Editing Management of Care (section)

== The Five Rights of Delegation ==

Delegation is the transfer of authority to perform a selected nursing task in a selected situation to a competent individual, while the delegating nurse retains accountability for the outcome (NCSBN & American Nurses Association [ANA], 2019). The delegatee is responsible for the task performed. The delegator remains accountable for the decision to delegate and for the supervision that follows. Accountability is never transferred.

=== 1. Right Task ===
The task must be one that is legally delegable, that recurs frequently in daily care, that is standardized and unvarying, that has a predictable outcome, that carries minimal risk, and that requires no independent nursing judgment. Ask: is this task within my own scope to begin with, and does my state and my facility permit it to be delegated to this category of worker?

=== 2. Right Circumstance ===
The patient must be '''stable''' with a '''predictable''' outcome, the setting must be appropriate, and the necessary equipment and resources must be available. The same task may be delegable for one patient and not for another. Ambulating a patient two days post-hip arthroplasty who walked well yesterday is a reasonable delegation. Ambulating that same patient for the first time after an episode of orthostatic hypotension is not.

=== 3. Right Person ===
The right person, delegating the right task, to the right patient. This requires that the nurse know the delegatee's job description, the delegatee's demonstrated competence, and the delegatee's current workload. "She has a certificate" is not the same as "I have verified she can do this."

=== 4. Right Direction and Communication ===
The delegation must be clear, concise, correct, and complete. It should state the specific task, the expected outcome, any limits, the time frame, and precisely '''what to report back and when'''. Vague delegation is the most common failure point. "Keep an eye on him" is not a delegation. "Take his blood pressure and heart rate every hour and tell me immediately if the systolic is below 100 or the heart rate is above 110" is a delegation.

=== 5. Right Supervision and Evaluation ===
The nurse monitors performance, is available for questions, intervenes when needed, gives feedback, and evaluates both the patient outcome and the delegation process. Supervision is not optional and it is not satisfied by being on the same unit. For a new employee or a high-risk task, supervision means direct observation.

'''Application note.''' When a delegated task goes wrong, examination items and real-world review both ask the same question: was the task appropriate, was the person competent, was the direction complete, and was supervision provided? If the nurse cannot answer yes to all four, the accountability sits with the nurse.

=== Delegation versus assignment ===
'''Assignment''' distributes work that is already within the receiving person's scope and job description, such as giving an LPN a group of stable medical patients. '''Delegation''' transfers authority for a task the delegatee would not otherwise be authorized to perform on their own. In practice on licensure examinations the two are tested with the same five-rights reasoning, but the distinction explains why an RN "assigns" patients to an LPN and "delegates" a task to assistive personnel.

=== Making an assignment ===
When distributing a group of patients among staff, the RN considers acuity and complexity, the stability and predictability of each patient, the skill and experience of each staff member, geographic clustering to reduce travel, continuity with prior shifts, and infection-control and isolation needs. The '''most complex, least stable, or newly admitted''' patients go to the RN. Float nurses and travelers receive the '''most stable''' and least specialized patients, because their orientation to the unit is limited. A pregnant staff member should not be assigned to a patient receiving internal radiation implants or with certain communicable exposures.