Although the development of working skills in delegation is an outcome expectation of baccalaureate nursing program graduates, delegation competency will be realized only if opportunities for prelicensure practice occur in the classroom, laboratory, and clinical settings. Novice and experienced nurses as well as NAs should receive delegation education upon hire, as part of the review of the state’s Nurse Practice Act, and the organization’s scope of practice and job descriptions.
Nurses must have a clear understanding of their accountability for the actions or inactions of others in the delegation process. In addition, RNs and NAs must fully understand what activities may be delegated implicitly as part of the NA job description. Ongoing delegation education stressing the need for clear communication of delegation instructions, with frequent, planned supervision and vigilance in evaluation should be included in the annual competency program.
Hansten and Jackson have outlined a best practice bundle of delegation and supervision skills that may mitigate factors attributed to care omissions and potential negative consequences. These bedside practices include planning assignments so that an NA reports to no more than 2 RNs; including NAs in shift handoffs; RN and NA patient rounding;
check-in points during the shift with "real-time" feedback provided; reevaluating delegation and supervision practices at intervals; and coaching and mentoring.