Workplace Issues

Delegation Decision-making Grid

The Delegation Decision-making Grid was developed as a tool to assist nurses in making delegation decisions. The tool can provide a scoring mechanism for seven elements that should be considered when making delegation decisions. The use of this grid builds on the overall assumption that the activity/task being performed is within the nurse’s scope of practice, and that the Nursing Practice Act and Rules support delegation. The proposed delegation should also be consistent with agency policy. The grid can be used to support sound delegation decisions. This document is intended to be used in conjunction with the resource describing the Five Rights of Delegation and provides a framework for assessing the client’s needs, the skills of the UAP, the licensed nurse, the activity, and the potential harm in delegating an activity.

The rating of the identified elements assists the nurse in evaluating the circumstances, client needs and available resources (including UAP and nurse competence) to support the delegation decision. A low score would indicate that the activity could be safely delegated, a high score would caution against delegation. For example, if the level of client stability is ranked 3 (client condition is unstable or acute or is/has a strong potential for change) and the UAP being considered for performing the activity also is rated 3 (novice in performing activities and in working with defined client population), that activity should not be delegated to that UAP. Each facility or agency would be expected to establish a policy regarding the level of score deemed acceptable for delegation.

Suggestions for Use:

The grid can be used:

By nurses in planning care for a group of patients. Each worksheet can be used to score the needs of up to four clients and allows comparison of those client situations.

By nurse managers to evaluate the delegation needs of a client unit or a client caseload.

For staff education regarding delegation.

For orientation of new staff both nurse and UAP.

For nursing education programs providing basic managerial skills for studcnts.

For Member Boards responding to questions about delegation (to assist in identification of elements to be considered). (Boards may consider including this tool as part of a delegation information packet.)

For orientation of new board members and attorneys.

For Member Board workshops and presentations regarding delegation issues.

For evaluation of discipline complaints involving concerns regarding delegation.

The Delegation Decision-making Grid is based on a concept developed by the American Association of Critical Care Nurses, used in their unlicensed assistive personnel materials.

National Council of State Boards of Nursing, Inc./1997

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