Delegation is transferring to a competent person the authority to perform a selected task in a selected situation, while the delegating nurse retains accountability for the overall care and for the decision to delegate.

Three related terms are often confused:

Assignment is giving a client or group of clients to a staff member whose own scope already includes that care (e.g., a charge nurse assigning clients to another registered nurse). Delegation usually means passing a task to someone whose role does not independently include it, such as a nursing attendant.

Supervision is the guidance, monitoring, and evaluation of delegated work. It can be:

• Direct (immediate) — the nurse is physically present and watching or immediately available on the unit
• Indirect — the nurse is available but not physically present, using reports, records, and periodic checks (common in community practice)

Why delegation matters. Good delegation lets the registered nurse spend time on work only a nurse can do — assessment, judgment, teaching, and care of unstable clients — and develops the skills of others. Poor delegation is a common root cause of missed care and adverse events.

The five rights of delegation

What the registered nurse does not delegate to unlicensed workers

• Assessment requiring professional judgment, including the initial assessment of a new admission and assessment of a client whose condition is changing
• Nursing diagnosis, planning, and evaluation of care
• Health teaching that requires judgment (e.g., teaching insulin self-injection, discharge teaching)
• Care of unstable or unpredictable clients (e.g., fresh post-operative, active bleeding, new chest pain)
• Medication administration and other acts that make up the practice of nursing

The Philippine Nursing Act of 2002 (RA 9173) Section 28 defines the scope of nursing to include providing care through the nursing process, health teaching, and administration of written prescriptions for treatments, therapies, and oral, topical, and parenteral medications. Section 35 penalizes practicing nursing without a certificate of registration and professional license. A nurse who hands such acts to an unlicensed worker exposes the client to harm, the worker to unlicensed practice, and the nurse to liability.

What can generally be delegated to a trained nursing attendant or nursing aide (per job description, competence, and hospital policy, for stable clients)

• Bathing, oral care, grooming, bed making, toileting
• Feeding clients who have no swallowing difficulty and no aspiration risk
• Turning, positioning, range-of-motion assistance, and ambulation of stable clients
• Measuring and recording routine vital signs, weight, and intake and output of stable clients — the nurse interprets the values
• Transporting stable clients, collecting routine specimens, restocking supplies

The delegation process

1. Assess the client's condition and the task.
2. Assess the worker's competence and workload.
3. Communicate clear instructions and expected reports, including specific values or signs that must be reported at once.
4. Supervise at the level needed.
5. Evaluate the client outcome and the worker's performance; give feedback.
6. Document as required by policy.

Philippine health workforce in general terms

In a common rural health unit arrangement, the public health nurse (with the municipal health officer) supervises the rural health midwives, who manage the barangay health stations and supervise and train BHWs; arrangements vary by local government unit. Supervision is often indirect, through supervisory visits, record reviews, and checklists.

Giving clear direction — example. "Please take Mrs. Santos's vital signs at 1000 and 1400. Tell me right away if her systolic pressure is below 90, her pulse is above 110, or she says she feels dizzy. Record the results in the chart." This names the client, task, times, limits, and reporting.

Common errors

• Under-delegation: doing everything oneself because of perfectionism, distrust, or wanting to be liked — leads to burnout and missed priorities.
• Over-delegation: passing tasks to someone already overloaded, or giving away one's own professional responsibilities.
• Improper delegation: wrong task, wrong person, or unclear instructions.
• Reverse delegation: a subordinate hands the task back upward; the nurse should coach rather than take it back routinely.
• Re-delegation: the person who accepts a delegated task may not pass it on to someone else.

• Know the legal scope of practice, the job descriptions, and the hospital policies for every worker on the team.
• Match each task to the client's condition and the worker's verified competence.
• Communicate clearly and confirm understanding.
• Supervise, intervene immediately if care is unsafe, and evaluate outcomes.
• Accept delegated or assigned work only within one's own competence; request orientation or help when unprepared.
• The nurse manager sets delegation policies, verifies competencies, and provides staffing that makes safe delegation possible.
• In community settings, the public health nurse trains, supervises, and supports midwives and BHWs and reviews their records.

• Accountability stays with the delegating nurse. A nurse can be held liable for negligent delegation (wrong task or wrong person) and negligent supervision (failure to monitor or to act on reported findings).
• The person who accepts a task is responsible for performing it correctly and for reporting problems.
• Unlicensed personnel must not perform acts that constitute the practice of nursing; RA 9173 Section 35 penalizes practice without a license.
• A nurse may refuse an assignment that would endanger clients because the nurse lacks competence, but should report the concern to the supervisor, propose a safe alternative, and not abandon clients already in care.
• The Code of Ethics for Registered Nurses (Board of Nursing Resolution No. 220, series of 2004) makes the nurse responsible for maintaining competence and for safe, quality care.
• Delegation instructions and findings reported back are documented according to policy.

Case 1. The nurse has four clients and one nursing attendant. Which task should be delegated to the attendant?

• A. Admission assessment of a client just arrived from the emergency room
• B. Teaching a newly diagnosed diabetic client insulin injection
• C. Ambulating a client on post-operative day 3 after an uncomplicated appendectomy
• D. Checking a client who reports new chest pain

Answer: C. The client is stable and ambulation is a routine task. A, B, and D require assessment, teaching, or judgment for an unstable situation.

Case 2. A nursing attendant reports that a client's blood pressure is 84/50 mmHg, lower than the reading four hours earlier. What should the nurse do first?

Answer: Go to the client and assess personally (level of consciousness, pulse, skin, bleeding, fluids). The nurse interprets data and acts; asking the attendant to repeat the reading later delays care.

Case 3. The charge nurse must assign a client with a new tracheostomy who is having thick secretions. The available registered nurses are a new graduate in the second week of orientation and a nurse with five years of surgical experience. Who should receive the client?

Answer: The experienced surgical nurse. Assignments match the client's acuity and complexity to the nurse's demonstrated competence.

Case 4. A public health nurse plans an immunization day in the barangay. Which task is appropriate for a BHW?

Answer: Listing eligible children from household records and reminding families to come. Screening for contraindications and giving vaccines require licensed health personnel.

• Believing accountability transfers with the task. It never does.
• Delegating because the task is "simple" without checking whether the client is stable. The same task (e.g., feeding) may be safe for one client and unsafe for another with dysphagia.
• Delegating "check on" or "see how she is" — this is assessment.
• Letting an attendant give "just oral" medications. Medication administration is within nursing scope under RA 9173.
• Choosing to do the task oneself when the question asks what to delegate. Under-delegation is not safer if it leaves the unstable client unattended.
• Forgetting to specify what to report and when.
• Allowing a nursing attendant to hand a delegated task to another worker. A delegatee may not re-delegate.
• Confusing direct supervision (present on site) with indirect supervision (available, periodic checks).

• Delegation transfers authority for a task; accountability remains with the registered nurse.
• Five rights: task, circumstance, person, direction and communication, supervision and evaluation.
• Do not delegate assessment, diagnosis, planning, evaluation, teaching needing judgment, unstable clients, or medication administration to unlicensed staff.
• Delegate routine, predictable care of stable clients: hygiene, feeding without aspiration risk, positioning, ambulation, routine vital signs, intake and output.
• The nurse interprets data collected by others.
• Match assignment to acuity and competence; the most unstable client goes to the most experienced nurse.
• RA 9173 Section 28 defines nursing scope, including medication administration; Section 35 penalizes unlicensed practice.
• Nursing students work under direct faculty supervision.
• Midwives have their own scope under RA 7392; BHWs are volunteers accredited under RA 7883.
• Negligent delegation and negligent supervision are grounds for liability.