🩺 “A systematic, scientific method to provide individualized nursing care.”
📚 It is the foundation of clinical nursing practice worldwide.
🗨️ The Nursing Process is a systematic, patient-centered, goal-oriented method used by nurses to assess, diagnose, plan, implement, and evaluate care.
💡 It ensures evidence-based, safe, and effective nursing interventions.
🔍 “What is the problem?”
✅ Collect subjective and objective data about the patient’s physical, emotional, spiritual, and social condition.
| 📂 Data Types | 🧾 Examples |
|---|---|
| 🗣️ Subjective | Patient says: “I feel dizzy.” |
| 👀 Objective | BP = 150/100 mmHg, Temp = 101°F |
📌 Tools used: Physical exam, history-taking, labs, reports, interviews
🩺 “What is the nursing issue?”
✅ Analyze data to identify actual or potential health problems within the scope of nursing practice (not medical diagnosis).
📘 Example:
❌ Medical Dx: Pneumonia
✅ Nursing Dx: Impaired gas exchange related to alveolar-capillary changes as evidenced by low O₂ saturation
📌 Uses NANDA (North American Nursing Diagnosis Association) terminology.
🗂️ “What can be done?”
✅ Set SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound) for patient outcomes
✅ Develop a nursing care plan (NCP) with prioritized interventions.
📘 Example:
🟢 Goal: “Patient will maintain SpO₂ above 95% within 24 hours.”
📋 Interventions:
🚑 “Let’s do it.”
✅ Execute the planned interventions — can be independent, dependent, or collaborative.
📘 Examples:
📌 Must document all care given!
🧠 “Did it work?”
✅ Determine if goals were met, partially met, or not met.
✅ Modify care plan if necessary.
📘 Example:
✔️ SpO₂ is now 97% → Goal met → Continue monitoring
❌ Pain persists → Goal not met → Reassess and revise intervention
🌀 The nursing process is continuous — if goals are not met, the nurse must reassess and restart the process.
✅ Ensures individualized and holistic care
✅ Enhances critical thinking and clinical judgment
✅ Provides legal documentation of care
✅ Improves communication among healthcare team
✅ Promotes evidence-based and outcome-driven practice
✅ Q: What is the correct order of the nursing process?
🅰️ Assessment → Diagnosis → Planning → Implementation → Evaluation (ADPIE)
✅ Q: What does the nursing diagnosis focus on?
🅰️ Patient’s response to health problems
✅ Q: Which stage involves setting SMART goals?
🅰️ Planning
✅ Q: What must the nurse do during implementation?
🅰️ Carry out and document interventions
✅ Q: What happens if the goal is not met in evaluation?
🅰️ Revise the care plan and reassess the patient
🩺 “It’s not just about disease — it’s about the patient’s response.”
📚 Nursing diagnoses guide care plans by identifying problems nurses can treat independently.
🗨️ A Nursing Diagnosis is a clinical judgment about a person’s response to actual or potential health problems/life processes, within the scope of nursing practice.
🔹 It is the second step of the nursing process (ADPIE)
🔹 It is not a medical diagnosis — it focuses on patient responses, not disease.
✅ Identify patient’s needs and problems
✅ Guide the development of the Nursing Care Plan (NCP)
✅ Enable goal setting and focused interventions
✅ Improve communication among health care team
✅ Promote evidence-based and individualized care
| 🌟 Type | 📖 Meaning | 🧾 Example |
|---|---|---|
| ✅ Actual | Existing problem with symptoms/signs | Impaired mobility R/T fracture AEB limping |
| ⚠️ Risk | High chance of developing problem | Risk for infection R/T surgical incision |
| 🧩 Health Promotion | Patient’s motivation to improve health | Readiness for enhanced nutrition |
| 🧠 Syndrome | Cluster of diagnoses (e.g., trauma, rape) | Post-trauma syndrome |
| 🌈 Possible | Suspected but incomplete evidence | Possible disturbed thought process |
(For Actual Diagnosis – 3-Part Statement)
🧠 PES Format:
🔹 P – Problem (NANDA Label)
🔹 E – Etiology (Related To – R/T)
🔹 S – Signs & Symptoms (As Evidenced By – AEB)
📘 Example:
Impaired gas exchange R/T alveolar-capillary membrane changes AEB SpO₂ 86%, dyspnea
| 🧠 Problem | 📝 Example |
|---|---|
| 🩺 Pain | Acute pain R/T surgical incision AEB verbal report of pain 7/10 |
| 🛌 Mobility | Impaired physical mobility R/T muscle weakness AEB unsteady gait |
| 😴 Sleep | Disturbed sleep pattern R/T anxiety AEB insomnia, fatigue |
| 💧 Hydration | Risk for deficient fluid volume R/T vomiting |
| 🧠 Cognition | Acute confusion R/T fever AEB disorientation |
| 🧍♂️ Falls | Risk for falls R/T impaired balance and history of falls |
| 💭 Mental Health | Ineffective coping R/T grief AEB crying, withdrawal |
| 📌 Aspect | 🩺 Nursing Diagnosis | 🧬 Medical Diagnosis |
|---|---|---|
| 📚 Focus | Patient’s response | Disease process |
| 🧠 Who makes it? | Nurse | Physician |
| 📝 Example | Ineffective breathing pattern | COPD |
| 🧭 Goal | Guide nursing care | Guide medical treatment |
✅ Q: What is a nursing diagnosis?
🅰️ A clinical judgment of patient responses that nurses can manage.
✅ Q: What is the format for writing nursing diagnosis?
🅰️ Problem + Related to (R/T) + As Evidenced By (AEB)
✅ Q: What type of nursing diagnosis is “Risk for infection”?
🅰️ Risk Diagnosis
✅ Q: Nursing diagnosis focuses on?
🅰️ The response of the patient to a health condition
✅ Q: Which organization standardizes nursing diagnosis?
🅰️ NANDA International (NANDA-I)
📝 “Transforming assessment into action through diagnosis, goals, and care.”
📚 Each case is based on real-life patient situations using NANDA-I nursing diagnoses.
| 🧾 Assessment Findings |
🔹 Incisional pain (8/10)
🔹 Grimacing on movement
🔹 Refuses to ambulate
🔹 TPR: 100°F, HR 102 bpm
📋 Nursing Diagnosis:
Acute pain R/T surgical incision AEB patient rating pain 8/10, facial grimace, refusal to ambulate
🎯 Goal:
Patient will verbalize pain < 3/10 within 24 hours of intervention.
🛠️ Interventions & Rationales:
1️⃣ Administer prescribed analgesic → Controls physiological response to pain
2️⃣ Teach relaxation techniques → Reduces anxiety and pain perception
3️⃣ Encourage splinting during movement → Reduces discomfort
4️⃣ Reassess pain after 30 minutes → Evaluate effectiveness of intervention
✅ Evaluation:
Patient reported pain 2/10 after analgesic; able to ambulate with assistance. Goal met.
| 🧾 Assessment Findings |
🔹 Hemiparesis on left side
🔹 Difficulty walking
🔹 Requires assistance for hygiene
🔹 At risk for fall due to poor balance
📋 Nursing Diagnosis:
Impaired physical mobility R/T neuromuscular impairment AEB difficulty walking, need for hygiene assistance
🎯 Goal:
Patient will perform ADLs with minimal assistance within 3 days.
🛠️ Interventions & Rationales:
1️⃣ Encourage passive/active ROM exercises → Maintain joint function
2️⃣ Use assistive devices for ambulation → Prevent falls
3️⃣ Involve physiotherapy → Strengthen muscle groups
4️⃣ Provide emotional support → Increases confidence and motivation
✅ Evaluation:
Patient performed hygiene with minimal assistance by day 3. Goal partially met.
| 🧾 Assessment Findings |
🔹 Shortness of breath on exertion
🔹 Pitting edema in legs
🔹 SpO₂: 88% on room air
🔹 Weight gain of 2 kg in 2 days
📋 Nursing Diagnosis:
Excess fluid volume R/T compromised regulatory mechanism AEB edema, weight gain, low SpO₂
🎯 Goal:
Patient will maintain clear lungs and stable weight within 72 hours.
🛠️ Interventions & Rationales:
1️⃣ Monitor daily weight → Tracks fluid retention
2️⃣ Elevate legs → Reduces edema
3️⃣ Administer diuretics as prescribed → Promotes fluid excretion
4️⃣ Educate on fluid & salt restriction → Prevents worsening of condition
✅ Evaluation:
Edema reduced, weight stabilized, lungs clear. Goal met.
| 🧾 Assessment Findings |
🔹 Disoriented to time/place
🔹 Repeats questions
🔹 Wandering in hallways
🔹 Diagnosed with UTI
📋 Nursing Diagnosis:
Acute confusion R/T infection AEB disorientation, wandering behavior
🎯 Goal:
Patient will be oriented to place and person within 2 days.
🛠️ Interventions & Rationales:
1️⃣ Reorient patient frequently → Reinforces awareness
2️⃣ Provide calendar & clock in room → Visual orientation aids
3️⃣ Maintain calm environment → Reduces overstimulation
4️⃣ Administer antibiotics as prescribed → Treats underlying UTI
✅ Evaluation:
Patient oriented to place by day 2, minimal confusion. Goal met.
✅ Q: What is the correct format for writing a NANDA nursing diagnosis?
🅰️ Problem + Related To (R/T) + As Evidenced By (AEB)
✅ Q: What is an appropriate goal for impaired mobility?
🅰️ Patient will perform ADLs with minimal assistance within 3 days
✅ Q: In CHF, which is the best nursing diagnosis?
🅰️ Excess fluid volume R/T compromised regulatory mechanism
✅ Q: What intervention helps reduce edema in CHF?
🅰️ Elevating legs above heart level
🩺 “A plan of action to deliver safe, individualized, and goal-directed care.”
📄 It is the heart of nursing process documentation.
🗨️ A Nursing Care Plan (NCP) is a written document that outlines a nurse’s plan to care for a specific patient.
It includes assessment data, nursing diagnosis, goals/outcomes, interventions, and evaluation — based on the nursing process (ADPIE).
✅ Provide individualized care
✅ Serve as a communication tool among healthcare providers
✅ Ensure continuity of care
✅ Guide clinical judgment and prioritization
✅ Provide a legal record of care planning
✅ Facilitate teaching, evaluation, and research
📌 Collect subjective & objective data
🧾 Example:
🗨️ Identify actual or potential problems using NANDA format:
Problem + Related to (R/T) + As Evidenced By (AEB)
🧾 Example:
Impaired gas exchange R/T alveolar-capillary membrane changes AEB low SpO₂, dyspnea, increased RR.
📌 Set SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound)
🧾 Example:
“Patient will maintain oxygen saturation ≥ 95% within 24 hours.”
📌 Include Independent, Dependent, and Collaborative interventions.
🧾 Examples:
📌 Provide scientific reasoning behind each intervention.
🧾 Example:
Elevating head of bed improves lung expansion and reduces dyspnea.
📌 Assess if goal was:
✔️ Met | ➖ Partially Met | ❌ Not Met
🧾 Example:
✔️ SpO₂ improved to 97%. Goal met. Continue monitoring and education.
| 🔢 Step | 📝 Content |
|---|---|
| Assessment | SOB, SpO₂ 88%, RR 28/min |
| Nursing Dx | Impaired gas exchange R/T fluid in alveoli AEB low SpO₂ |
| Goal | SpO₂ ≥ 95% within 24 hours |
| Interventions | – Administer O₂ – Elevate HOB – Monitor vitals |
| Rationale | Improves oxygenation & reduces work of breathing |
| Evaluation | Goal met; SpO₂ 97%, RR normal |
| 📂 Type | 📘 Use |
|---|---|
| Formal NCP | Written & documented in records |
| Informal NCP | Mentally planned by the nurse |
| Individualized NCP | Specific to one patient |
| Standardized NCP | For patients with common needs (e.g., surgery) |
| Computerized NCP | Digital care plans in EMR systems |
✅ Q: What does a nursing care plan contain?
🅰️ Assessment, nursing diagnosis, goals, interventions, rationale, evaluation
✅ Q: What is the purpose of rationale in a care plan?
🅰️ To explain the scientific reasoning behind interventions
✅ Q: Which goals should be used in a care plan?
🅰️ SMART goals
✅ Q: What is the format of nursing diagnosis as per NANDA?
🅰️ Problem + Related To (R/T) + As Evidenced By (AEB)
✅ Q: Name one example of a collaborative nursing intervention.
🅰️ Administering IV medication as per doctor’s order
🖊️ “If it isn’t documented, it wasn’t done.”
🛡️ Accurate documentation is the nurse’s legal shield, communication tool, and care continuity anchor.
🗨️ Documentation in nursing is the written or electronically recorded account of nursing care given, patient responses, and relevant clinical events.
It is legal evidence, communication among team members, and proof of nursing accountability.
✅ Document immediately after care is given
⏱️ Avoid delays that lead to forgotten or inaccurate information
📌 Use real-time documentation if possible
✅ Record exact observations, interventions, and outcomes
🔍 Use only approved abbreviations
❌ Avoid vague words like “seems,” “appears,” “some”
✅ Include all relevant data, responses, medications, patient complaints, and actions taken
🧾 Ensure nothing essential is omitted
✅ Record only what you see, hear, feel, or do
🚫 Avoid personal opinions, assumptions, or judgments
📌 Example: “Patient grimaced and stated pain as 8/10” (not “Patient is faking”)
✅ Handwritten entries must be clear and readable
💻 In electronic records, ensure correct field entries
📌 Don’t use correction fluid — use single-line strikethrough + initials
✅ Sign each entry with your name, designation, and date/time
📌 E.g., “R. Patel, B.Sc. Nursing, 19/04/2025, 10:15 AM”
👩⚕️ Never document for another nurse unless required legally
✅ Follow HIPAA (or local data protection laws)
🔒 Secure both paper and digital records
🚫 Never discuss patient details in public areas
✅ Enter information in the order events occurred
📆 Helps in tracking patient progress accurately
✅ Documentation must follow legal and institutional standards
📌 Remember: Poor documentation = Poor defense in court
| 📄 Type | 📘 Example |
|---|---|
| Narrative Notes | “Patient c/o chest pain, 8/10…” |
| SOAP Notes | Subjective, Objective, Assessment, Plan |
| PIE Notes | Problem, Intervention, Evaluation |
| DAR Notes | Data, Action, Response |
| Flow Sheets | Vitals, intake-output, etc. |
🚫 Documenting before care is given
🚫 Leaving blank lines or skipping time slots
🚫 Using unapproved abbreviations
🚫 Failing to report abnormal findings
🚫 Writing judgmental statements
✅ Ensures patient safety
✅ Supports legal protection
✅ Enhances interdisciplinary communication
✅ Tracks progress and quality of care
✅ Promotes continuity of care
✅ Q: What is the golden rule in nursing documentation?
🅰️ If it wasn’t documented, it wasn’t done.
✅ Q: Which principle ensures data is truthful and unbiased?
🅰️ Objectivity
✅ Q: What should a nurse do after making a documentation error?
🅰️ Strike through with a single line, initial, and correct entry
✅ Q: Which type of documentation uses Subjective, Objective, Assessment, Plan?
🅰️ SOAP Notes
✅ Q: Why is documentation important in legal terms?
🅰️ It serves as legal evidence of care provided.
📝 Structured formats to document patient progress, interventions, and responses.
🔹 SOAP = S – Subjective, O – Objective, A – Assessment, P – Plan
| 🅂 Subjective | “I’m having sharp pain at my incision site.” |
|---|---|
| 🅾 Objective | BP: 140/90 mmHg, HR: 104 bpm, Patient grimacing |
| 🅰 Assessment | Acute pain related to surgical incision |
| 🅿 Plan | Administer prescribed analgesic, reassess pain in 30 mins, educate on splinting wound while coughing |
| 🅂 | “I feel cold and tired.” |
|---|---|
| 🅾 | Temp: 102°F, chills, flushed skin |
| 🅰 | Hyperthermia related to infection |
| 🅿 | Administer antipyretic, monitor temperature q2h, encourage fluid intake |
🔹 DAR = D – Data, A – Action, R – Response
💡 Commonly used in focus charting
| 🅓 Data | Blood sugar: 320 mg/dL, patient c/o headache & dizziness |
|---|---|
| 🅐 Action | Administered insulin as prescribed, offered 500 mL water |
| 🅡 Response | Blood sugar dropped to 180 mg/dL in 1 hour, patient alert, no dizziness |
| 🅓 | Patient found attempting to get out of bed without call bell |
|---|---|
| 🅐 | Instructed on using call bell, placed fall risk sign, adjusted bed alarm |
| 🅡 | Patient verbalized understanding, remained in bed during shift |
📂 Different formats used to record, communicate, and evaluate nursing care.
🖊️ Free-text format used to document patient status, care, and response in chronological order.
✅ Useful in ICUs, emergency, and detailed care
📈 Used for frequent data recording — e.g., vitals, I&O chart, wound care, glucose chart.
✅ Saves time, easy trend tracking.
📋 Contains brief patient care summary: diagnosis, allergies, diet, mobility, treatments.
✅ Quick reference tool for shift handovers.
📉 Used to chart vital signs graphically — temperature, pulse, BP, respirations, pain.
✅ Visual trends over time.
💊 Records medications given, time, route, dose, and nurse initials.
✅ Helps prevent medication errors.
⚠️ Used for reporting unusual events (e.g., falls, medication error).
✅ NOT part of medical record; used for quality improvement and legal defense.
🏥 Admission: Includes history, allergies, vitals, primary concern
🏁 Discharge: Includes condition, education given, follow-up instructions
✅ Q: What does “S” stand for in SOAP note?
🅰️ Subjective data
✅ Q: In which format is the DAR note used?
🅰️ Focus charting
✅ Q: Which type of record includes BP, pulse, temp charts?
🅰️ Graphic records
✅ Q: What does the MAR include?
🅰️ Medication name, dose, route, time, nurse initials
✅ Q: Are incident reports part of the patient record?
🅰️ No — used for internal review only
⚖️ “Your notes are your best legal defense.”
🖊️ Proper documentation = Legal protection + Quality care + Professional accountability
🗨️ Legal documentation in nursing refers to the accurate, complete, and timely recording of all nursing assessments, interventions, and patient responses — which becomes part of the legal medical record.
📌 These records are admissible in court and reviewed in audits, licensing, or litigation.
✅ Serves as legal proof of care
✅ Supports the nurse’s accountability and professionalism
✅ Protects against negligence or malpractice claims
✅ Ensures compliance with hospital policies & nursing laws
✅ Used in insurance claims, audits, and legal proceedings
🔍 Document only what you see, hear, measure, or do.
❌ Avoid vague or judgmental terms (e.g., “patient seems fine”).
🕰️ Chart immediately after care is delivered.
📌 Delayed or late entries must be marked as such with exact time.
📋 Include all nursing actions, medications, education, communication, and outcomes.
📌 Missing information may imply care was not given.
🔒 Keep patient information private and protected as per HIPAA or local laws.
❌ Never share details with unauthorized persons or in public areas.
✍️ Every entry must include the nurse’s full name, signature, designation, and date/time.
📌 Use hospital-approved signature style.
🚫 Never use white-out or erase errors.
✅ Use a single line, write “error,” initial and date, then make the correct entry.
📚 Use approved abbreviations, symbols, and terminology per hospital policy.
📅 Entries should be made in sequence of care given.
📌 Helps track clinical events clearly.
📁 The medical record is the property of the hospital, but patients have right to access their own records.
🔴 Allegations of negligence or malpractice
🔴 Loss of nursing license
🔴 Inability to defend actions in court
🔴 Risk to patient safety and outcomes
🔴 Audit failure or penalties to institution
✅ “Patient ambulated with assistance for 10 feet, BP 118/78 mmHg post-activity.”
✅ “Medication X 250 mg IV given at 10:45 AM as prescribed, no adverse reaction noted.”
✅ “Patient verbalized understanding of insulin injection technique.”
✅ Q: What is the legal significance of documentation in nursing?
🅰️ It serves as legal proof of the care provided.
✅ Q: What should you do if you make a charting error?
🅰️ Strike through with a single line, label “error,” initial, and correct it.
✅ Q: Is a nurse allowed to use white-out in the chart?
🅰️ No. It is legally unacceptable.
✅ Q: Who owns the patient’s record?
🅰️ The healthcare institution.
✅ Q: Why is timely documentation essential?
🅰️ To ensure accuracy and prevent legal issues.
🩺 “The method behind how care is delivered.”
📚 Nursing modalities define the structure for delivering nursing care efficiently and effectively.
🗨️ Nursing Modality refers to the system or method by which nursing care is assigned, organized, and delivered to patients within a healthcare setting.
Each modality determines who does what, how care is coordinated, and how responsibilities are shared among the team.
✅ Ensure efficient use of resources
✅ Provide patient-centered and quality care
✅ Clarify roles and responsibilities
✅ Improve continuity of care
✅ Support team coordination and communication
👩⚕️ “One nurse – All care – One shift.”
| 🔹 Characteristics |
|---|
| – One nurse is assigned to complete care of one or more patients during their shift |
| – Nurse performs everything: meds, assessments, hygiene, communication |
| – Common in ICUs, private care, post-op rooms |
✅ Advantages:
❌ Disadvantages:
🛠️ “Divide tasks, not patients.”
| 🔹 Characteristics |
|---|
| – Each staff member is assigned a specific task |
| – For example: |
| 🟢 One nurse gives meds |
| 🔵 One nurse does wound care |
| 🔴 One assistant handles hygiene |
| – Common in military hospitals, long-term care |
✅ Advantages:
❌ Disadvantages:
👥 “A team led by an RN cares for a group of patients.”
| 🔹 Characteristics |
|---|
| – Led by an RN (Team Leader) |
| – Includes LPNs and nursing assistants |
| – Team shares responsibility for 6–10 patients |
| – Common in medical-surgical and general wards |
✅ Advantages:
❌ Disadvantages:
👩⚕️ “One RN = One patient = 24-hour responsibility”
| 🔹 Characteristics |
|---|
| – One primary RN plans and coordinates care throughout patient’s stay |
| – Associate nurses implement the plan in her absence |
| – Common in hospitals focusing on continuity of care |
✅ Advantages:
❌ Disadvantages:
📦 “Care delivered in modules — smaller teams.”
| 🔹 Characteristics |
|---|
| – A mini team (RN + assistant) is assigned to patients in one physical area or “module” |
| – Based on geography of ward |
| – Ideal for medical wards with side rooms |
✅ Advantages:
❌ Disadvantages:
📈 “Care level depends on patient’s condition.”
| 🔹 Characteristics |
|---|
| – Patient is transferred to different units as condition changes |
| – Example: ICU → Step-down unit → General ward → Home |
| – Emphasizes acuity-based movement |
✅ Advantages:
❌ Disadvantages:
📊 “RN case manager = patient advocate and coordinator.”
| 🔹 Characteristics |
|---|
| – One nurse (case manager) coordinates all care from admission to discharge |
| – Works with multidisciplinary team |
| – Common in complex or chronic illness, rehabilitation, oncology |
✅ Advantages:
❌ Disadvantages:
| ⚙️ Modality | 👤 Focus | 👥 Best For | ✅ Advantage | ❌ Disadvantage |
|---|---|---|---|---|
| Total Care | Individual RN | ICU/Private | Holistic care | Costly |
| Functional | Task-based | High-volume wards | Efficient | Fragmented care |
| Team Nursing | Group effort | General wards | Collaboration | Needs good leadership |
| Primary Nursing | Individualized 24-hr care | Long-term care | Continuity | High RN demand |
| Modular Nursing | Geographic care units | Medical wards | Local efficiency | Uneven work |
| Progressive Care | Level-based shifting | Tertiary hospitals | Resource use | Transfer breaks continuity |
| Case Management | Long-term coordination | Chronic/complex patients | Continuity & efficiency | Advanced skills needed |
✅ Q: Which nursing modality uses task distribution?
🅰️ Functional Nursing
✅ Q: Which modality ensures highest patient-nurse continuity?
🅰️ Primary Nursing
✅ Q: What is the key role of a case manager?
🅰️ Coordinates care from admission to discharge
✅ Q: Which modality is geography-based within a ward?
🅰️ Modular Nursing
✅ Q: Which modality shifts patient through different care levels?
🅰️ Progressive Patient Care
🛡️ “Right task, right person, right time.”
📚 Delegation = Distributing tasks safely while maintaining accountability.
🗨️ Delegation in nursing is the transfer of responsibility for the performance of a task from a licensed nurse (RN) to a competent individual, while the nurse retains accountability for the outcome.
📌 It is not giving away responsibility, but assigning tasks within scope of practice.
| 🔢 Right | 📘 Explanation |
|---|---|
| 1️⃣ Right Task | Appropriate task for delegation (e.g., vital signs, hygiene) |
| 2️⃣ Right Circumstance | Patient condition must be stable & safe for delegation |
| 3️⃣ Right Person | Delegate to someone competent, trained, and permitted (e.g., ANM, GNM, or Nursing Assistant) |
| 4️⃣ Right Direction/Communication | Clear instructions with expected outcomes and timelines |
| 5️⃣ Right Supervision/Evaluation | RN must monitor, guide, and evaluate performance & outcomes |
➡️ High delegation model
🟡 Tasks (meds, hygiene, wound care) are assigned to different staff
🟢 Requires clear direction and supervision
🛑 Risk: Fragmentation if communication is poor
➡️ Balanced delegation under team leader (RN)
📋 RN delegates according to each team member’s scope & skills
✅ Effective teamwork and communication required
🛑 Leader RN must ensure quality & reassess outcomes
➡️ Limited delegation
🔹 Primary RN has full responsibility for planning care
🔸 May delegate routine care to associates
🔍 Maintains strong accountability
➡️ Delegation within the assigned module
👩⚕️ RN leads care in a physical zone with 1–2 aides
✅ Ensures better supervision due to proximity
🛑 Must balance load across modules
➡️ Minimal to no delegation
👩⚕️ RN provides all care — full accountability retained
✅ Best for critical care, ICU
🛑 Requires high nurse-patient ratio
➡️ No direct care — only coordination and supervision
🧠 RN case manager delegates tasks via interprofessional teams
✅ Coordinates home care, follow-ups, and discharge planning
| 🧍 Role | ✅ Can Be Delegated | ❌ Cannot Be Delegated |
|---|---|---|
| 🧑⚕️ GNM/ANM | Vitals, bathing, feeding, catheter care | Care planning, medication titration |
| 🧹 Nursing Assistant | Bed making, hygiene, ambulation | Assessment, education, IV medications |
| 👩⚕️ RN to LPN | Dressing change, oral meds, wound care | Initial assessment, unstable patients |
🛡️ The RN remains legally and ethically accountable for the delegated task
📋 Documentation must include what was delegated, to whom, and outcome evaluation
✅ Q: What is the first right of delegation?
🅰️ Right Task
✅ Q: Who retains accountability after delegation?
🅰️ The Registered Nurse (RN)
✅ Q: In which nursing modality is delegation highest?
🅰️ Functional Nursing
✅ Q: What cannot be delegated to a Nursing Assistant?
🅰️ Nursing assessment or IV medication administration
✅ Q: What is the purpose of delegation in team nursing?
🅰️ To share workload effectively based on team members’ skill sets