Delegation decisions are sometimes made based on a list of tasks found in a job description, such as taking vital signs, bathing, or ambulating patients. In these cases the RN is really assigning tasks rather than using professional judgment to match the staff member's skills to patient needs. Assigning nursing assistants to perform all the baths or take all the vital signs for a group of patients indicates that the delegation is task based rather than judgment based. Making assignments based on a list of tasks in a job description short-circuits the critical thinking skills of the RN because the RN's judgment is not utilized. Matching the staff member's expertise to patient needs is essential for sound delegation decisions.
An example of this matching would be an RN's decision that an LPN with five years of long term care experience prior to working in orthopedics is a more qualified care giver for a 91 year old post operative arthroplasty patient than an LPN who is also available but who has less background in caring for geriatric patients. It is the understanding of the geriatric patient's needs at this point in time that would lead the RN to intentionally select the LPN with long term care experience. In this situation, the RN would still assume the responsibility of first assessing the patient before delegating the care to the LPN, and the responsibility of clarifying expectations of the care to be given in order to meet the desired outcomes. The RN would periodically assess the patient's status and not hesitate to instruct the LPN about what to monitor and direct specific interventions. In this example, the matching of patient need to the nurse skills would be very intentional, relying on the RN's professional judgment.