Provision 4
Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and provide optimal care.
4.4 Assignment and Delegation
Nurses are accountable and responsible for the assignment and the delegation of nursing activities. Such assignment or delegation must be consistent with nursing standards of practice and organizational policy. Nurses must make a reasonable effort to assess individual competence when delegating selected nursing activities. This assessment includes the evaluation of the knowledge, skill, experience, and qualifications of the individual to whom the care is assigned or delegated; the complexity of the tasks; and the nursing needs of the recipient of care.
Nurses are responsible for monitoring the activities and evaluating the quality and outcomes of the delegated care provided by other staff. Nurses may delegate nursing assessment and evaluation only to other qualified nurses. Nurses should not knowingly assign or delegate nursing assessment and evaluation to any non-nurse member of the interprofessional team or any technology-based interface. Employer policies or directives do not relieve the nurse of responsibility for making assignment or delegation decisions.
Nurses in leadership roles have a responsibility to foster a safe and ethical environment that supports and facilitates appropriate assignment and delegation. This environment includes adequate and flexible staffing; orientation and skill development; licensure, certification, continuing education, and competency verification; and policies that protect both the patient and the nurse from inappropriate assignment or delegation of nursing responsibilities, activities, or tasks. Nurses in leadership roles should facilitate open communication with nurses, allowing them, without fear of reprisal, to express concerns or even to refuse an assignment for which they feel unprepared.
Nurses are responsible and accountable for providing oversight of student nurses to ensure their knowledge, skill, and comportment are sufficient to provide the assigned nursing care. Nurses in an educator or preceptor role have a reasonable expectation that they will be provided with appropriate institutional support to allow for supervision of students without compromising patient safety or well-being or incurring conflicts of commitment.