Scope of Practice
This document provides specific guidance about RN scope of practice, delegation, and supervision.
The NMBA (2016) Registered Nurse Standards for Practice.
These are five principles RNs must consider before delegating to others.
1. Right activity
2. Right circumstance
3. Right person
4. Right communication
5. Right supervision and evaluation
This is the initial step in the delegation process.
1. Right activity: identify the activity that can be delegated.
This concept refers to an individual's ability to effectively carry out patient care
Competence
Effective application of combined knowledge, understanding, skills, and judgement demonstrated in daily practice or job performance.
In nursing, skills may be cognitive, psychomotor or technical AND a range of personal attributes and attitudes are relevant.
This category of health professionals has the authority to delegate to RNs, ENs and other healthcare workers.
Registered nurses
This term refers to the obligation to carry out tasks or duties that have been delegated
Responsibility
Responsibility can be delegated (accountability cannot be delegated)
The delegators transfer to the delegee; however, the delegator always remains accountable for the completion of the task.
A critical step of the delegation process that is often overlooked
Evaluation - evaluation of the outcomes of care and any feedback or changes.
Critical to ensuring successful task completion and team collaboration.
What is the benefit of delegation to the RN?
Can focus on more complex patients
Manage workload
Which nurse can supervise other nurses?
RNs (supervise other RNs, ENs, AINs, students).
This must be performed by RNs before they consider delegating patient care activities
The RN must make an assessment of the patient's care needs.
The step in the delegation involves self-assessment and situational assessment
2. Right circumstances:
Does the RN have the skills and knowledge to safely delegate
Does the skill mix enable appropriate supervision?
The primary goal of assignment of tasks or responsibilities to others
Ensuring that patients get quality care.
These 3 factors determine an individual nurse's scope of practice.
This term refers to the improper delegation of patient care activities
Dumping means delegating to another individual because the RN does not want to complete the work
This step of delegation is critical to preventing errors
4. Right communication:
How, when, where, expectations, any questions
Circumstances under which a delegee may refuse to accept delegation
When they do not have the competence and confidence to complete the activity.
When the delegator does not clearly define the task and expectations.
These factors, including education and regulatory guidelines, determine the RN scope of practice (name at least 3)
What is the difference between delegation and allocation?
In work or task allocation, there is no transfer of responsibility. The allocation is related to the job description and the organisational structure
These 3 considerations help decide what and when to delegate patient care activities
The predictability of patient outcomes
Scope of practice of delegee
Competence and confidence of delegee
What are key areas for risk related to delegation?
Understaffing
Working in unfamiliar settings
Complex or unstable patient conditions