Reducing Your Risk

Reducing Your Risk
Identify areas of potential liability
Identify ways to reduce risk
In this writing assignment, you will examine how your state’s nurse practice act addresses delegation as well as explore how proper delegation reduces risk for the patient and liability for the nurse. You can access the grading rubric for this assignment here: Writing Rubric.
A two-page (500-word) paper
Step 1 Read the article.
Download the Joint Statement on Delegation.
Step 2 Locate your state’s nurse practice act.
Using the Internet, find your state’s nurse practice act and read how the issue of delegation of nursing tasks is addressed. There may be a state practice act that does not address this clearly. If necessary, you may use another state’s information to complete this assignment.
Step 3 Answer the questions.
Think of a situation in which you delegated responsibility to another health care provider, such as an aide. Write a two-page (500-word) paper responding to the following questions.
What made you decide to delegate the task?
How did you decide which health care provider to give the task to?
In what ways did you follow your nurse practice act guidelines?
What patient risks were reduced by delegating properly?
What liabilities might exist if you had delegated improperly?
Cite any sources used in the format designated by your instructor.

Joint Statement on Delegation
American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)


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.

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.


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.

Joint Statement on Delegation
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
? 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
5. Under the right supervision and evaluation.
? Chief Nursing Officers are accountable for establishing systems to assess, monitor, verify and
communicate ongoing competence requirements in areas related to delegation.

Joint Statement on Delegation
American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)
American Nurses Association (ANA) and the National Council