Authority
RNs, by virtue of their professional licensure, have the authority to transfer a selected nursing activity in a specific situation to a competent individual (NCSBN, 1995). Authority is the right to act in areas where one is given and accepts responsibility (Creative Health Care Management, 2008). RNs have authority, or legitimate power, to analyze assessments, plan nursing care, evaluate nursing care, and exercise nursing judgment (NCSBN) which includes delegation. In the scenario at the beginning of the article, the RN had the authority, but did not exercise this authority, to delegate to the LPN and/or nursing assistant.
Summary
In the delegation process accountability rests within the decision to delegate, while responsibility rests within the performance of the task. LPNs are accountable for the quality of their performance and responsible for caring out the activities assigned to them. When a RN delegates an activity, such as medication administration, to an LPN, the LPN is accountable for safely performing this medication administration according to established regulations and standards, and responsible for completing this activity. The RN is then accountable to follow up with the LPN to review the outcome. This intentional reflection on the delegated activity directs future efforts and promotes learning (Creative Health Care Management, 2008). Understanding the difference between responsibility and accountability helps to clarify how RNs can delegate work to another without being held responsible for their actions.