National Guidelines for Nursing Delegation
Effective Date: 4/29/2019
Status: Replaces NCSBN and ANA 2010 Joint Statement on Delegation
Written by: NCSBN – ANA
Jointly Adopted by: NCSBN Board of Directors /ANA Board of Directors
I. Purpose
Delegation is an essential nursing skill. Building on previous work of NCSBN and the American Nurses
Association (ANA), this joint statement reects an effort to standardize the nursing delegation process based
on research ndings and evidence in the literature and is applicable to all levels of nursing licensure (advanced
practice registered nurse [APRN], registered nurse [RN], licensed practical/vocational nurse [LPN/VN]) where
the nurse practice act (NPA) is silent.
These guidelines can be applied to:
• APRNs when delegating to RNs, LPN/VNs and assistive personnel (AP)
• RNs when delegating to LPN/VNs and AP
• LPN/VNs (as allowed by their state/jurisdiction) when delegating to AP.
Note: These guidelines do not apply to the transfer of responsibility for care of a patient between licensed
health care providers (e.g., RN to another RN or LPN/VN to another LPN/VN), which is considered a handoff
(Agency for Healthcare Research and Quality, 2015).
Introduction
Health care is continuously changing and necessitates adjustment for evolving roles and responsibilities of
licensed health care providers and assistive personnel. The abilities to delegate, assign and supervise are
critical competencies for every RN. It is important to note that states/jurisdictions have different laws and
rules/regulations about delegation, and it is the responsibility of all licensed nurses to know what is permitted
in their jurisdiction. When certain nursing care needs to be delegated, it is imperative that the delegation
process and the jurisdiction NPA be clearly understood so that it is safely, ethically and effectively carried out.
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 difference between delegation and assignment has
been a source of debate for years.
Page 2 of 10
Denitions
Accountability: “To be answerable to oneself and others for one’s own choices, decisions and actions as
measured against a standard…” (American Nurses Association, 2015, p. 41).
Delegated Responsibility: A nursing activity, skill or procedure that is transferred from a licensed nurse to
a delegatee.
Delegatee: One who is delegated a nursing responsibility by either an APRN, RN or LPN/VN (where
jurisdiction NPA allows), is competent to perform it and verbally accepts the responsibility. A delegatee
may be an RN, LPN/VN or AP.
Delegator: One who delegates a nursing responsibility. A delegator may be APRN, RN, or LPN/VN (where
jurisdiction NPA allows).
Assignment: The routine care, activities and procedures that are within the authorized scope of practice
of the RN or LPN/VN or part of the routine functions of the AP.
Licensed Nurse: A licensed nurse includes APRNs, RNs and LPN/VNs. In some states/jurisdictions,
LPN/VNs may be allowed to delegate.
Assistive Personnel (AP): Any assistive personnel trained to function in a supportive role, regardless
of title, to whom a nursing responsibility may be delegated. This includes but is not limited to certied
nursing assistants or aides (CNAs), patient care technicians, CMAs, certied medication aids, and home
health aides (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]).
When performing a fundamental skill on the job, the delegatee is considered to be carrying out an assignment.
The routine care, activities and procedures assigned are those which would have been included in the
delegatee’s basic educational program. A licensed nurse is still responsible for ensuring an assignment is
carried out completely and correctly. Delegation is allowing a delegatee to perform a specic nursing activity,
skill, or procedure that is beyond the delegatee’s traditional role and not routinely performed. This applies to
licensed nurses as well as AP. Regardless of the current role of the delegatee (RN, LPN/ VN or AP), delegation
can be summarized as follows:
• A delegatee is allowed to perform a specic nursing activity, skill or procedure that is outside the
traditional role and basic responsibilities of the delegatee’s current job.
• The delegatee has obtained the additional education and training, and validated competence to perform
the care/delegated responsibility. The context and processes associated with competency validation
will be different for each activity, skill or procedure being delegated. Competency validation should be
specic to the knowledge and skill needed to safely perform the delegated responsibility as well as to
the level of practitioner (i.e., RN, LPN/VN, AP) to whom the activity, skill or procedure has been delegated.
The licensed nurse who delegates the “responsibility” maintains overall accountability for the patient.
However, the delegatee bears the responsibility for the delegated activity, skill or procedure.
Page 3 of 10
• The licensed nurse cannot delegate nursing judgment or any activity that will involve nursing judgment
or critical decision making.
• Nursing responsibilities are delegated by someone who has the authority to delegate.
• The delegated responsibility is within the delegator’s scope of practice.
• When delegating to a licensed nurse, the delegated responsibility must be within the parameters of the
delegatee’s authorized scope of practice under the NPA. Regardless of how the state/jurisdiction denes
delegation, as compared to assignment, appropriate delegation allows for transition of a responsibility in a
safe and consistent manner. Clinical reasoning, nursing judgment and critical decision making cannot
be delegated.
The delegation process is multifaceted. It begins with the administrative level of the organization including:
determining nursing responsibilities that can be delegated, to whom, and what circumstances; developing
delegation policies and procedures; periodically evaluating delegation processes; and promoting positive
culture/work environment. The licensed nurse must be responsible for determining patient needs and when
to delegate, ensure availability to delegate, evaluate outcomes of and maintain accountability for delegated
responsibility. Finally, the delegatee must accept activities based on their competency level, maintain
competence for delegated responsibility and maintain accountability for delegated activity.
Page 4 of 10
Five Rights of Delegation
Right task: The activity falls within the delegatee’s job description or is included as part of the established
written policies and procedures of the nursing practice setting. The facility needs to ensure the
policies and procedures describe the expectations and limits of the activity and provide any necessary
competency training.
Right circumstance: The health condition of the patient must be stable. If the patient’s condition changes,
the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the
situation and the appropriateness of the delegation.
Right person: The licensed nurse along with the employer and the delegatee is responsible for ensuring
that the delegatee possesses the appropriate skills and knowledge to perform the activity.
Right directions and communication: Each delegation situation should be specic to the patient, the
licensed nurse and the delegatee. The licensed nurse is expected to communicate specic instructions
for the delegated activity to the delegatee; the delegatee, as part of two-way communication, should ask
any clarifying questions. This communication includes any data that need to be collected, the method
for collecting the data, the time frame for reporting the results to the licensed nurse, and additional
information pertinent to the situation. The delegatee must understand the terms of the delegation
and must agree to accept the delegated activity. The licensed nurse should ensure that the delegatee
understands that she or he cannot make any decisions or modications in carrying out the activity without
rst consulting the licensed nurse.
Right supervision and evaluation: The licensed nurse is responsible for monitoring the delegated activity,
following up with the delegatee at the completion of the activity, and evaluating patient outcomes.
The delegatee is responsible for communicating patient information to the licensed nurse during the
delegation situation. The licensed nurse should be ready and available to intervene as necessary. The
licensed nurse should ensure appropriate documentation of the activity is completed.
Source: NCSBN. (1995, 1996)
Page 5 of 10
Guidelines for Delegation
Employer/Nurse Leader Responsibilities
1. The employer must identify a nurse leader responsible for oversight of delegated responsibilities
for the facility. If there is only one licensed nurse within the practice setting, that licensed nurse must be
responsible for oversight of delegated responsibilities for the facility.
Rationale: The nurse leader has the ability to assess the needs of the facility, understand the type
of knowledge and skill needed to perform a specic nursing responsibility, and be accountable for
maintaining a safe environment for patients. He or she is also aware of the knowledge, skill level
and limitations of the licensed nurses and AP. Additionally, the nurse leader is positioned to develop
appropriate stafng models that take into consideration the need for delegation. Therefore, the decision
to delegate begins with a thorough assessment by a nurse leader designated by the institution to oversee
the process.
2. The designated nurse leader responsible for delegation, ideally with a committee (consisting of
other nurse leaders) formed for the purposes of addressing delegation, must determine which nursing
responsibilities may be delegated, to whom and under what circumstances. The nurse leader must be
aware of the state/jurisdiction’s NPA and the laws/rules and regulations that affect the delegation process
and ensure all institution policies are in accordance with the law.
Rationale: A systematic approach to the delegation process fosters communication and consistency of
the process throughout the facility.
3. Policies and procedures for delegation must be developed. The employer/nurse leader must outline
specic responsibilities that can be delegated and to whom these responsibilities can be delegated. The
policies and procedures should also indicate what may not be delegated. The employer must periodically
review the policies and procedures for delegation to ensure they remain consistent with current nursing
practice trends and that they are consistent with the state/jurisdiction’s NPA (institution/employer policies
can be more restrictive, but not less restrictive).
Rationale: Policies and procedures standardize the appropriate method of care and ensure safe practices.
Having a policy and procedure specic to delegation and delegated responsibilities eliminates questions
from licensed nurses and AP about what can be delegated and how they should be performed.
4. The employer/nurse leader must communicate information about delegation to the licensed nurses
and AP and educate them about what responsibilities can be delegated. This information should include
the competencies of delegatees who can safely perform a specic nursing responsibility.
Rationale: Licensed nurses must be aware of the competence level of staff and expectations for
delegation (as described within the policies and procedures) in order to make informed decisions on
whether or not delegation is appropriate for the given situation. Licensed nurses maintain accountability
for the patient. However, the delegatee has responsibility for the delegated activity, skill or procedure.
Page 6 of 10
Employer/Nurse Leader Responsibilities (continued)
5. All delegatees must demonstrate knowledge and competency on how to perform a delegated
responsibility. Therefore, the employer/nurse leader is responsible for providing access to training and
education specic to the delegated responsibilities. This applies to all RNs, LPN/VNs and AP who will
be delegatees. Competency validation should follow education and competency testing should be kept
on le. Competency must be periodically evaluated to ensure continued competency. The context and
processes associated with competency validation will be different for each activity, skill or procedure
being delegated. Competency validation should be specic to the knowledge and skill needed to safely
perform the delegated responsibility as well as to the level of practitioner (i.e., RN, LPN/VN, AP) to whom
the activity, skill, or procedure has been delegated.
Rationale: This ensures that competency of the delegatee is determined not only at the beginning of the
delegation process, but on an ongoing basis, as well.
6. The nurse leader responsible for delegation, along with other nurse leaders and administrators
within the facility, must periodically evaluate the delegation process. The licensed nurse and/or his or
her manager (if applicable) must report any incidences to the nurse leader responsible for delegation. A
decision should be made about corrective action, including if further education and training are needed,
or if that individual should not be allowed to perform a specic delegated responsibility.
Rationale: Patient safety should always be the priority for a health care setting. If any compromises in care
are noted, immediate action must be taken. Gravlin and Bittner (2010) identied that evaluation of the
effectiveness of the delegation process and resolution of any issues is critical to delegation.
7. The employer/nurse leader must promote a positive culture and work environment for delegation.
Rationale: A positive culture nurtures effective communication and collaboration in order to create an
environment supportive of patient directed care.
Page 7 of 10
Licensed Nurse Responsibilities
Any decision to delegate a nursing responsibility must be based on the needs of the patient or population,
the stability and predictability of the patient’s condition, the documented training and competence of
the delegatee, and the ability of the licensed nurse to supervise the delegated responsibility and its
outcome, with special consideration to the available staff mix and patient acuity. Additionally, the licensed
nurse must consider the state/jurisdiction’s provisions for delegation and the employer’s policies and
procedures prior to making a nal decision to delegate. Licensed nurses must be aware that delegation
is at the nurse’s discretion, with consideration of the particular situation. The licensed nurse maintains
accountability for the patient, while the delegatee is responsible for the delegated activity, skill or
procedure. If, under the circumstances, a nurse does not feel it is appropriate to delegate a certain
responsibility to a delegatee, the delegating nurse should perform the activity him/herself.
1. The licensed nurse must determine when and what to delegate based on the practice setting, the
patients’ needs and condition, the state/jurisdiction’s provisions for delegation, and the employer
policies and procedures regarding delegating a specic responsibility. The licensed nurse must
determine the needs of the patient and whether those needs are matched by the knowledge, skills and
abilities of the delegatee and can be performed safely by the delegatee. The licensed nurse cannot
delegate any activity that requires clinical reasoning, nursing judgment or critical decision making. The
licensed nurse must ultimately make the nal decision whether an activity is appropriate to delegate to
the delegatee based on the Five Rights of Delegation (NCSBN, 1995, 1996).
Rationale: The licensed nurse, who is present at the point of care, is in the best position to assess the
needs of the patient and what can or cannot be delegated in specic situations.
2. The licensed nurse must communicate with the delegatee who will be assisting in providing patient
care. This should include reviewing the delegatee’s assignment and discussing delegated responsibilities,
including information on the patient’s condition/stability, any specic information pertaining to a certain
patient (e.g., no blood draws in the right arm), and any specic information about the patient’s condition
that should be communicated back to the licensed nurse by the delegatee.
Rationale: Communication must be a two-way process involving both the licensed nurse delegating
the activity and the delegatee being delegated the responsibility. Evidence shows that the better
the communication between the nurse and the delegatee, the more optimal the outcome (Corazzini,
Anderson, Mueller, Hunt-McKinney et al., 2013). The licensed nurse must provide information about the
patient and care requirements. This includes any specic issues related to any delegated responsibilities.
These instructions should include any unique patient requirements. The licensed nurse must instruct the
delegatee to regularly communicate the status of the patient.
Page 8 of 10
Licensed Nurse Responsibilities (continued)
3. The licensed nurse must be available to the delegatee for guidance and questions, including
assisting with the delegated responsibility, if necessary, or performing it him/herself if the patient’s
condition or other circumstances warrant doing so.
Rationale: Delegation calls for nursing judgment throughout the process. The nal decision to delegate
rests in the hands of the licensed nurse as he or she has overall accountability for the patient.
4. The licensed nurse must follow up with the delegatee and the patient after the delegated
responsibility has been completed.
Rationale: The licensed nurse who delegates the “responsibility” maintains overall accountability for
the patient, while the delegatee is responsible for the delegated activity, skill or procedure.
5. The licensed nurse must provide feedback information about the delegation process and any
issues regarding delegatee competence level to the nurse leader. Licensed nurses in the facility
need to communicate, to the nurse leader responsible for delegation, any issues arising related to
delegation and any individual that they identify as not being competent in a specic responsibility
or unable to use good judgment and decision making.
Rationale: This will allow the nurse leader responsible for delegation to develop a plan to address
the situation.
Delegatee Responsibilities
Everyone is responsible for the well-being of patients. While the nurse is ultimately accountable for
the overall care provided to a patient, the delegatee shares the responsibility for the patient and is
fully responsible for the delegated activity, skill or procedure.
1. The delegatee must accept only the delegated responsibilities that he or she is appropriately
trained and educated to perform and feels comfortable doing given the specic circumstances
in the health care setting and patient’s condition. The delegatee should conrm acceptance of
the responsibility to carry out the delegated activity. If the delegatee does not believe he or she has
the appropriate competency to complete the delegated responsibility, then the delegatee should
not accept the delegated responsibility. This includes informing the nursing leadership if he or she
does not feel he or she has received adequate training to perform the delegated responsibility, is not
performing the procedure frequently enough to do it safely, or his or her knowledge and skills need
updating.
Rationale: The delegatee shares the responsibility to keep patients safe and this includes only
performing activities, skills or procedures in which he or she is competent and comfortable doing.
Page 9 of 10
Delegatee Responsibilities (continued)
2. The delegatee must maintain competency for the delegated responsibility.
Rationale: Competency is an ongoing process. Even if properly taught, the delegatee may become less
competent if he or she does not frequently perform the procedure. Given that the delegatee shares
the responsibility for the patient, the delegatee also has a responsibility to maintain competency.
3. The delegatee must communicate with the licensed nurse in charge of the patient. This includes
any questions related to the delegated responsibility and follow-up on any unusual incidents that may
have occurred while the delegatee was performing the delegated responsibility, any concerns about a
patient’s condition, and any other information important to the patient’s care.
Rationale: The delegatee is a partner in providing patient care. He or she is interacting with the
patient/family and caring for the patient. This information and two-way communication is important
for successful delegation and optimal outcomes for the patient.
4. Once the delegatee veries acceptance of the delegated responsibility, the delegatee is
accountable for carrying out the delegated responsibility correctly and completing timely and
accurate documentation per facility policy. The delegatee cannot delegate to another individual. If
the delegatee is unable to complete the responsibility or feels as though he or she needs assistance,
the delegatee should inform the licensed nurse immediately so the licensed nurse can assess the
situation and provide support. Only the licensed nurse can determine if it is appropriate to delegate
the activity to another individual. If at any time the licensed nurse determines he or she needs to
perform the delegated responsibility, the delegatee must relinquish responsibility upon request of the
licensed nurse.
Rationale: Only a licensed nurse can delegate. In addition, because they are responsible, they need
to provide direction, determine who is going to carry out the delegated responsibility, and assist
or perform the responsibility him/herself, if he or she deems that appropriate under the given
circumstances.
References
Agency for Healthcare Research and Quality. (2015). Patient safety primers: Handoffs and signouts. Retrieved
from www.psnet.ahrq.gov/primer.aspx?primerID=9
American Diabetes Association. (2008). Diabetes care tasks at school: What key personnel need to know.
Retrieved from www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/school-
stafftrainings/diabetes-care-tasks.html
American Nurses Association. Code of ethics for nurses with interpretive statements. Silver Spring, MD:
Nursebooks.org, 2015.
Anthony, M. K., & Vidal, K. (2010). Mindful communication: A novel approach to improving delegation and
increasing patient safety. The Online Journal of Issues in Nursing, 15(2).
Bittner, N. P., & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. JONA, 39(3),
142–146.
Page 10 of 10
Budden, J. (2011). The rst national survey of medication aides. Journal of Nursing Regulation, 2(3), 4–12.
Corazzini, K. N., Anderson, R. A., Rapp, C. G., Mueller, C., McConnell, E. S., & Lekan, D. (2010). Delegation
in long-term care: Scope of practice or job description? The Online Journal of Issues in Nursing, 15(2).
doi:10.3912/OJIN.Vol15No02Man04
Corazzini, K. N., Anderson, R. A., Mueller, C., Hunt-McKinney, S., Day, L., & Porter, K. (2013). Understanding RN and
LPN patterns of practice in nursing homes. Journal of Nursing Regulation, 4(1), 14–18.
Corazzini, K. N., Anderson, R. A., Mueller, C., McConnell, E. S., Landerman, L. R., Thorpe, J. M., & Short, N. M. (2011).
Regulation of LPN scope of practice in long-term care. Journal of Nursing Regulation, 2(2), 30–36.
Corazzini, K. N., Anderson, R. A., Mueller, C., Thorpe, J. M., & McConnell, E. S. (2013). Licensed practical nurse
scope of practice and quality of nursing home care. Nursing Research, 62(5), 315–324.
Damgaard, G., & Young, L. (2014). Virtual nursing care for school children with diabetes. Journal of Nursing
Regulation, 4(4), 15–24.
Gravlin, G., & Bittner, N. P. (2010). Nurses’ and nursing assistants’ reports of missed care and delegation. JONA,
40(7/8), 329–335.
Jenkins, B., & Joyner, J. (2013). Preparation, roles, and perceived effectiveness of unlicensed assistive personnel.
Journal of Nursing Regulation, 4(3), 33–39.
Kalisch, B. J. (2011). The impact of RN-UAP relationships on quality and safety. Nursing Management, 42(9), 16–22.
McMullen, T. L., Resnick, B., Chin-Hansen, J., Geiger-Brown, J. M., Miller, N., & Rubenstein, R. (2015). Certied
nurse aide scope of practice: State-by-state differences in allowable delegated activities. Journal of the
American Medical Directors Association, 16(1), 20–24.
Mitty, E., Resnick, B., Allen, J., Bakerjian, D., Hertz, J., Gardner, W., … Mezey, M. (2010). Nursing delegation and
medication administration in assisted living. Nursing Administration Quarterly, 34(2), 162– 171.
Mueller, C., Anderson, R. A., McConnell, E. S., & Corazzini, K. (2012). Licensed nurse responsibilities in nursing
homes: A scope-of-practice issue. Journal of Nursing Regulation, 3(1), 13–20.
Mueller, C., & Vogelsmeier, A. (2013). Effective delegation: Understanding responsibility, authority, and
accountability. Journal of Nursing Regulation, 4(3), 20–27
NCSBN. (1995). Delegation decision-making process. National Council of State Boards of Nursing 1995 Annual
Meeting Business Book.
NCSBN. (1996). Delegation: Concepts and decision-making process. National Council of State Boards of Nursing
1996 Annual Meeting Business Book.
NCSBN. (2016) National Guidelines for Nursing Delegation – Continuing Education Journal of Nursing Regulation
(April 2016 7(1) www.ncsbn.org/NCSBN_Delegation_Guidelines.pdf
Saccomano, S. J., & Pinto-Zipp, G. (2011). Registered nurse leadership style and condence in delegation. Journal
of Nursing Management, 19, 522–533.
Young, L., & Damgaard, G. (2015). Transitioning the virtual nursing care for school children with diabetes study to
a sustainable model of nursing care. Journal of Nursing Regulation, 6(2), 4–9.
