When Should a Nurse Delegate?
Depending on the role of the nurse (NP, RN, LPN), nurses can delegate tasks to the appropriate level depending on their scope of practice. A nurse can essentially delegate any time when help is needed; however, they may only do so if the task is appropriate for their skill level.
Delegating Up and Down
A nurse can delegate to a higher or lower scope. An example of delegating to a higher scope might include an RN asking an NP for a diagnosis so the RN can provide care instructions. An RN might also ask an NP to diagnose for purposes of treating. For example, if a patient arrives at urgent care complaining of a sore throat, and the RN assesses and feels the patient may have strep throat, he or she may ask the NP to examine and diagnose so the patient can be treated.
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Another example of a nurse delegating to a higher scope is if a charge nurse encounters problems with a coworker that is not resolved by speaking to him or her. The charge nurse may escalate the issue higher and ask the nurse manager to intervene.
Nurses may also delegate tasks to those with a more narrow scope of practice. For example, an RN might delegate PO med passes to the LPN. An LPN may delegate tasks such as ambulating or feeding a patient to the CNA.
The question of when a nurse should delegate is dependent on many factors. Usually, nurses delegate when they need help to prevent patient care delay. For example, an RN might be tied up with admitting a patient and ask the LPN to pass PO meds for him or her. In the example above involving a charge nurse and problematic coworker, the nurse delegated when action was needed that fell out of his or her scope of practice.
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Other Instances Where Delegation Might Be Necessary
Another example of when a nurse can delegate is if a task conflicts with personal beliefs or other personal issues. For example, a nurse who strongly opposes birth control may delegate the task of birth control counseling to someone else. A nurse who may be asked to care for a patient on comfort care may ask to switch assignments if he or she has experienced a recent loss.
When delegating tasks, it's important that nurses are familiar with the scope of practice laws in their state. Asking someone to perform a task, or agreeing to do a task that is outside one's scope of practice can lead to discipline by the appropriate board of nursing and possibly by the employer. However, nurses inherently want to help, both patients as well as each other. Therefore, appropriate delegation benefits both nurses and patients.
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