Running head: DELEGATION IN NURSING

Delegation in Nursing
Bobbie Chahal
California State University, Stanislaus
October 14, 2014

DELEGATION IN NURSING

Delegation in Nursing
Quality patient care requires the coordination and skills of dozens of different skilled
professionals in any given shift. In a perfect world, each member would always be able to
complete all of the tasks assigned to him or her. However, with the increasing nursing shortage
and the varying level of care patients require, nurses are one example of professionals in
healthcare that must delegate to nurses and assisting personnel to prevent the compromise of
patient care when the nurse is not able to accomplish the entire list of tasks required to meet
patient needs.
Delegation is defined as the act of assigning the completion of a delegable nursing duty
to a person who is qualified and competent to perform the duty, while retaining accountability
(Knippa et al., 2011). As a nursing student, I am delegated assignments by the nurse I am
working with many times throughout any given day. A memorable delegated task that a nurse
recently assigned to me was of inserting a nasogastric tube. The patient already had an orogastric
tube in place when I arrived to the Intensive Care Unit (ICU). The patient also had an
endotracheal tube connected to a ventilator but was conscious enough to attempt to pull out the
two tubes whenever her restraints were taken of. Before administering medication, I checked for
the orogastric tubes placement through auscultation. I realized the tube was actually not in place.
The nurse then confirmed this when she auscultated herself. The nurse asked me if I would like
to place the nasogastric tube that was ordered since the orogastric tube had to be taken out.
Thankful for such a great opportunity to practice this skill, I agreed.
According to Knippa et al. (2011), the nurse must meet the five rights of delegation so
that he or she delegates correctly. The nurse must ensure that the right person is assigned the
right task, in the right circumstance, and equipped with the right directions/communication while
providing the right amount of supervision. The nurse, who is the delegator in this case, explained

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to me the importance of practicing nursing skills under a supervised environment as much as

possible since one day, I will be expected to do so independently. Although nasogastric
placement is quiet invasive, requires supervision, and is not repetitive, it is a task a student nurse
must learn and so this right out of the five rights was not fully met. The nurse then asked me
what I knew about nasogastric tube placement and then summarized all of the steps along with
how I would then chart the placement. This action by the nurse met the requirements of the right
person and the right direction/communication. In my opinion, I had enough information to
complete the task. Since I am not yet licensed, I was supervised with monitoring and feedback
while performing the task which met the requirements of the right supervision. The nurse did not
go over whether the circumstance was right for me to perform the task. To meet the requirements
of the right circumstance, a nurse must assess the health status and complexity of the care
required, match that complexity of care to the skill level of the person assigned the task, and
lastly, consider the workload of the member. Because I am a student nurse, I do not carry the
workload of an actual nurse to any degree so I happily performed the task and was not burdened
by her delegation. This was my first nasogastric tube placement and I successfully (based on
auscultation) placed it on my first attempt. In order to truly verify the correct placement, an Xray was performed which confirmed the placement. The client did wiggle and grunt in protest
during the task. Other than that, there was no adverse outcome of this delegated task. The task
was completed correctly and in a timely fashion while satisfying four out of the five rights of
delegation. If allowed to go back in time and do the task differently, I would have liked to control
the facial expressions on my face while the client was grunting. In order to stay in control of my
nerves, I repeatedly told myself that although this is quite unpleasant to the patient, she needs

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this nasogastric tube so that she can have her medications and receive her feeding which was to
be started later on in the shift.
While delegation is a great way to accomplish tasks that might otherwise prove to be
burdensome or impossible to complete by one nurse alone, it is crucial that the delegation
process is performed correctly. According to Potter and Parsons (2009), when delegation is
unsuccessful, there is an added workload on the nurse and the task might actually be left undone.
When the workload increases and tasks are left undone, there is an increased risk of medical
errors and lack of quality care (Potter & Parsons, 2009). Because of the negative consequences
that can result from unsuccessful delegation, learning how to correctly delegate and creating an
environment of teamwork becomes increasingly important. According to Mueller and
Vogelsmeier (2013), effective delegation leads to safe and effective patient care and allows
nurses to handle more complex patient care.

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5
References

Knippa, A., Prater, D., Sommer, S., Archer, E., Ball, B., Crawford, C., Churchill, L., Groninger,
H., Elkins, C., Herre, M., Janowski, M., Lehman, A., Roberts, K., Shindler, J., Wright,
M., & Stacy, B. (2011). Nursing leadership and management. (5th ed.). USA: Assessment
Technologies Institute, LLC.
Mueller, C., & Vogelsmeier, A. (2013). Effective delegation: understanding responsibility,
authority, and accountability. Journal of Nursing Regulation, 4(3), 20-27.
Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered nurses
and nursing assistive personnel. Journal of Nursing Management, 18(2), 157-165.
doi:10.1111/j.1365-2834.2010.01062.x