized to assess patients in the RN scope

of practice.

Both papers consider supervision

to be the provision of guidance and oversight of a delegated nursing

task. ANA refers to on-site supervision and NCSBN refers to direct supervision, but both have to do with

the physical presence and immediate availability of the supervising nurse. The ANA refers to off-site

supervision, and NCSBN refers to indirect supervision. Both have to do with availability of the supervising

nurse through various means of written and verbal communication.

1 ANA and NCSBN have different constituencies. The constituency of ANA is state nursing associations and member

RNs. The constituency of NCSBN is state boards of nursing and all licensed nursing. Although for the purpose of

collaboration, this joint paper refers to registered nurse practice, NCSBN acknowledges that in many states LPN/VNs

have limited authority to delegate.

ANA defines supervision to be the active process of directing, guiding, and influencing the outcome of an individual’s

performance of a task. Similarly, NCSBN defines supervision as the provision of guidance or direction, oversight,

evaluation and follow-up by the licensed nurse for the accomplishment of a delegated nursing task by assistive

personnel. Individuals engaging in supervision of patient care should not be construed to be managerial supervisors

on behalf of the employer under federal labor law.

American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

Policy Considerations

 State nurse practice acts define the legal parameters for nursing practice. Most states authorize RNs

to delegate.

 There is a need and a place for competent, appropriately supervised nursing assistive personnel in

the delivery of affordable, quality health care.

 The RN assigns or delegates tasks based on the needs and condition of the patient, potential for

harm, stability of the patient’s condition, complexity of the task, predictability of the outcomes, abilities

of the staff to whom the task is delegated, and the context of other patient needs.

 All decisions related to delegation and assignment are based on the fundamental principles of

protection of the health, safety and welfare of the public.

Principles of Delegation

 The RN takes responsibility and accountability for the provision of nursing practice.

 The RN directs care and determines the appropriate utilization of any assistant involved in providing

direct patient care.

 The RN may delegate components of care but does not delegate the nursing process itself. The

practice pervasive functions of assessment, planning, evaluation and nursing judgment cannot be

delegated.

 The decision of whether or not to delegate or assign is based upon the RN’s judgment concerning the

condition of the patient, the competence of all members of the nursing team and the degree of

supervision that will be required of the RN if a task is delegated.

 The RN delegates only those tasks for which she or he believes the other health care worker has the

knowledge and skill to perform, taking into consideration training, cultural competence, experience

and facility/agency policies and procedures.

 The RN individualizes communication regarding the delegation to the nursing assistive personnel and

client situation and the communication should be clear, concise, correct and complete. The RN

verifies comprehension with the nursing assistive personnel and that the assistant accepts the

delegation and the responsibility that accompanies it.

 Communication must be a two-way process. Nursing assistive personnel should have the opportunity

to ask questions and/or for clarification of expectations.

 The RN uses critical thinking and professional judgment when following the Five Rights of Delegation,

to be sure that the delegation or assignment is:

1. The right task

2. Under the right circumstances

3. To the right person

4. With the right directions and communication; and

State nurse practice acts define the legal parameters for nursing practice. Most states authorize RNs

There is a need and a place for competent, appropriately supervised nursing assistive personnel in

The RN assigns or delegates tasks based on the needs and condition of the patient, potential for

All decisions related to delegation and assignment are based on the fundamental principles of

The RN takes responsibility and accountability for the provision of nursing practice.

The RN directs care and determines the appropriate utilization of any assistant involved in providing

The RN may delegate components of care but does not delegate the nursing process itself. The

The decision of whether or not to delegate or assign is based upon the RN’s judgment concerning the

The RN delegates only those tasks for which she or he believes the other health care worker has the

The RN individualizes communication regarding the delegation to the nursing assistive personnel and

Communication must be a two-way process. Nursing assistive personnel should have the opportunity

The RN uses critical thinking and professional judgment when following the Five Rights of Delegation,

Chief Nursing Officers are accountable for establishing systems to assess, monitor, verify and

Assess and plan the delegation, based on the patient needs and available resources.

Communicate directions to the delegate including any unique patient requirements and

Surveillance and supervision of the delegation, including the level of supervision needed for the

Evaluation and feedback to consider the effectiveness of the delegation, including any need to adjust

The nursing profession determines the scope of nursing practice.

The nursing profession defines and supervises the education, training and utilization for any

The RN takes responsibility and accountability for the provision of nursing practice.

The RN directs care and determines the appropriate utilization of any assistant involved in

The RN accepts aid from nursing assistive personnel in providing direct patient care.

The RN may delegate elements of care but does not delegate the nursing process itself.

The RN has the duty to answer for personal actions relating to the nursing process.

The RN takes into account the knowledge and skills of any individual to whom the RN may

The decision of whether or not to delegate or assign is based upon the RN’s judgment concerning

The RN delegates only those tasks for which she or he believes the other health care worker has

The RN uses critical thinking and professional judgment when following The Five Rights of