Delegation and referral in nursing – how to tell the difference
Processes underpin teamwork, authority and professional liability in care delivery
In a recent online lecture, one of my students asked for clarification on the difference between delegating and referring a task.
While on a clinical placement, their manager would sometimes say they were delegating a task to them and sometimes say they were referring a task, causing some confusion about the difference between the two.
Delegation and referral are terms you will become very familiar with as nurses. Both are processes that are used to share the delivery of care between team members, and although there are similarities between them, there are also differences.
Delegation in nursing practice
The term delegation is used when one
Processes underpin teamwork, authority and professional liability in care delivery
In a recent online lecture, one of my students asked for clarification on the difference between delegating and referring a task.
While on a clinical placement, their manager would sometimes say they were delegating a task to them and sometimes say they were referring a task, causing some confusion about the difference between the two.
Delegation and referral are terms you will become very familiar with as nurses. Both are processes that are used to share the delivery of care between team members, and although there are similarities between them, there are also differences.
Delegation in nursing practice
The term delegation is used when one nurse wants another to take on a role or task. If a registered nurse assigns a task to a healthcare support worker or nursing student, for example, this would be a form of delegation.
The registered nurse would expect the person to whom they have delegated the task to undertake it in an appropriate manner, reporting back to them if there are any problems and when the task has been completed.
‘The main difference between delegation and referral is liability: who has the liability for the task being delegated or referred?’
Delegation is usually from a person who has authority to another person over whom they have some form of authority. This could be line management or hierarchal authority, such as a registered nurse delegating a task to a nursing student.
Although delegation does not require any form of direct supervision, this may occur under certain circumstances. A registered nurse in charge of a shift asking a nursing student to manage a bay of four patients, for example, is a form of delegation that requires supervision.
Referral – widening professional input in care delivery
Referral is similar to delegation in that one person asks another to take on an aspect of a patient’s care. The difference is that the nurse making the referral is asking the other person to take over the care or to consult on an aspect of care.
Generally, this would be where a nurse asks a colleague to provide specific input, such as a nurse asking a tissue viability nurse specialist to provide input for a patent’s wound that is not healing or referring the patient to an outpatient tissue viability service.
Referrals can be made between practitioners of equal standing or from someone lower down in a hierarchy. For example, under guidance from your practice supervisors or assessor, you could refer a patient to a physiotherapist or occupational therapist for their specialist input into the patient’s care.
A question of liability
With both delegation and referral, the person making the request must ensure they have made it to an appropriate person who is able adequately to take it on. The main difference between delegation and referral is liability: who has the liability for the task being delegated or referred?
Referring a task to another practitioner means the liability for that task is referred as well. The person who has the task referred to them takes on the lability for it, with the referrer relinquishing liability once the task is accepted by the other practitioner.
In delegation, liability is retained by the nurse who delegates the task, but the practitioner who is delegated to also accepts liability for competent completion of that task.
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