Assignment Criteria: Develop a scholarly paper that addresses the following criteria: The scholarly paper should be in narrative format, 4 pages excluding the title and reference page.Include an introductory paragraph, purpose statement( it’s the last sentence of the introduction), and a conclusion.Include level 1 and 2 headings to organize the paper.Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used. Include a minimum of 2 professional peer-reviewed scholarly journal references to support the paper (review in Ulrich Periodical Directory) and be less than five (5) years old and a case study. (Not use the case study #10 because is the example essay from the professor)APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations). Submit the assignment to Turnitin prior to the final submission, review the originality report, and make any needed changes.
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Assignment 1: Delegation Paper
There are 3 ways that delegation occurs.
1. A simple task assignment based on job descriptions
2. Matching staff expertise to patient needs
According to the National Council of State Boards of Nursing (NCSBN) there are 5 Rights in
1. The Right Task
2. The Right Circumstance
3. The Right Person
4. The Right Directions and Communication
5. The Right supervision and evaluation
There are also some Barriers to successful delegation.
1. Poor Partnerships
2. Unhealthy Attitudes
3. Lack of a sense of Team
For this assignment, students will be assigned a case study from LaCharity, L. Kumagai, C. &
Bartz,B.(2014).Prioritization, delegation, and assignment: Practice exercises for the NCLEX
Examination,3rd ed. St. Louis, Missouri: Elsevier. The student will use the case study and assign
personnel on the unit different tasks using the delegation guideline presented in the textbook and
from the NCSBN).
Develop a scholarly paper that addresses the following criteria:
1. The scholarly paper should be in narrative format, 3 to 4 pages excluding the title and
2. Include an introductory paragraph, purpose statement, and a conclusion.
3. Include level 1 and 2 headings to organize the paper.
4. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and
in a scholarly manner. To clarify:I, we, you, me, our may not be used. In addition,
describing yourself as the researcher or the author should not be used.
5. Include a minimum of 2 professional peer-reviewed scholarly journal references to
support the paper (review in Ulrich Periodical Directory) and be less than five (5)
6. APA format is required (attention to spelling/grammar, a title page, a reference page,
and in-text citations).
7. Submit the assignment to Turnitin prior to the final submission, review the originality
report, and make any needed changes.
8. Submit by the posted due date.
You will be provided with a case study for the Delegation Assignment.
Approach this assignment as if you are the RN tasked with delegating the care of the patients
listed in the scenario. Think for a minute about your personal strengths and challenges regarding
delegation (as a new nurse).
Please address the following delegation issues with regard to the case study
Explain how the Principles of Delegation would guide your delegation of care for the
patients identified in the case study.
Provide support/rationales for your decisions about delegating the care of these patients
Identify what you perceive as the barriers (actual/potential) to your ability to effectively
Identify the tasks/responsibilities that would be the easiest to delegate/ and why?
As you write, focus on the delegation principles/process from the lens of nursing
leadership/management. Keep patient diagnosis/descriptions brief (you may refer to them as
Ms. A or Mr. R …). You don’t have to speak to each individual patient description- find 4 from
the group listed in your case study that best exemplifies the need to delegate.
As always, please reach out as needed.
Cover Page- (APA format), Headings (APA format), Reference Page (APA format), APA
National Guidelines for Nursing
National Council of State Boards of Nursing
In early 2015, the National Council of State Boards of Nursing convened two panels of experts representing education, research,
and practice. The goal was to develop national guidelines based on current research and literature to facilitate and standardize
the nursing delegation process. These guidelines provide direction for employers, nurse leaders, staff nurses, and delegatees.
Keywords: Delegation, evidence-based, guidelines, nursing assignment, regulation, research
Understand evidence-based, state-of-the-art standards for
Explain the differences between assignment and delegation
and the responsibilities of the employer, nurse leader, delegating nurse, and delegatee in the process of delegation.
ealth care is continuously changing and this includes
the roles and responsibilities of licensed health
care providers and assistive personnel. The number of licensed nurses (i.e., advanced practice registered nurses
[APRNs], registered nurses [RNs], or licensed practical nurse/
vocational nurses [LPN/VNs]) may be limited in certain regions
and/or institutions. Therefore, care may need to extend beyond
the traditional role and assignments of RNs, LPN/VNs, and
unlicensed assistive personnel (UAP). When certain aspects of
nursing care need to be delegated beyond the traditional role
and assignments of a care provider, it is imperative that the delegation process and the state nurse practice act (NPA) be clearly
understood so that it is safely and effectively carried out.
The delegation process is multifaceted. It begins with
decisions made at the administrative level of the organization
and extends to the staff responsible for delegating, overseeing
the process, and performing the responsibilities. It involves
effective communication, empowering staff to make decisions based on their judgment and support from all levels of
the health care setting. The employer/nurse leader, individual
licensed nurse, and delegatee all have specific responsibilities within the delegation process. (See Figure 1.) It is crucial
to understand 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 state
NPA, rules/regulations, and policies.
In early 2015, the National Council of State Boards of
Nursing (NCSBN) convened two panels of experts representing
Volume 7/Issue 1 April 2016
education, research, and practice to discuss the literature and key
issues, and evaluate findings from delegation research funded
through NCSBN’s Center for Regulatory Excellence Grant
Program. The goal was the development of national guidelines
to facilitate and standardize the nursing delegation process.
They build on previous work by NCSBN and the American
Nurses Association, and provide clarification on the responsibilities associated with delegation.
Additionally, these guidelines are meant to address delegation with respect to the various levels of nursing licensure
(i.e., APRN, RN, and LPN/VN, where the state NPA allows).
Delegation Versus Assignment
Delegation has been a source of significant debate for many years
and includes many philosophical discussions over the differences
between assignment and delegation. Much of the literature surrounding nursing delegation has focused on the nursing home
setting. The Centers for Medicare & Medicaid Services (CMS)
requires nursing homes to employ certified nursing assistants or
aides (CNAs) as part of a mechanism to ensure higher standards
of care. Through this mechanism, CMS supports federal regulations concerning CNA training and competency, which were
established by the Omnibus Budget Reconciliation Act of 1987.
These regulations require nursing homes to employ CNAs who
complete state-approved CNA programs, outline the fundamental skills that should be included in all CNA programs, and
require the CNA to pass a competency evaluation administered
and evaluated only by the state or by a state-approved entity
and be added to the state registry. The interpretation of these
guidelines by the nursing practice community has likely led to
some confusion about what activities, skills, or procedures can
be delegated to CNAs. The regulations define the minimum
curriculum to be included in a CNA program but do not necessarily define all the activities, skills, or procedures that can
Employer/Nurse Leader Responsibilities
Identify a nurse leader
Determine nursing responsibilities that can be
delegated, to whom, and in what circumstances
Develop delegation policies and procedures
Periodically evaluate delegation process
Promote positive culture/work environment
delegation process and
Licensed Nurse Responsibilities
⦁ Determine patient needs and when to delegate
⦁ Ensure availability to delegatee
⦁ Evaluate outcomes of and maintain
accountability for delegated responsibility
be performed by a CNA. It is likely that nursing practice has
understood these regulations to mean that CNAs can only perform those activities, skills, or procedures that were learned in
the basic state-approved CNA training program. CMS defers to
state requirements for what CNAs are allowed to perform (Sheila
Blackstock, personal communication, December 7, 2015).
When performing a fundamental skill on the job, the
delegatee is considered to be carrying out an assignment.
Delegation is allowing a delegatee to perform a specific 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 UAP.
Regardless of the current role of the delegatee (RN, LPN/
VN, or UAP), delegation can be summarized as follows:
⦁ A delegatee is allowed to perform a specific 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 specific 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, UAP) to whom the activity,
skill, or procedure has been delegated.
Journal of Nursing Regulation
Accept activities based on own competence level
⦁ Maintain competence for delegated responsibility
⦁ Maintain accountability for delegated activity
The licensed nurse who delegates the “responsibility” maintains overall accountability for the patient. However, the delegatee bears the responsibility for the delegated activity, skill,
⦁ 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
⦁ 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 defines delegation
as compared to assignment, appropriate delegation allows for the
transition of a responsibility in a safe and consistent manner. The
licensed nurse transfers the performance of an activity, skill, or
procedure to a delegatee. However, the practice pervasive functions of clinical reasoning, nursing judgment, or critical decision
making cannot be delegated.
Delegation should not be confused with assignment.
Assignment is defined as follows:
⦁ 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 UAP
The above are included in the coursework taught in the delegatee’s basic educational program.
A licensed nurse is still responsible for ensuring an assignment given to a delegatee is carried out completely and correctly.
An example of assignment is an LPN/VN caring for a diabetic patient. He or she takes vital signs, checks the blood sugar
level using a blood glucose meter, monitors input and output,
documents the information, and reports data to the RN. This is
considered an “assignment” because these functions are taught
in the LPN/VN program and are part of the LPN/VN scope of
One exception to these definitions pertains to advanced
UAP roles. Skills once believed exclusive to the RN and LPN/
VN role are now taught in certain advanced UAP programs. In
a basic course, examples of this include:
⦁ Certified medication aides taught to pass out medications
⦁ Certified medical assistants taught to give injections.
Even if taught in a basic education program, when the
activity requires a significant level of skill and knowledge, such
as administering medications or injections, it is advised that
employers/nurse leaders regard these procedures as being delegated and validate competency.
For example, an APRN works with a certified medical assistant (CMA) in a physician’s office. The CMA has been
taught to give injections in his or her basic coursework and
administering injections is part of the CMA role; however, due
to the skill and knowledge required and the potential risk to
patient safety if not done correctly, the APRN considers injections a delegated responsibility. While additional coursework
may not be necessary, competency validation is required. In this
scenario, prior to delegating injections, the APRN observes the
CMA drawing up medication and administering an injection
on different types of patients. Once the APRN is comfortable
that the CMA is competent to perform the procedure, it can be
routinely delegated to him or her.
Additional Key Definitions
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 state NPA allows),
is competent to perform it, and verbally accepts the responsibility. A delegatee may be an RN, LPN/VN, or UAP.
Delegator: One who delegates a nursing responsibility.
A delegator may be an APRN, RN, or LPN/VN (where state
Licensed Nurse: A licensed nurse includes APRNs, RNs
and LPN/VNs. In some states/jurisdictions, LPN/VNs may be
allowed to delegate.
Volume 7/Issue 1 April 2016
UAP: Any unlicensed 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
CNAs, patient care technicians, CMAs, certified medication
aides, and home health aides.
A review of the literature was conducted in CINAHL and
MEDLINE to search for current articles published in the United
States on nursing delegation from 2010 to September 2015. The
published evidence surrounding delegation is limited, although
communication or the collaborative relationship between the
licensed nurse and the UAP and scope of practice or scope of
employment/function (in the case of the UAP) were primary
themes of the published literature.
Evidence shows that the better the communication and
collaborative relationship between the nurse and the delegatee, the more optimal the outcome of the delegation process
(Anthony & Vidal, 2010; Bittner & Gravlin, 2009; Corazzini,
Anderson, Mueller, Hunt-McKinney et al., 2013; Damgaard
& Young, 2014; Gravlin & Bittner, 2010; Kalisch, 2011;
Saccomano & Pinto-Zipp, 2011; Young & Damgaard, 2015). In
Gravlin and Bittner’s (2010) descriptive, exploratory study, they
1) measured RNs’ and nurse assistants’ (NAs) reports of missed
nursing care and reasons for missed care, 2) identified RNs’ and
NAs’ reports of factors related to successful delegation, and 3)
described the nurse managers’ reports of missed care. They found
that communication between an RN and an NA contributes
to effective delegation. Similarly, the literature suggests that a
collaborative relationship between the licensed nurse and the
UAP influences the effectiveness of delegation and promotes
positive patient outcomes (Bittner & Gravlin, 2009; Corazzini,
Anderson, Mueller, Hunt-McKinney et al., 2013; Saccomano &
Pinto-Zipp, 2011). Bittner and Gravlin (2009) found in their
study that nurturing a work relationship based on trust and
respect is necessary for effective teamwork and therefore effective delegation.
Additionally, evidence also demonstrates that the UAP’s
level of competence and knowledge impacts effective delegation
(Damgaard & Young, 2014; Gravlin & Bittner, 2010; Young &
Damgaard, 2015). Damgaard and Young (2014) and Young and
Damgaard (2015) evaluated a nursing care model that included
partnering trained UAP at a school with RNs via telehealth
technology. The UAP consisted of teachers, school administrators, and administrative assistants who agreed to assist in
the management of the children with diabetes. The American
Diabetes Association’s (ADA) standardized curriculum, Diabetes
Care Tasks at School: What Key Personnel Need to Know (ADA,
2008), was used to train the UAP. Damgaard and Young found
that this model was an effective method of delegating diabetes
nursing care tasks to UAP. Although this research supports how
Five Rights of Delegation
⦁ 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.
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 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 specific to the patient, the licensed nurse, and the delegatee.
⦁ The licensed nurse is expected to communicate specific
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
modifications in carrying out the activity without first
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: National Council of State Boards of Nursing. (1995, 1996).
Journal of Nursing Regulation
the UAP’s level of competence impacts effective delegation, further research may include evaluating the impact of the licensed
nurse’s competence on effective delegation.
Another prominent theme in the delegation literature
involves the effect role confusion has on de …
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