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What is delegation?
Delegation is a process by which a health care professional who has legal authority to perform a controlled act transfers that authority to an unauthorized person.
There are 14 controlled acts in the Regulated Health Professions Act, 1991. 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 RHPA: Scope of Practice, Controlled Acts Model
What are some common examples of delegation?
A nurse who works in the community could delegate the administration of heparin by injection to an unregulated care provider who is providing care in the client’s home. In this example, the nurse has delegated the controlled act of “administering a substance by injection.”
In another example, a nurse who provides home care to a client requiring dressing changes for a wound extending below the dermis could delegate the controlled act to the client’s spouse. In this instance, the nurse has delegated the controlled act of “performing a procedure below the dermis.”
Also, 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 regulation?
The regulation sets out the categories and classes of nurses who can delegate (for example, RNs and RPNs in the general class and NPs).
It also prohibits delegating certain controlled acts (for example, NPs cannot delegate setting a fracture).
The regulation lists the requirements to delegate and to accept delegation (for example, considering the best interests of the client), as well as the requirements for documenting the delegation.
Sub-delegation is prohibited. Sub-delegation occurs when an individual who accepted 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 without delegation (see Question 1).
Where can I find the requirements for delegating or accepting delegation?
The Authorizing Mechanisms practice documentlists all 10 requirements that nurses must meet when delegating to others. It also lists the 7 requirements that nurses must meet when accepting delegation.
How do orders and delegation differ?
Delegation provides the legal authority to perform a controlled act. An order outlines how to perform that controlled act.
An order may or may not be related to a controlled act. An order can be:
- a direct order (client specific), or
- a directive (implemented for a number of clients when specific clinical conditions and specific circumstances are met)
If a nurse receives an order for a controlled act procedure that she already has access to through the Nursing Act, 1991 (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 procedure for which she or he is not authorized through the Nursing Act, 1991 (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 the controlled act teach a nurse how to perform the procedure?
Yes. It is important to note that 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 procedure is performed safely. One of the requirements is being satisfied that the delegatee has the knowledge, skill and judgment. One of the ways to ensure this is through teaching.
Who can delegate, which acts can be delegated and who can accept delegation?
RNs and RPNs can delegate and accept delegation if they are registered in the General, Extended or Emergency Assignment Class. RNs and RPNs cannot delegate the controlled act of dispensing a drug.
NPs cannot delegate the following controlled acts:
- prescribing, dispensing, selling or compounding medication
- ordering the application of a form of energy
- setting a fracture or joint dislocation
Nurses in the Temporary Class cannot delegate or accept delegation. Nurses in the Special Assignment Class cannot delegate the authority to perform controlled acts to others, but may accept delegation.