About the Five (5) Rights of Delegation
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." |
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 3.05 244 CMR 3.05 (2) (b) |
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| 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 |
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) Nursing Board: 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, 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. |
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.] |
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| 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 |
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Nursing Board: 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. |
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Situation specific communication includes:
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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 |
|---|---|---|---|
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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) 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). |
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Nursing Board: 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, 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:
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Nursing Board: 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, 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:
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Nursing Board: 244 CMR 3.02 [3.03] (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.] |