3.1 Delegation & Supervision Introduction

As health care technology continues to advance, clients require complex nursing care, and as staffing becomes more challenging, health care agencies respond with an evolving variety of nursing and assistive personnel roles and responsibilities to meet these demands. As an RN, you are on the frontlines caring for ill or injured clients and their families, advocating for clients’ rights, creating nursing care plans, educating clients how to self-manage their health, and providing leadership throughout the complex health care system. Delivering safe, effective client care with a high standard of quality requires the RN to coordinate care by the nursing team as tasks are assigned, delegated, and supervised. Nursing team members include advanced practice registered nurses (APRN), registered nurses (RN), licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).^[1] Assistive personnel include certified nursing assistants (CNA), client care technicians (PCT), certified medical assistants (CMA), certified medication aides, and home health aides.^[2]Making assignments, delegating tasks, and supervising delegatees are essential components of the RN role and can also provide the RN more time to focus on the complex needs of clients. For example, an RN may delegate collecting vital signs on stable clients to assistive personnel while closely monitoring vital signs and the effectiveness of interventions in maintaining a complex client’s hemodynamics, thermoregulation, and oxygenation. This collaboration among the nursing care team members allows for the delivery of optimal care as various skill sets are implemented to care for the patient.

Properly assigning and delegating tasks to nursing team members can promote efficient client care. However, inappropriate assignments or delegation can compromise client safety and produce unsatisfactory client outcomes that cause legal issues. How does the RN know what tasks can be assigned or delegated to nursing team members and assistive personnel? What steps should the RN follow when determining if care can be delegated? After assignments and delegations are established, what is the role and responsibility of the RN in supervising client care? This chapter will explore and define the fundamental concepts involved in assigning, delegating, and supervising client care according to the most recent joint national delegation guidelines published by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA).^[3]