Accountability and Responsibility
The National Council of State Boards in Nursing defines delegation as “transferring to a competent individual the authority to perform a selected nursing task in a selected situation” (National Council of State Boards of Nursing, Resources section, 4). When delegating, the registered nurse (RN) assigns nursing tasks to unlicensed assistive personnel (UAP) while still remaining accountable for the patient and the task that was assigned. Delegating is a management strategy that is used to provide more efficient care to patients. Authorizing other individuals to take on nursing responsibilities allows the nurse to complete other tasks that need tended to. However, delegation is done at the nurses’ discretion and is a personal choice.
Nurses must make careful decisions regarding delegation, taking into account the skill and training of the UAP, the difficulty and risk of the task, and the patient’s condition. The expected outcomes, a time frame for completion, and any limitations should be explained to the UAP at the time that the task was delegated.
Accountability and responsibility are two important parts of delegation. Accountability is defined as, “being responsible and answerable for actions or inactions of self or others in the context of delegation” (National Council of State Boards of Nursing, Resources section, 4). This refers to the nurse’s legal liability for her actions and patient outcomes. Responsibility is defined as the “reliability, dependability, and the obligation to accomplish work.
Responsibility also includes each person’s obligation to perform at an acceptable level, the level that the person has been educated” (Kelly-Heidenthal, 2003, p. 268). Accountability and responsibility differ, because responsibility belongs to the person doing the task and accountability belongs to the person who assigned the task. The nurse is both accountable for the task being completed and is also responsible for evaluating the task or the results of the task. Therefore, within every delegated procedure, both the nurse and the UAP hold responsibility, yet only the nurse is accountable. If a procedure is done wrong or the patient is harmed by the task, the nurse is at fault because she delegated that procedure and she is ultimately accountable for patient outcomes.
For example, Jill is a RN and Marie is a UAP at General Hospital. Jill and Marie are assigned to work together. Jill delegates to Marie the vital signs, patient hygiene, and blood glucose monitoring of all of her patients except for Mrs. Smith, who is sicker than any of the other patients. Jill decides not to delegate any of Mrs. Smith’s care because all of her care will require professional nursing judgment due to the severity of her condition; therefore Jill will be accountable and responsible for Mrs.
Smith’s care. Marie is responsible for performing the duties that were delegated to her by Jill; however Jill remains accountable for all of the delegated tasks. If Jill overlooks a patient’s blood glucose level of 45 and the patient suffers because of it, she is held accountable. Even if Marie obtained the patient’s blood glucose level and forgot to report it to Jill. It is Jill’s responsibility as the RN to find out and assess the results of the delegated tasks and to then act accordingly on the results.
Delegation can be a useful time management tool if utilized appropriately.
As a RN, it is important to consider accountability and responsibility before making delegation decisions. As long as the RN remembers to make careful decisions before delegating to the UAP and evaluates the results of the delegated task then the outcomes should be fine. .