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Delegation
What is delegation?
Delegation occurs when a regulated health professional (delegator) who is legally authorized and competent to perform a controlled act temporarily grants their authority to perform that act to another individual (delegatee).
There are 14 controlled acts in the Regulated Health Professions Act, 1991 (RHPA). By definition, a controlled act can cause harm if it is performed by an individual who is not competent. To learn more about controlled acts, see the Scope of Practice standard.
What are some common examples of delegation?
(i) A nurse who works in the community can delegate the administration of heparin by injection along with an order from an authorized provider to an unregulated care provider who is providing care in a client’s home. In this example, the nurse is delegating the controlled act of “administering a substance by injection.”
(ii) A nurse who provides home care to a client requiring a wound dressing below the dermis can delegate the controlled act to the client’s spouse. In this instance, the nurse is delegating the controlled act of “performing a procedure below the dermis.”
(iii) A nurse may accept the authority to defibrillate through delegation from a physician. Defibrillation falls under the controlled act of “applying a form of energy."
What do I need to know about the delegation legislation?
The legislation sets out the:
- categories and classes of nurses who can delegate (for example, RNs and RPNs in the general class and NPs)
- requirements to delegate and to accept delegation (for example, considering the best interests of the client), and
- requirements for documenting the delegation.
Nurses can only delegate controlled acts that they are trained or competent to perform. The regulation also prohibits delegating certain controlled acts (for example, NPs cannot delegate setting a fracture and Registered Nurses with prescribing authority cannot delegate prescribing a drug or communicating a diagnosis for the purposes of prescribing).
Sub-delegation is prohibited. Sub-delegation occurs when an individual who accepts a delegation then delegates the same act to another person. This is not allowed because the individual who is sub-delegating does not have legal authority to perform the act.
Where can I find the requirements for delegating or accepting delegation?
CNO’s Scope of Practice standard lists the ten requirements nurses must meet before delegating to others. It also lists the seven requirements nurses must meet when accepting delegation.
How do orders and delegation differ?
Delegation and orders are two different authorities.
If a nurse receives an order for a controlled act that they already have authority to perform (for example, the administration of a substance by injection), the nurse does not need delegation.
If the nurse receives an order for a controlled act they are not authorized to perform (for example, managing a labour or conducting the delivery of a baby), then the nurse needs delegation from an authorized individual, such as a physician, as well as an order for the procedure..
Can someone who does not have authority to delegate a controlled act teach a nurse how to perform the procedure?
Yes. Teaching may be part of the delegation process, but it is not equivalent to delegating.
For example, a nurse educator with the appropriate knowledge, skill, and judgement may teach a group of nurses how to adjust a pacemaker. Following the education session, the nurses will have the competence, but they will not have the authority to perform the controlled act until it is delegated by an authorized practitioner, such as a physician.
A number of requirements need to be met to ensure the delegated activity is performed safely. One of the requirements is being satisfied that the delegatee has the knowledge, skill and judgment.This can be done through teaching.
Additional Resources:
- Scope of Practice
- Interprofessional Guide on the Use of Orders, Directives and Delegation for Regulated Heath Professionals in Ontario
