Nursing Fundamentals: A Guide to Delegation and the Nursing Process

Delegation as a new nurse can be confusing and difficult to assign. So let’s go over the nursing process together and better understand the practice of delegation.

The Nursing Process

The nursing process is probably the most important and basic part of being a nurse. It is the framework that holds nursing together. Starting with assessment and ending with evaluation, this process breaks down the nurses role for a typical shift. Let’s go over these five steps: assessment, analysis, planning, implementing, and evaluating.

Assessment

First comes assessment. Once you get a new assignment, you’re going to assess your patient. Look and listen. What is the patient here for? What are their chief complaints? Where does it hurt? Are there any assessment abnormalities? These are the basic questions you are going to be asking yourself as you complete your assessments.

For more information, visit How to do a Quick yet Effective Head-to-Toe Assessment and Nursing Fundamentals: A Guide to Wounds.

Analysis

Next comes analysis. What is going on with your patient? Have the right tests been ordered? Are the patients’ labs normal? Are they trending up or down? What does this mean? Has the doctor been notified of any critical lab values?

For more information, visit Important Lab Values.

Plan

Based on your assessment and analysis, what is the plan? Is there a specific PRN that should be ordered? Should a lab redraw be ordered? Does the doctor need to be notified? All in all, your plan needs to address whatever it is that’s holding the patient back from being discharged.

If the doctor does need to be notified, visit Tips for New Nurses on Calling the Doctor.

Implement

Now that you have a plan in place lets implement it! Get those new doctors orders. Check over those new labs. And get that patient one step closer to being discharged!

If a new mediation has been ordered, be sure to visit Nursing Fundamentals: A Guide to the 10 Rights of Medication Administration before administering.

Evaluation

After you implement the new plan, it’s time to evaluate. Was the plan successful? Did you meet both your and your patients’ goals for the shift? Does the plan need to be modified for the next shift to meet the goals?

Pass this information onto the next nurse so they can continue the nursing process on the next shift. Also visit Essentials of a Good Bedside Handoff Report for more information on what to include in your handoff.

Delegation

Now that we know the nursing process, let’s go over what we can and cannot delegate during our shift.

As mentioned in Nursing Fundamentals: A Guide to the Complete Healthcare Team, there are different types of nurses that can be assigned different nursing tasks. As a Registered Nurse (RN), the two main roles we delegate to are 1) Practical Nurses (PNs) and 2) Assistive Personnel (APs) including Certified Nursing Assistants (CNAs). But we can also delegate to other RNs in cases where we need help performing a skill. Every state is different in their delegation guidelines, so check with your state before delegating certain tasks.

The Five Rights of Delegation

Before delegating any task, make sure to go over the five rights of delegation to determine if this task can in fact be safely delegated. The five rights include; the right task, circumstance, person, communication, and supervision/evaluation.

1. Right Task

Is this the right task to be delegating to this RN, PN, or AP?

Tasks for Practical Nurses (PNs)

• PNs are able to monitor findings
• Reinforce patient teaching
• Perform trach care (including suctioning)
• Give enteral feedings
• Insert a Foley
• Administer medications that are not IV

Tasks for Assistive Personnel (APs)

• Bathing/grooming/dressing
• Making and cleaning the patients’ bed
• Ambulating and repositioning
• Toileting
• Feeding
• Monitoring input and output
• Collecting specimens (urine, feces, sputum)
• Taking vital signs

2. Right Circumstance

Is this patient stable? Can the AP take the vital signs or should you have a RN taking and monitoring them?

3. Right Person

Do you need a Foley inserted? Then you know you cannot delegate this task to an AP based on the chart above, but you can delegate it to another RN or a PN.

4. Right Communication

Did you give clear communication to your PN or AP? Do they know exactly what needs to be done? What should to be reported back to you? What you’re expecting them to chart on? Or the time frame in which it needs to be done?

5. Right Supervision and Evaluation

Was the delegated task completed? Was it done in a timely manner? Did the PN or AP report back to you? Has the task been completed satisfactorily?

Respect

Lastly, we need to address respect. Some people feel uncomfortable delegating tasks to their coworkers because it feels more like telling them what to do than delegating. Especially when your PNs and APs are older than you! So, build rapport and strong communication with your co-workers. Ask them if they’re busy before delegating a task to them. Continue to check in with them and see if you can help them turn or reposition your patients. Your PNs, APs, and CNAs are going to be busy, so make sure you’re helping them out just like you would want them to help you out.

At the end of the day, we’re all part of a team, and if we can’t lean on each other then all our jobs are going to be a lot harder than they need to be. So build respect and communication and you’re going to be fine.

And that’s it!

After you begin going to clinicals and working, the nursing and delegation processes will become second nature. Make sure you aren’t taking on more than you can chew and start delegating as soon as possible!

How do you delegate? Comment below!

Also be sure to check out the following posts on shift organization:

• Start of Shift Plan for New Nurses
• How to Organize Your 12-Hour Nursing Shift
• Organizational Brain Template for New Nurses
• Charting Tips for New Nurses
• The Role of Code Teams in the Hospital Setting

And the rest of the Nursing Fundamentals Series!