Safe delegation lets the registered nurse (RN) focus on work that requires nursing judgment while the team completes other care. Poor delegation is a leading cause of missed care and harm. In the United States, delegation is governed first by each state's Nurse Practice Act (NPA) and board of nursing rules; the National Guidelines for Nursing Delegation, jointly issued by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) and effective April 2019, apply where the NPA is silent. They replaced the 2010 NCSBN–ANA joint statement and remain the current national guidance.

Key terms (NCSBN–ANA 2019)

In everyday practice and on examinations, the RN is said to assign routine care and delegate tasks to LPN/VNs and AP; the principles below apply either way.

Responsibility and accountability

• The delegating nurse keeps overall accountability for the client and for the decision to delegate.
• The delegatee is responsible for performing the delegated activity correctly and reporting.
• The delegatee cannot re-delegate the task to anyone else.

The Five Rights of Delegation

What the RN may not delegate. Clinical reasoning, nursing judgment, and critical decision-making cannot be delegated. In practice this means the RN keeps:

• Assessment — especially initial and admission assessment and reassessment of a changed condition
• Nursing diagnosis and planning of care
• Evaluation of the client's response and outcomes
• Teaching that requires judgment — initial, discharge, and new-medication teaching
• Care of unstable or unpredictable clients, and any task whose outcome is uncertain
• Triage and decisions about priorities

General scope by role (varies by state and facility — always check the NPA and job description)

The delegation process

1. Assess the client and the situation; decide what care is needed.
2. Decide whether the task can be delegated (five rights, state law, facility policy, delegatee competence, the RN's ability to supervise).
3. Communicate specific instructions and parameters ("Report any systolic pressure below 100 or a pulse above 110 right away").
4. Supervise — be available, check progress.
5. Evaluate the client's outcome and the delegatee's performance, and give feedback.

Supervision is guiding, directing, and evaluating the work of others. It can be direct (the nurse is physically present) or indirect (the nurse is available but not in the room). The more unstable the client or complex the task, the closer the supervision needed.

Making assignments (charge nurse)

• Match client acuity and complexity to staff competence and scope.
• Give the most unstable and complex clients to the most experienced RNs.
• Give float nurses clients whose needs match their competence (a pediatric float nurse to stable adult clients with routine care, not the fresh postoperative client with a new chest tube).
• Consider continuity, geographic grouping of rooms, infection control (do not assign the same nurse to a neutropenic client and a client with an active infection when avoidable), and workload balance.

Giving good directions — be specific: "Please take Mr. J's vital signs at 1000 and 1400. Tell me right away if his temperature is 38.3 °C (101 °F) or higher or his oxygen saturation is below 92%."

Vague: "Keep an eye on Mr. J."

Common delegation examples

• New admission → RN does the admission assessment; AP may measure weight and vital signs.
• First ambulation after surgery → RN assesses tolerance (orthostatic changes, pain, dizziness); later routine ambulation may be delegated to AP.
• Client receiving a blood transfusion → RN stays with and assesses the client during the first 15 minutes; AP may take scheduled vital signs later but cannot assess for a reaction.
• Discharge teaching about new medications → RN; an LPN/VN can reinforce it.
• Feeding a client after a stroke with dysphagia → RN or licensed nurse (aspiration risk requires assessment); feeding a stable client without swallowing difficulty → AP.
• Client whose pulse oximetry falls → AP reports; RN assesses.

Under-delegation (doing everything yourself, not trusting staff) wastes RN time and delays priority care. Over-delegation (delegating tasks requiring judgment or beyond competence) harms clients.

Nurse leader / employer: designate a nurse leader for delegation oversight; set policies about what can be delegated, to whom, and under what circumstances (policies may be more restrictive, never less restrictive, than state law); provide training and competency validation; evaluate the delegation process; foster a positive culture.

Licensed nurse (delegator): decide what and when to delegate based on client needs and stability; communicate clearly; remain available; follow up; evaluate outcomes; report competency concerns to the nurse leader; perform the task personally if delegation is not appropriate.

Delegatee: accept only tasks they are trained and competent to perform; say so if not competent; communicate changes in the client's condition promptly; document; never re-delegate; relinquish the task if the nurse decides to take it over.

Accepting assignments. The ANA position is that RNs have the professional right to accept, reject, or object in writing to an assignment that would put clients or themselves at serious risk of harm, and an obligation to raise such concerns. Follow facility policy (often a written "assignment despite objection" form) and do not abandon clients already in your care.

• Scope is set by state law — the NPA and board rules. A task legal in one state may not be in another; facility policy may narrow but not expand scope.
• The RN can be liable for negligent delegation: delegating to someone known to be incompetent, delegating a task that requires judgment, giving inadequate instructions, or failing to supervise.
• Patient abandonment generally refers to leaving clients after accepting responsibility without a proper handoff; objecting to an assignment before accepting it is not abandonment.
• Documentation: the delegatee documents care performed; the RN documents assessments, evaluation, and any follow-up.
• The ANA Code of Ethics (2025), Provision 4, addresses assignment and delegation: nurses remain accountable for their practice, including the decision to delegate.
• The nurse may refuse a provider's or manager's direction that would require acting outside scope.

Case 1 — Which task can be delegated to AP?

Clients: (a) a client admitted 30 minutes ago with chest pain; (b) a client 2 days after hip replacement who needs help with a bath; (c) a client with new-onset confusion; (d) a client going home today who needs insulin teaching.

Correct answer: (b) — routine hygiene for a stable client.

Why: (a) requires admission assessment, (c) is an unexpected change requiring assessment, and (d) is teaching — all RN responsibilities.

Case 2 — Assignment to an LPN/VN.

Clients: (a) a client with a new tracheostomy and oxygen saturation of 88%; (b) a client with stable type 2 diabetes who needs scheduled subcutaneous insulin and a dressing change; (c) a client receiving a first unit of packed red blood cells; (d) a client being admitted from the emergency department.

Correct answer: (b) — stable, predictable, and within typical LPN/VN scope.

Why: (a) is unstable, (c) requires RN monitoring for transfusion reactions and blood administration is restricted in many states, (d) requires an initial assessment.

Case 3 — AP reports a change. AP reports that a client's blood pressure is 88/50 mm Hg, lower than earlier.

Correct action: the RN assesses the client immediately.

Why: telling AP to recheck later or to "keep an eye on it" delegates judgment; the circumstance is no longer stable.

Case 4 — Delegatee lacks competence. A newly hired patient care technician says she has never removed a urinary catheter.

Correct action: the RN performs the task (or arranges supervised training and competency validation later) and informs the nurse leader.

Why: right person — the delegatee must be competent, and she correctly declined.

• Delegating "assess," "evaluate," "teach," or "monitor for complications" to AP — these require judgment.
• Assuming a task is safe to delegate because the client is "usually stable" — reassess when the condition changes.
• Assigning the most stable clients to the RN and the most complex to the LPN/VN or float nurse.
• Forgetting that the delegator stays accountable for the client and the delegation decision.
• Allowing AP to pass a task to another AP — delegatees cannot re-delegate.
• Giving vague instructions without parameters or report times.
• Assuming national guidelines override state law — the state NPA governs.
• Confusing RN-to-RN handoff with delegation.

• NCSBN–ANA National Guidelines for Nursing Delegation (2019) are current; the state NPA takes precedence
• Five rights: task, circumstance, person, directions and communication, supervision and evaluation
• RN does not delegate assessment, planning, evaluation, judgment-based teaching, or unstable clients
• LPN/VN: stable, predictable clients; data collection; reinforce teaching; scope varies by state
• AP: ADLs, vital signs on stable clients, I&O, ambulation, specimens — report, never interpret
• Delegator keeps overall accountability; delegatee is responsible for the task and cannot re-delegate
• Give specific instructions with report parameters
• Facility policy can be more restrictive, never less, than state law
• Most complex clients to the most experienced RNs; float nurses get clients matching their competence
• Nurses may object in writing to unsafe assignments (ANA)