Supervision & Follow-Up After Delegation

Delegation transfers a task, not accountability. The RN who delegates remains legally and professionally responsible for the client outcome, which makes supervision and follow-up non-negotiable. Supervision exists on a spectrum: direct supervision means the RN is physically present or immediately available during task performance; indirect supervision means the RN provides direction and checks results afterward but is not present during the task. The level required depends on the task complexity, the delegate's competency, and the client's stability. Follow-up has a clear structure: you verify the task was completed, evaluate the client's response to the intervention, and compare findings against expected outcomes. If the outcome deviates from what was expected — a blood pressure remains elevated after repositioning, a blood glucose stays critically low after juice — the RN must intervene, not re-delegate. Documentation of supervision includes what was delegated, to whom, the follow-up findings, and any corrective actions taken. Failure to follow up is the most commonly tested delegation error on NCLEX because it represents a breach of the standard of care even when the initial delegation was appropriate.