The Board of Registration in Nursing presents this framework for delegation decision-making and accountability based on a model which identifies the five (5) key elements of any delegated act:

The Five (5) Rights of Delegation clarify the critical components of the delegation 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 integrity of the nursing care delivery system.

Right Task

Nursing Service Administrator (NSA) Applicable Regulations

Staff Nurse

Applicable Regulations

  • Appropriate activities for consideration in delegation decisions are identified in UAP job descriptions/role delineation.
Nursing Board: 244 CMR 3.05 (2)(d)
The unlicensed person shall have documented competencies... on file with the employing agency. an administratively designated nurse shall communicate this information to the ... nurse who will be delegating..."
  • Appropriate delegation activities are identified for specific patients.

Nursing Board: 244 CMR 3.05 (2)(a) and (b)
"the ...nurse is directly responsible for the nursing care given to the patient... the final decision as to what nursing activity can be safely delegated...is within the scope of that ....nurse's professional judgment."

  • Organizational policies, procedures and standards describe expectations of and limits to activities.
Nursing Board: 244 CMR 3.05
"Delegation by Registered Nurses and Licensed practical Nurses must fall within their respective scope of practice....Said delegation must occur within the framework of the job description of the delegatee and organizational policies and procedures..."
  • Appropriate activities are identified for specific UAP

Nursing Board: 244 CMR3.05 (2) (D)
"The unlicensed person shall have documented competencies ...on file with the employing agency."

Generally, appropriate activities for consideration in delegation decision-making include those:

  1. which frequently recur in the daily care of a patient or group of patients
  2. which recognize that UAP do not have a knowledge base upon which to make nursing judgments;
  3. which do not require complex or multi-dimensional application of the nursing process by a licensed nurse;
  4. for which the results are predictable and the potential risk is minimal; and
  5. which utilize a standard and unchanging procedure.

Right Circumstances

Nursing Service Administrator (NSA) Applicable Regulations Staff Nurse

Applicable Regulations

  • Assess the health status of the patient community, analyze the data and identify collective nursing care needs, priorities and necessary resources.
  • Assess health status of individual patient(s), analyze the data and identify patient-specific goals and nursing care needs.
Nursing Board: 244 CMR 3.05 "Assessment/identification of the nursing needs of a patient, the plan of nursing actions, implementation of the plan, and evaluation of the plan, are essential components of nursing practice, and are the functions of the qualified licensed nurse."

244 CMR 3.05 (2) (b)

"The qualified licensed nurse must make an assessment of the patient's nursing care needs prior to delegating."

  • Provide appropriate staffing and skill mix, identify clear lines of authority and reporting, and provide sufficient equipment and supplies to meet the collective nursing care needs.
Nursing Board: 244 CMR 3.05

"The full utilization of the services of a qualified licensed nurse may permit him/her to delegate selected nursing activities to unlicensed personnel. although unlicensed personnel may be used to complement the qualified licensed nurse in the performance of nursing functions, such personnel cannot be used as a substitute for the qualified licensed nurse."

  • Match the complexity of the activity with the UAP competency and with the level of supervision available.

Nursing Board: 244 CMR 3.05 (2) (c)"The nursing activity must be one that a reasonable and prudent nurse would determine to be delegatable...; would not require the unlicensed person to exercise nursing judgment; and that can be properly and safely performed by the unlicensed person involved, without jeopardizing the patient's welfare."

  • Provide appropriate preparation in management techniques to deliver and delegate care.
  • Provide for appropriate supervision for safe, effective performance of the activity and determination of the patient's response.

244 CMR 3.05 (3) "The degree of supervision required shall be determined by the qualified licensed nurse after an evaluation of appropriate factors involved, including....the proximity and availability of the ...nurse to the unlicensed person when performing the nursing activity.

Nursing Board: 244 CMR 3.05 (3)

"The ...nurse shall provide supervision of all nursing activities delegated to an unlicensed person in accordance with the following conditions:

The degree of supervision required shall be determined by the qualified licensed nurse after an evaluation of appropriate factors involved, including, but not limited to the following:

(a) the stability of the condition of the patient;

(b) the training and capability of the unlicensed person to whom the nursing task is delegated

(c) the nature of the nursing task being delegated;

(d) the proximity and availability of the...nurse to the unlicensed person when performing the .... activity."

Right Person

Nursing Service Administrator (NSA) Applicable Regulations

Staff Nurse

Applicable Regulations

  • Establish organizational standards consistent with applicable law and rules which identify educational and training requirements and competency measurements of nurses and UAPs.
  • Instruct and/or assess, verify and identify the UAP's competency on an individual, task and patient -specific basis.

Nursing Board: 244 CMR 3.02 [3.03]
A registered nurse [licensed practical nurse] may delegate nursing activities to other...health care personnel, provided that the delegating registered [licensed practical] nurse shall bear full ...responsibility for:

(1) making an appropriate assignment;

(2) properly and adequately teaching, directing and supervising the delegatee; and

(3) the outcomes of that delegation [all within the parameters of his/her generic and continuing education and experience.]

  • Incorporate competence standards into institutional policies; assess nurse and UAP performance; perform evaluations based upon standards; and take steps to remedy failure to meet standards, including reporting nurses who fail to meet standards to the Board of Nursing
  • Implement own professional activities based on assessed needs and professional standards and take steps to remedy failure to meet standards;
  • Perform evaluations of UAP performance based upon standards and take steps to remedy failure to meet standards.

Nursing Board:
244 CMR 5.04
the overriding consideration in determining whether a specific program/offering qualifies as acceptable continuing education is that it be a planned program of learning which contributes directly to the professional competence of the licensed nurse."

244 CMR 3.5 (2) (e) "The qualified licensed nurse shall adequately supervise the performance of the delegated nursing activity in accordance with the requirements for supervision as found in 244 CMR 3.05 (3).

Right Direction/Communication

Nursing Service Administrator (NSA) Applicable Regulations

Staff Nurse

Applicable Regulations

  • Communicate acceptable activities, UAP competencies and qualifications, and the supervision plan through a description of a nursing service delivery model, standards of care, role descriptions and policies/procedures.
Nursing Board: 244 CMR 3.05 (2)(d)
The unlicensed person shall have documented competencies... on file with the employing agency. An administratively designated nurse shall communicate this information to the ... nurse who will be delegating..."
  • Communicate delegation decision on a patient-specific and UAP-specific basis. The detail and method (oral and/or written) vary with the specific circumstances.

Nursing Board: 244 CMR 3.05 (1)
Supervision: Provision of guidance by a qualified licensed nurse for the accomplishment of a nursing task or activity, with initial direction of the task or activity and periodic inspection of the actual accomplishing the task or activity.

  • Monitor and evaluate the process and outcome. Communicate data to all involved parties to improve process and outcome.

Situation specific communication includes:

  • specific data to be collected and method and time for reporting
  • specific activities to be performed and any patient-specific instruction and limitation; and
  • the expected results or potential complications and time lines for communicating such information

Nursing Board: 244 CMR 3.02(3) (f) [& 3.03 (3)(g)]
A registered nurse [licensed practical nurse] shall act within his/her generic and continuing education and experience to: (f) [(g)] collaborate, communicate and cooperate as appropriate with other health care providers to ensure quality and continuity of care.

Right Supervision/Evaluation

Supervision shall be provided by the delegating licensed nurse or by other licensed nurses designated by nursing service administrators or the delegating nurse. The supervising nurse must know the expected method of supervision (direct or indirect), the competencies and qualifications of UAP, the nature of the activities which have been delegated, and the stability/predictability of patient condition.

Nursing Service Administrator (NSA) Applicable Regulations Staff Nurse

Applicable Regulations

  • Provide appropriate staffing and skill mix, identify clear lines of authority and reporting, and provide sufficient equipment and supplies to meet the collective nursing care needs.
  • Supervise performance of specific nursing activities or assign supervision to other licensed nurses
Nursing Board: 244 CMR 3.05 (1)
Supervision: Provision of guidance by a qualified licensed nurse for the accomplishment of a nursing task or activity, with initial direction of the task or activity and periodic inspection of the actual accomplishing the task or activity.

244 CMR 3.5 (2) (e) "The qualified licensed nurse shall adequately supervise the performance of the delegated nursing activity in accordance with the requirements for supervision as found in 244 CMR 3.05 (3).

  • Identify the licensed nurses responsible to provide supervision by position, title, role delineation. and competency.
  • Provide directions and clear expectations of how the activity is to be performed:

- monitor performance and intervene as necessary;

- obtain and provide feedback

- ensure proper documentation.

Nursing Board: 244 CMR 3.05 (3)
"The ...nurse shall provide supervision of all nursing activities delegated to an unlicensed person in accordance with the following conditions:

The degree of supervision required shall be determined by the qualified licensed nurse after an evaluation of appropriate factors involved, including, but not limited to the following:

(a) the stability of the condition of the patient;

(b) the training and capability of the unlicensed person to whom the nursing task is delegated

(c) the nature of the nursing task being delegated;

(d) the proximity and availability of the ...nurse to the unlicensed person when performing the nursing activity."

Provide directions and clear expectations of how the activity is to be performed:

  • monitor performance and intervene as necessary
  • obtain and provide feedback
  • ensure proper documentation.

Nursing Board: 244 CMR 3.05 (3)
"The ...nurse shall provide supervision of all nursing activities delegated to an unlicensed person in accordance with the following conditions:

The degree of supervision required shall be determined by the qualified licensed nurse after an evaluation of appropriate factors involved, including, but not limited to the following:

(a) the stability of the condition of the patient;

(b) the training and capability of the unlicensed person to whom the nursing task is delegated

(c) the nature of the nursing task being delegated;

(d) the proximity and availability of the ...nurse to the unlicensed person when performing the nursing activity."

  • Evaluate outcomes of patient community and use information to develop quality assurance and to contribute to risk management plans.
  • Evaluate the entire delegation process:

- evaluate the patient; and

- evaluate the performance of the activity.

- evaluate the outcome of delegation.

Nursing Board: 244 CMR 3.02 [3.03]
A registered nurse [licensed practical nurse] may delegate nursing activities to other...health care personnel, provided that the delegating registered [licensed practical] nurse shall bear full ...responsibility for:

(1) making an appropriate assignment;

(2) properly and adequately teaching, directing and supervising the delegatee; and

(3) the outcomes of that delegation [all within the parameters of his/her generic and continuing education and experience.]



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