Delegation in nursing is a process when a registered nurse guides another person to accomplish some clinical errands and activities. During my first clinical experience at the Hebrew Home at Riverdale, I observed an instance where the delegation was a problem for the registered nurse who delegated some of her tasks to a student nurse. The main problem in this delegation process was that the registered nurse did not fully consider the five rights of delegation, which resulted in misunderstanding and confusion.
In my example, a new graduate registered nurse, let call her Mary, had to change the bed linen, control and administer intravenous pain medications hourly, and ensure that all patients take medications on time. Mary was in the middle of her busy day shift, and she realized that some of her tasks had to be delegated. However, she did not know how to do it properly. Thus, she asked one of the student nurses to change the bed linen for those patients who urinated or vomited. The second student nurse was asked to make sure that a group of patients took all medications on time. Mary was busy with administering intravenous pain medications and giving oral medications to another group of patients. When the shift came to an end, Mary noticed that some of her patients complained of high blood pressure, dizziness, and headache. As it turned out, the student nurse confused the drugs, putting the health of patients at risk.
In the analyzed case, delegation was a problem not only for the registered nurse but also for the student nurse and the patients. The student nurse gave drugs that were supposed to raise low blood pressure to the patients with normal blood pressure, which caused hypertension and headaches. The issue occurred because of the student nurse’s lack of experience and knowledge of the names of drugs. Mary’s mistake was that she did not evaluate the delegate’s competence and knowledge, and it led to serious consequences for her, the student nurse, and several patients.
To improve the delegation process, Mary should have taken into account the five rights of delegation. According to Barrow and Sharma (2020), the five rights of delegation include “right task, right circumstance, right person, right supervision, [and] right direction and communication” (p. 2). Having analyzed this case, I can conclude that Mary could have improved the situation if she analyzed the circumstance better, evaluated the delegate’s competence, and gave the right instruction and communication to the delegate. First, if the registered nurse knew that some of her patients were at risk of high blood pressure, she should not delegate the task of giving medicines to the inexperienced staff member. Second, if she could not complete this task by herself, she should better evaluate the delegate’s skills and knowledge and choose the right person who would be able to complete the task safely. Third, Mary could provide the student nurse with a written list of drugs to ensure that they would not confuse the names of the drugs.
The delegation and supervision processes are important for clinical practice since they help to complete nursing tasks more effectively. However, sometimes, these processes may become a problem for the delegator, the other staff members, or even the patients. To prevent negative consequences of the task delegation, registered nurses should approach this process with all responsibility, accountability, and authority. They should consider the five rights of delegation before determining assignments for other people.
Barrow, J.M., & Sharma, S. (2020). Five rights of nursing delegation. StatPearls [Internet]. StatPearls Publishing.