Accepting, Rejecting & Delegating a Work Assignment: A Guide for Nurses

Main Page | Purpose and Statement of Problem | Legal Considerations
Responsibilities | Application of the Guide for Decision-Making
Algorithm 1 | Algorithm 2 | Glossary | References


Individual nurses, nurse supervisors, chief nurse executives, and employers all have responsibilities that contribute to safe, effective patient care. Key responsibilities of licensed nurses [244 CMR: 3.00] and organizations involved in the provision of nursing care are summarized below.

The individual nurse:

  • Determines and maintains nursing competence consistent with the NPA and Board regulations.
  • Provides competent nursing care to patients.
  • Exercises informed judgment and uses individual compe­tence and qualifications as criteria in accepting responsi­bilities, seeking consultation, and delegating nursing ac­tivities to others.
  • Clarifies assignments and assesses personal knowledge, skills, and abilities prior to accepting a work assignment.
  • Seeks assistance and/or additional training if gaps in knowl­edge, skills, or abilities are identified. If necessary, negoti­ates options for all or part of the work assignment when appropriate training and supervision are not available to meet immediate patient care needs.
  • Communicates the need for alternate means of care when patient needs exceed the individual nurse’s knowledge, skills, or abilities, or other available resources.
  • Delegates only those activities which are within the nurse’s area of responsibility and competency to delegate. Assess­es the needs of patients and the documented competency of unlicensed personnel prior to delegating nursing activi­ties. [244 CMR: 3.05(4)].
  • Refuses to engage in nursing activities that are beyond the parameters of the NPA, and/or the nurse’s education, capa­bilities, and experience.
  • Does not (cannot) accept responsibility and accountability for an unlicensed individual performing a nursing task that has been delegated by another nurse or individual.

The nurse supervisor:

  • Evaluates the knowledge, skills, and abilities of nursing staff to provide care.
  • Identifies nursing care requirements and organizes resourc­es to ensure that patients receive appropriate care.
  • Collaborates with the nurse to clarify work assignments. Also collaborates with the nurse to assess knowledge, skills and abilities, and options for performing a work as­signment or components of it when the nurse judges the work assignment to be beyond his/her competency.
  • Provides education to staff and supports the decision-mak­ing process regarding patient care assignments and reas­signments, including patient placement and allocation of resources.
  • Provides the nurse with documented competencies of unli­censed personnel.

The chief nurse executive:

In collaboration with nursing personnel, establishes a system for provision of care which includes defining a model of nursing prac­tice that:

  • Determines competencies of licensed and unlicensed nurs­ing staff.
  • Supports the provision of competent nursing care to pa­tients.
  • Provides for periodic re-evaluation of the competency of individuals to whom nursing tasks are delegated.
  • Determines the competency of nurses to delegate or accept a work assignment.
  • Recognizes that the final decision regarding delegation of specific tasks or accepting a work assignment is within the scope of the individual nurse’s professional judgment.
  • Institutes screening procedures, hiring practices, and edu­cation and training, which assure the provision of safe care by nurses and unlicensed assistive personnel.
  • Conducts ongoing monitoring and evaluation of the quality of patient care.
  • Defines roles and responsibilities of all categories of care­givers.
  • Provides a formal process for timely review and resolution of conflicts related to work assignments.
  • Assures that resources are adequate to meet patient care needs.
  • Initiates internal or agency disciplinary action for violation of policies and procedures of the facility.

Professional Regulatory Considerations

Nursing, like all professions, regulates itself through professional standards of practice, certification and an ethical code.

Main Page | Purpose and Statement of Problem | Legal Considerations
Responsibilities | Application of the Guide for Decision-Making
Algorithm 1 | Algorithm 2 | Glossary | References