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What is delegation?
Delegation is a process by which a health care professional who has legal authority to perform a controlled act transfers that authority to an unauthorized person.
There are 14 controlled acts in the Regulated Health Professions Act, 1991 (RHPA). By definition, a controlled act can cause harm if it is performed by an individual who is not competent. To learn more about controlled acts, see RHPA: Scope of Practice, Controlled Acts Model.
What are some common examples of delegation?
A nurse who works in the community can delegate the administration of heparin by injection to an unregulated care provider who is providing care in the patient’s home. In this example, the nurse is delegating the controlled act of “administering a substance by injection.”
In another example, a nurse who provides home care to a patient requiring dressing changes for a wound extending below the dermis can delegate the controlled act to the patient’s spouse. In this instance, the nurse is delegating the controlled act of “performing a procedure below the dermis.”
Also, a nurse may accept the authority to defibrillate through delegation from a physician. Defibrillation falls under the controlled act of “applying a form of energy."
What do I need to know about the delegation regulation?
The regulation sets out the:
- categories and classes of nurses who can delegate (for example, RNs and RPNs in the general class and NPs)
- requirements to delegate and to accept delegation (for example, considering the best interests of the client), and
- requirements for documenting the delegation.
Nurses can only delegate controlled acts that they are trained or competent to perform. The regulation also prohibits delegating certain controlled acts (for example, NPs cannot delegate setting a fracture).
Sub-delegation is prohibited. Sub-delegation occurs when an individual who accepts a delegation then delegates the same act to another person. This is not allowed because the individual who is sub-delegating does not have legal authority to perform the act.
Where can I find the requirements for delegating or accepting delegation?
CNO’s Authorizing Mechanisms practice guidelinelists the 10 requirements nurses must meet when delegating to others. It also lists the 7 requirements nurses must meet when accepting delegation.
How do orders and delegation differ?
Delegation and orders are two different authorities.
Delegation provides the legal authority to perform a controlled act. An order outlines how to perform that controlled act.
Refer to CNO’s Authorizing Mechanisms to learn more about orders.
If a nurse receives an order for a controlled act procedure that they already have authority to perform through the Nursing Act, 1991 (for example, the administration of a substance by injection), the nurse does not need delegation.
If the nurse receives an order for a controlled act procedure for which they are not authorized to perform (for example, managing a labour or conducting the delivery of a baby), then the nurse needs delegation from an authorized individual, such as a physician, as well as an order for the procedure.
Can someone who does not have authority to delegate a controlled act teach a nurse how to perform the procedure?
Yes. Teaching may be part of the delegation process but it is not equivalent to delegating.
For example, a nurse educator with the appropriate knowledge, skill, and judgement may teach a group of nurses how to adjust a pacemaker. Following the education session, the nurses will have the competence but they will not have the authority to perform the controlled act until it is delegated by an authorized practitioner, such as a physician.
A number of requirements need to be met to ensure the delegated procedure is performed safely. One of the requirements is being satisfied that the delegatee has the knowledge, skill and judgment. One of the ways to ensure this is through teaching.
Who can delegate, which acts can be delegated and who can accept delegation?
RNs and RPNs can delegate and accept delegation if they are registered in the General, Extended or Emergency Assignment Class. RNs and RPNs cannot delegate the controlled act of dispensing a drug or treating, by means of psychotherapy technique.
NPs cannot delegate the following controlled acts:
- prescribing, dispensing, selling or compounding medication
- ordering the application of a form of energy
- setting a fracture or joint dislocation
- treating by means of psychotherapy technique
Nurses in the Temporary Class cannot delegate or accept delegation. Nurses in the Special Assignment Class cannot delegate the authority to perform controlled acts to others, but may accept delegation.
Nurses are accountable for ensuring that delegation is supported by setting specific legislation, for example Fixing Long-Term Care Homes Act or your employer policies.