The Board of Registration in Nursing issues this Advisory Ruling in response to questions regarding licensed nurses' responsibilities when delegating selected nursing activities to unlicensed assistive personnel.

The Advisory is based on the Nurse Practice Act and the Board's regulations at 244 Code of Massachusetts Regulations, section 3.05.

Date Adopted: November 3, 1998

Advisory Ruling:
The Nurse Practice Act, in Massachusetts General Laws, Chapter 112, section 80B, establishes the standard that each licensed nurse is directly accountable for the safety of the nursing care s/he delivers. The Board's regulations hold that the nurse is also responsible for all of the nursing care that a patient receives under her/his direction. The regulations define the legal criteria for delegation and supervision by licensed nurses. Appropriate application of the regulations requires that nurses and nurse employers accurately understand the directives in 244 CMR 3.05.

Because of the accountability and responsibility that individual licensed nurses bear for the nursing care received by patients for whom they are accountable, it is imperative that nurse employers acknowledge and grant individual nurses the requisite authority for delegation decision-making.

A licensed nurse is held accountable for all aspects of the delegation decision-making process, its implementation, supervision and evaluation. Key concepts include:

  • The final decision as to what nursing activity can be safely delegated to a UAP in any given situation is within the specific scope of the individual licensed nurse's professional judgment.
  • A nurse must assess a patient's nursing care needs prior to his/her delegation of any nursing activity.
  • It must be recognized that UAP do not have a nursing knowledge base upon which to make nursing judgments.
  • The nurse must determine that the UAP has documented competency to perform the activity safely. The employing agency must maintain such documentation and make it available to the individual nurse delegator.
  • The nurse must determine the appropriate degree of supervision required, and provide it based on the stability of the patient's condition, the training and capabilities of the UAP, the nature of the delegated task and the proximity and availability of the nurse while the UAP is carrying out the activity.
  • Board regulations prohibit nurses from delegating nursing activities that require on-going nursing assessment and judgment. Formulation of plans of nursing care and evaluation of the patient's response to the care may not be delegated. Health teaching and health counseling, as it relates to nursing and nursing services, may not be delegated.

The Five Rights of Delegation clarify the critical elements of the decision-making process. The Five Rights delineate professional and legal accountability for nurses at all levels, from nursing service administrators to staff nurses. Nursing service administrators and staff nurses must work together collaboratively and cooperatively to protect the public and maintain the integrity of the nursing care delivery system.

This information is provided by the Division of Health Professions Licensure within the Department of Public Health.