DELEGATION AND

SUPERVISION
( Seminar In Teaching Health
Education)

YAIMIN
Master Of Art In Education Health Education
15-2-61734
Delegation / Delegate
A delegation relationship exists when one member of
the multidisciplinary health care team delegates
aspects of consumer care, which they are competent
to perform and which they would normally perform
themselves, to another member of the health care
team from a different discipline, or to a less
experienced member of the same discipline.
Delegations are made to meet consumers needs
and to ensure access to health care services; that is,
that the right person is available at the right time to
provide the right service to a consumer. The
delegator retains accountability for the decision to
delegate and for monitoring outcomes.
Delegation may be either the:
transfer of authority to a competent person
to perform a specific activity in a specific
context OR

conferring of authority to perform a specific

activity in a specific context on a competent
person who does not have autonomous
authority to perform the activity.
Delegation is a two-way, multi-level activity,
requiring a rational decision-making and risk
assessment process, and the end point of
delegation may come only after teaching and
competence assessment. Delegation is different
from allocation or assignment which involves
asking another person to care for one or more
consumers on the assumption that the required
activities of consumer care are normally within
that persons responsibility and scope of
practice. Many of the same factors regarding
competence assessment and supervision that
are relevant to delegation also need to be
considered in relation to allocation / assignment
Responsibilities when
delegating
To maintain a high standard of care when delegating
activities, the professionals responsibilities include:
teaching (although this may be undertaken by another

competent person; and teaching alone is not delegation)

competence assessment
providing guidance, assistance, support and clinically-

focused supervision
ensuring that the person to whom the delegation is

being made understands their accountability and is

willing to accept the delegation
evaluation of outcomes
reflection on practice.
Responsibilities when accepting
a delegation
A key component of delegation is the readiness of the
recipient of the delegation to accept the delegation.
The recipient has the responsibility to:
negotiate, in good faith, the teaching, competence

assessment and level of clinically-focussed supervision

needed
notify in a timely manner if unable to perform the

activity for an ethical or other reason

be aware of the extent of the delegation and the

associated monitoring and reporting requirements

seek support and direct clinically-focussed supervision

until confi dent of own ability to perform the activity

Activities delegated to another person by a
registered nurse or midwife cannot be
delegated by that person to any other
individual, unless they have since obtained
the autonomous authority to perform the
activity. If changes in the context occur that
necessitate re-delegation, a person without
that autonomous authority must consult
with a registered nurse or
Supervision / Supervise
There are three types of supervision in a practice
context:
a. managerial supervision involving performance
appraisal, rostering, staffing mix, orientation,
induction, team leadership etc
b. professional supervision where, for example, a
midwife preceptors a student undertaking a course
for entry to the midwifery profession, or a
registered nurse supports and supervises the
practice of an enrolled nurse
c. clinically-focussed supervision, as part of
delegation.
 In relation to consumer care activities
delegated to another person by a midwife
from a midwifery plan of care or by a
registered nurse from a nursing plan of
care, clinically-focused supervision includes:
providing education, guidance and support

for individuals who are performing the

delegated activity
directing the individuals performance
monitoring and evaluating outcomes,

especially the consumers response to the

activity.
 There is a range of clinically-focused supervision
between direct and indirect. Both parties (the
delegator and the person accepting the delegation)
must agree to the level of clinically-focussed
supervision that will be provided.
Direct supervision is when the supervisor is
actually present and personally observes, works
with, guides and directs the person who is being
supervised.
Indirect supervision is when the supervisor
works in the same facility or organisation as the
supervised person, but does not constantly observe
their activities. The supervisor must be available for
reasonable access. What is reasonable will depend
on the context, the needs of the consumer and the
needs of the person who is being supervised.
Newly registered nurses and midwives may
require support and guidance to develop
confi dence in delegation and supervision.
Enrolled nurses will require support to make
decisions on determining whether
delegated activities are within their scope of
practice
The following guidelines are intended to
provide guidance for registered and enrolled
nurses and midwives on delegation and
supervision. They can also be used as cues
or indicators that a nurse or midwife is
demonstrating the relevant competency
standards.
Guidelines for Delegation and
Supervision
1. The delegation of nursing and midwifery
care occurs between registered nurses
(including nurse practitioners) and
registered midwives, and by registered
nurses and midwives to enrolled nurses.
The registered nurse and/ or midwife may
also delegate aspects of care, within a
healthcare setting, to non-nurse, non-
midwife support workers.
Guidelines for Delegation and
Supervision
2. The registered nurse or midwife must determine the
level of skill and knowledge required to ensure the
safety, comfort, and the security of the consumer prior
to delegating care.
This determination must be based on a comprehensive
health assessment of the consumer, including
consideration of the complexity of the care required,
and after identifying risk hazards together with
strategies to avoid them. It should also be made,
wherever possible, in consultation with the consumer,
their families and support network and in collaboration
with other members of the multidisciplinary health
care team.
Guidelines for Delegation and
Supervision
3. The registered nurse or midwife is responsible
for assessing each activity to determine that:
The delegation of care and supervision (direct or

indirect) is lawful;
The delegation is appropriate to the context

taking into consideration organisational capacity,

resources, support and skill mix of personnel;
Delegation follows appropriate consultation,

planning and risk assessment and management,

and should be followed by evaluation of the
outcomes;
Guidelines for Delegation and
Supervision
The person who has been delegated
the activity has the appropriate level of
knowledge, skill, experience,
competence and legal authority to
perform the delegated activity;
The person who has been delegated

the activity understands and

acknowledges: the delegated activity;
knows when and who to ask for
assistance; and to whom to report;
Guidelines for Delegation and
Supervision
Ongoing monitoring of the consumers
health status is planned;
The necessary support and supervision

will be provided to the person

performing the delegated activity; and
The person who has been delegated

the task accepts the delegation

Guidelines for Delegation and
Supervision
4. A registered nurse or midwife cannot
assume that the policies, protocols and
practices of the employer are always in
accordance with legislation affecting
nursing and midwifery practice in
health care. Registered nurses and
midwives should seek advice or
assistance from the regulatory
authority on these matters
Guidelines for Delegation and
Supervision
5. An appropriately educated and
experienced registered nurse or
midwife may supervise across more
than one context of care. This is
providing that the processes for
supervision, and the context, are
appropriate
Guidelines for Delegation and
Supervision
6. Registered and enrolled nurses and midwives
and non-nurse, non-midwife support workers,
including nursing and midwifery students,
should only undertake activities for which they
have the legal authority and the competence to
perform. The registered nurse and midwife
retain accountability for evaluating whether the
person carrying out the delegated activities
maintains the relevant standards and
outcomes. The person performing the
delegated activity is accountable for his or her
own actions and is also accountable to the
registered nurse or midwife.
Guidelines for Delegation and
Supervision
7. It is the registered nurse or midwifes
responsibility to provide direct or indirect
supervision according to the nature of the
delegated task. The registered nurse or
midwife should understand the role and
function of the enrolled nurse as well as
the role and function of non-nurse, non-
midwife support workers to ensure that
they are not required to function beyond
the limits of their education, competence,
experience and lawful authority.
Guidelines for Delegation and
Supervision
8. Registered and enrolled nurses and
midwives must maintain current
knowledge and awareness of the
appropriate legislation and bylaws relating
to delegation and supervision in their
state/territory of practice. Nursing and
midwifery regulatory authorities policies
and position statements reflecting the
relevant legislative requirements may be
an additional resource for nurses and
midwives delegating care.
Guidelines for Delegation and
Supervision
9. These determinations must occur prior
to the commencement of any
delegated activity, and should take
place in a collaborative context where
employers, managers, nurses and
midwives and other health workers
share the responsibility to create and
maintain environments, processes and
infrastructure that support safe decision
making