Delegate, assign, supervise: three verbs, one accountability
Three horizontal lanes, each with an RN node and a receiver node; in the delegate lane a task token crosses while a dashed accountability loop stays anchored to the RN, in the assign lane both a task and partial accountability cross while a dashed loop labeled MATCH stays behind, and in the supervise lane nothing crosses at all, only an arc out and back with tick marks reading direct, monitor, evaluate.
THREE VERBS, ONE ACCOUNTABILITY
This is a vocabulary problem with a licensure consequence. The exam uses these three words precisely, and the same clinical situation produces three different correct answers depending on which one appears in the stem.
| DELEGATE | ASSIGN | SUPERVISE | |
|---|---|---|---|
| What moves | One specific task, for one specific patient, in one specific situation | Work already inside the receiver's role, for a shift | Nothing moves |
| To whom | A person whose role does not otherwise include this task | A person whose job description already includes this work | The person who received the task or the assignment |
| What stays with the RN | Accountability for the outcome and for the decision to delegate | Accountability for the appropriateness of the match | Everything, because this is the RN's own act |
| How it ends | With evaluation of the result | At handoff | Only when the shift ends |
| The stem word | ask the assistive personnel to | which client should be assigned to | the nurse observes the assistive personnel |
One situation, three questions
A patient two days after hip arthroplasty who walked once yesterday is due for a hallway walk.
- Delegation question: the nurse asks the assistive personnel to ambulate the client. The right answer turns on whether this particular walk is routine and predictable and whether this particular person has done it here before.
- Assignment question: which client should be assigned to the LPN/LVN. The right answer turns on whether the whole patient is stable with a predictable course, not on the walk.
- Supervision question: the assistive personnel reports that the client became short of breath and sat down. The right answer is an action by the RN, because supervision is the RN's own work and the report has just changed the patient.
Memory hook: THE RN NEVER HANDS OFF THE JUDGMENT, ONLY THE HANDS.
Watch outseveral states define assignment differently from the wording above, and some use delegation to cover both acts. Scope of practice is set by your state Nurse Practice Act and by facility policy, and the Nurse Practice Act supersedes this table.
Takeawayyou can move a task and you can move a shift's work, but you can never move the accountability for having chosen correctly.
→ BOOK 01 · P20 for the one-page version of this distinction.