Which principle guides ethical delegation when patient safety is at risk?

• A. The nurse retains accountability for the overall outcomes; delegation is appropriate but must ensure safety and competency
• B. The delegatee is fully responsible for outcomes
• C. Patient safety is delegated
• D. No accountability after delegation

Answer: (A)

When patient safety is at risk, the essential idea is that the nurse who delegates remains accountable for the overall outcomes and must ensure the person taking on the task is competent and properly supervised. Delegation is appropriate only if the delegatee has the necessary training and skills, the task is within the delegatee’s scope, and there is a plan for monitoring, communication, and intervention if safety concerns arise. This keeps patient safety as a shared but clearly governed responsibility, with the delegating nurse maintaining the ultimate responsibility for ensuring safe, effective care.

The notion that the delegatee would bear complete responsibility is not accurate, because accountability in nursing practice does not transfer entirely. Similarly, the idea that patient safety itself can be delegated away is incorrect, since safety remains a professional responsibility of the caregiver and the supervising nurse. Finally, there is not a scenario in which there is no accountability after delegation; accountability continues for the delegating nurse to ensure safe outcomes.