Understanding Delegation (ENs Part 5)

Delegation

Delegation is the conferring (granting) of authority to perform a specific activity or activities in a specific situation, on an individual whose role and function does not have the authority to perform them autonomously.  Delegation is necessary when a nurse or other health practitioner (or unlicensed healthcare worker) is required to perform a task that is not recognised as being within their usual scope of practice or authority to perform. 

Delegation occurs when one member of multidisciplinary team delegates aspects of consumer care (which they are competent to perform and which they would normally perform themselves) to another. This may occur between or across different discipline, or to less experienced member of same discipline

Delegation occurs to meet clients’ needs and to ensure access to health care services — that is, the right person is available at the right time to provide the right service to a consumer.

The delegator retains accountability for the decision to delegate and for monitoring outcomes.

The delegation process includes clinical supervision, professional supervision, an assessment of competence, ongoing monitoring of performance and client health outcomes and a professional judgement and decision to delegate. 

The therapeutic benefit to the client is embedded in all aspects of decision-making regarding delegation. The registered nurse retains accountability for the decision to delegate as well as the process for the delegation. 

Delegation may be either the:

·       transfer of authority to a competent person to perform a specific activity in a specific context or

·       conferring of authority to perform a specific activity in a specific context on a competent person who does not have autonomous authority to perform the activity

The decision to delegate care is based on the registered nurse’s professional judgment. It includes consideration of the client’s needs, the skills/experience and the education/training requirements of the person/s providing the delegated care, the extent of supervision required and the availability and access to resources (both equipment and support infrastructure).  

It is therefore imperative to the delegation process that the registered nurse retains the authority for the decision to delegate and would use their professional judgment to determine when it was not be appropriate to delegate a health care task or duty.

A decision not to delegate a health care task or duty would include circumstances, which involve:

• a compromise to client safety and well being
• a client with unstable, unpredictable care needs
• a breach of professional or regulatory standards
• being outside of the nurses’ or midwives’ scope of practice or competence to delegate
• a breach of legislation
• a person who does not demonstrate competence or who has breached (or works outside of) their delegated responsibility.