Key Takeaways
- Right Task: The delegated task must be within the delegatee's legal scope of practice and facility policy
- Right Circumstance: The patient must be stable with predictable outcomes; unstable patients require RN care
- Right Person: The delegatee must have documented competency to perform the specific task being delegated
- Right Direction/Communication: The RN must provide clear, specific instructions including what to report
- Right Supervision/Evaluation: The RN must follow up to ensure the task was done correctly and interpret results
Five Rights of Delegation
The Five Rights of Delegation provide a systematic framework for making safe delegation decisions. These rights are tested heavily on the NCLEX and guide clinical practice.
The Framework
| Right | Question to Ask |
|---|---|
| Right Task | Can this task be legally delegated? |
| Right Circumstance | Is this the right situation for delegation? |
| Right Person | Is this person qualified to perform this task? |
| Right Direction | Have I given clear, specific instructions? |
| Right Supervision | Am I providing appropriate oversight? |
Right Task
The task must be within the delegatee's scope of practice and facility policy.
Questions to Consider:
- Is this task permitted by the Nurse Practice Act?
- Does facility policy allow this task to be delegated?
- Does the task require nursing judgment or assessment?
- Is this a routine task with predictable outcomes?
| Delegable Tasks (Typically) | Non-Delegable Tasks |
|---|---|
| Routine vital signs on stable patients | Initial assessment |
| Hygiene and ADLs | Evaluation of patient status |
| Ambulation of stable patients | Nursing diagnosis |
| Feeding (no swallowing risk) | Care planning |
| Specimen collection | Patient/family teaching |
| Intake and output measurement | Medication administration (varies by state) |
Right Circumstance
The patient must be stable and the setting must support safe delegation.
Stable Patient Characteristics:
- Vital signs within normal range
- Predictable clinical trajectory
- No complex monitoring needs
- Established care routines
Unstable Patient Indicators (DO NOT Delegate):
- Fluctuating vital signs
- Recent change in condition
- Post-procedure within monitoring period
- Complex or high-risk interventions needed
| Scenario | Delegate? |
|---|---|
| Post-op day 3 patient, stable vitals | Yes |
| Patient 2 hours post-cardiac catheterization | No |
| Patient with new-onset chest pain | No |
| Long-term care patient, routine ADLs | Yes |
Right Person
The delegatee must have demonstrated competency for the specific task.
RN Must Verify:
- Appropriate licensure or certification
- Skills check-off or competency documentation
- Experience with similar patients
- Comfort level with the task
| Level | Competency Verification |
|---|---|
| UAP (CNA) | Skills check-off, orientation completion |
| LPN/LVN | License verification, skills competency |
| New Graduate RN | Preceptor oversight, demonstrated skills |
Important: A person may be generally competent but not competent for a specific task. The RN must verify task-specific competency.
Right Direction/Communication
The RN must provide clear, concise, and specific instructions.
Effective Communication Includes:
| Component | Example |
|---|---|
| What to do | "Measure blood pressure on the left arm" |
| When to do it | "Every 4 hours: 0800, 1200, 1600, 2000" |
| How to report | "Report immediately if systolic >160 or <90" |
| What to expect | "This patient's baseline is usually 130/80" |
| Who to contact | "I will be available in room 4, or use the call system" |
Elements of Complete Direction:
- Specific data collection required
- Time frame for completion
- Expected findings (what is normal)
- Reporting parameters (what is abnormal)
- Priority level of the task
- Availability of the delegating nurse
Right Supervision/Evaluation
The RN must follow up to ensure correct completion and interpret results.
Supervision Components:
| Component | Action |
|---|---|
| Monitoring | Observe task completion when appropriate |
| Follow-up | Check on delegatee and patient periodically |
| Evaluation | Assess outcomes of delegated care |
| Feedback | Provide constructive feedback to delegatee |
Levels of Supervision:
| Level | When Used | Example |
|---|---|---|
| Continuous | Learning new skill, complex task | Direct observation throughout |
| Intermittent | Routine task, competent delegatee | Check in periodically |
| Available | Stable situation, experienced staff | Available for questions |
Applying the Five Rights: Case Example
Scenario: The RN considers delegating blood pressure monitoring to a UAP.
| Right | Assessment | Meets Criteria? |
|---|---|---|
| Task | VS on stable patients is delegable | Yes |
| Circumstance | Patient is post-op day 3, stable | Yes |
| Person | UAP completed skills check-off | Yes |
| Direction | "Check BP q4h, report if <90 or >160 systolic" | Yes |
| Supervision | RN will check documentation and patient q shift | Yes |
Result: Delegation is appropriate.
Common Delegation Errors
| Error | Why It's Problematic |
|---|---|
| Delegating assessment | Requires nursing judgment |
| Vague instructions | Delegatee doesn't know what to report |
| Assuming competency | Person may not be trained for specific task |
| No follow-up | Outcomes not evaluated |
| Delegating to unstable patients | Requires RN assessment |
On the NCLEX
Questions test your ability to:
- Apply all five rights to clinical scenarios
- Recognize when delegation criteria are not met
- Provide appropriate direction and supervision
- Identify safe vs. unsafe delegation decisions
Exam Tip: If ANY of the five rights is not met, the delegation is inappropriate. Look for the right that is violated in NCLEX questions.
The RN asks a UAP to take vital signs on a patient who just returned from cardiac catheterization 30 minutes ago. This delegation is inappropriate because it violates which right?
An RN tells the UAP, "Check on the patient when you can and let me know if anything seems off." This communication violates which right of delegation?
The RN delegates feeding to a UAP for a patient with a new stroke diagnosis. The UAP has not completed dysphagia training. This violates which right?