NURS 489 Week 5 Nursing Peer Interviews Example

Nursing Peer Interviews: How Well Do Three Virginia Nurses Know the State's Delegation Rules, and How Is Delegation Handled on Their Unit?

What the Rules Require

I hold a Virginia nursing license, so I reviewed the delegation provisions in the Virginia Board of Nursing's regulations governing the practice of nursing (Virginia Board of Nursing, n.d.). They permit a registered nurse to delegate certain tasks to an appropriately trained unlicensed person, but only after the nurse has assessed the patient and judged the delegation safe, and they keep the registered nurse accountable for the delegation decision and for supervising and evaluating the outcome. Work that depends on a nurse's judgment stays with the nurse: the regulations do not allow assessment, care planning or evaluation of a patient's response to be handed to an assistant. The national guidelines published by the NCSBN (2016) agree and give nurses a practical test before any handoff: is this the proper task, given these circumstances, to a person able to do it, with clear directions, and can I supervise and evaluate the result? The guidelines also place responsibility on the employer, which must provide policies, training and a culture in which delegation can be done safely, so a weak delegation process is never only an individual nurse's failure.

Method

I interviewed three registered nurses on my medical-surgical unit during breaks, each for about ten minutes, after explaining the assignment and promising not to use names. I asked four questions: What do you know about Virginia's rules on delegation? Which tasks may you not delegate? How do you decide what to delegate to a nursing assistant? How does delegation work on our unit, and what goes wrong?

Findings

The new graduate, eleven months into practice, remembered "the five rights" from school but could not name any Virginia rule. She delegates vital signs, bathing and ambulation and said she often feels uncomfortable directing assistants who are older and more experienced than she is.

The nurse with eight years' experience knew that assessment could not be delegated and that she remained responsible for the patient. She described delegation on our unit as "mostly automatic": assistants do vitals, baths and intake and output for their assigned patients, and nurses rarely give specific instructions.

The twenty-year veteran knew the most about the rules in general, having served on a policy committee, but said she had never read the Board's regulations herself. She worries that assistants are not told which patients are unstable and that abnormal vital signs sometimes sit in the computer for an hour before a nurse sees them.

Across all three, knowledge of the specific state rules was limited, though all understood that nurses stay accountable and cannot delegate assessment. Delegation on the unit depends on routine rather than on deliberate decisions, and communication with assistants, especially about which patients are unstable and which values must be reported right away, is the weakest link.

Discussion

These findings mirror recent research. In a scoping review of RN and nursing assistant teamwork in acute care, Wong et al. (2025) found that teamwork rested on clear roles, sound delegation, good communication, the culture of the ward and working relationships, and that leaving assistants out of handover weakened shared goals for patient care. Moradi et al. (2024) interviewed nurses who described delegation as a double-edged sword for the quality of care, helpful when done well and a source of risk when tasks are handed to people without the needed preparation or oversight. Polancich et al. (2025) found that a care delivery model supported by teamwork and delegation training improved several measures of missed care and teamwork on a medical-surgical unit. Our unit's habit of "automatic" delegation without specific directions falls short of the right directions and supervision that the guidelines require.

Biblical Principles

Delegation is a form of stewardship. In the parable of the talents, servants were entrusted with their master's resources and later asked to give an account (English Standard Version Bible, 2001/2016, Matthew 25:14-30). A nurse who delegates entrusts part of a patient's care to another person but still answers for it. That accountability calls for clear direction, trust in the assistant's abilities and humble follow-up, not suspicion or neglect. Scripture also asks believers to do every task wholeheartedly, as service rendered to the Lord rather than to an earthly employer (English Standard Version Bible, 2001/2016, Colossians 3:23). Applied to delegation, that verse speaks to both sides of the handoff: the assistant who takes vital signs carefully even when no one checks, and the nurse who gives directions carefully even when she is busy. A unit where both take that seriously would need fewer rules, because each person would treat the patient's care as a trust rather than a chore.

Recommendations

I will propose three changes to our unit council: include nursing assistants in the start-of-shift huddle so they know which patients are unstable, post a short list of values that assistants must report immediately and offer a brief review of Virginia's delegation rules at a staff meeting. As a charge nurse, I will also give specific directions when I delegate rather than assuming. For example, instead of asking an assistant to "do the 4 a.m. vitals," I will name the two patients whose blood pressure must be reported to me right away if it falls below a set value. Finally, I will ask the assistants themselves what gets in the way of reporting, since the interviews captured only the nurses' side of delegation, and the assistants may see problems that none of the three nurses mentioned. Delegation that runs on habit is delegation no one is actually supervising.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Moradi, T., Rezaei, M., & Alavi, N. M. (2024). Delegating care as a double-edged sword for quality of nursing care: A qualitative study. BMC Health Services Research, 24(1), 592. https://doi.org/10.1186/s12913-024-11054-4

NCSBN. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3

Polancich, S., Dick, T., Ledlow, J., White-Williams, C., Chambers, A., Thomas, K., Poe, T., & Miltner, R. (2025). Implementing a care-based nursing workforce model: Implications for missed care, teamwork, and satisfaction. Journal of Nursing Care Quality, 40(1), 32-38. https://doi.org/10.1097/NCQ.0000000000000815

Virginia Board of Nursing. (n.d.). Regulations governing the practice of nursing (18VAC90-19). Virginia Department of Health Professions. https://law.lis.virginia.gov/admincode/title18/agency90/chapter19/

Wong, K. L., Chua, W. L., Griffiths, P., Goh, Q. L. P., Low, K. W. C., Tan, J. Q. A., & Liaw, S. Y. (2025). Teamwork between registered nurses and unlicensed assistive personnel in acute care settings: A scoping review. International Journal of Nursing Studies Advances, 8, 100293. https://doi.org/10.1016/j.ijnsa.2025.100293