What are some examples of tasks you might delegate to an unlicensed assistive staff member?

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Delegation Overview
RN’s (Registered Nurses)
LPN’s (Licensed Practical Nurses)
UAP’s (Unlicensed Assistive Personnel)

Definitions

Delegation is defined as the “transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome. Example: the nurse, in delegating an activity to an unlicensed individual, transfers the responsibility for the performance of the activity but retains professional accountability for the overall care” (ANA, 1992). It is the entrusting of a selected nursing task to an individual who is qualified, competent, and able to perform such a task.

The majority of health care institutions have care delivery systems that include various levels of caregivers. The acuity of patients within hospitals has increased during the past 10 years, and many hospitals have moved from total patient care, primary care, and other care delivery systems that require an all–registered nurse staff. To meet the needs of the higher-acuity patients, nurses must delegate aspects of care to non–registered nurse team members. Delegation changes as the health care environment changes. Since the advent of the nursing shortage, unlicensed assistive personnel (UAP) have been used to help fill the workforce gaps. The role of these assistive personnel is defined by the institution that employs them and defines their practice. In addition to UAP, they are called noncredentialed assistive personnel. Individuals hired into these jobs are trained by the facility and by facility personnel and are evaluated by the facility. They may use a variety of titles, such as nursing assistant (NA), patient care associate (PCA), nursing technician, unit technician, and others (Carroll, 1998). They cannot practice nursing, and they must be directed, supervised, and evaluated by a registered nurse, who is ultimately responsible for all patient care (see Box 3-1 for the nurse’s responsibility in delegation). One form of licensed personnel, the licensed practical nurse (LPN), is used by many facilities. The LPN works under the direction and supervision of the registered nurse. Licensed personnel work according to the state board regulations (see Chapter 7), but the job descriptions will vary from institution to institution. Sample job descriptions can be obtained at the websites listed in Table 3-1.

Box 3-1 NURSE’S RESPONSIBILITY IN DELEGATION

Criteria for Delegation

Adapted from State of Kentucky. (1999). Delegation of nursing tasks. KRS 311A.170, 314.011, 201 KAR 20:400. Retrieved July 2, 2007, from www.lrc.state.ky.us/kar/201/020/400.htm.

There are two types of nursing activities that may be delegated: direct patient care activities and indirect patient care activities. Direct patient care activities include activities such as assisting with feeding, grooming, hygienic care, taking vital signs, ambulation, electrocardiogram tracing, and measuring blood sugar levels. Indirect patient care activities are those activities that are routinely done to support the functioning of the patient care unit. Such activities include the restocking of supplies, the transport of patients, and clerical activities.

The National Council of State Boards of Nursing (1997) has defined the Five Rights of Delegation, as follows:

To assist you in reviewing these five rights, Box 3-2 will help you to determine if you are following these rights in your delegation (ANA and NCSBN, 2008).

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Snapshot: This article reviews the scope of practice for different types of nurses and nursing assistants, and tasks that may and may not be delegated to different types of personnel. Delegation is a central feature of contemporary nursing practice, and a key component of professional academic nursing knowledge.

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Delegation Overview RN’s (Registered Nurses) LPN’s (Licensed Practical Nurses) UAP’s (Unlicensed Assistive Personnel)

Delegation Overview

Delegation is the act of transferring responsibility and accountability to another person to carry out a task while maintaining accountability for the action and the outcome.
RN’s must delegate numerous tasks, and delegation is a core nursing responsibility. Nurses most frequently delegate tasks to LPN’s (Licensed Practical Nurses) and to unlicensed assistive personnel (UAP).
In deciding when and what to delegate, RN’s must take a number of factors into account, including the scope of practice required for the task, the complexity and predictability of the task, the potential for harm, and level of critical thinking required to perform the task.
Delegation is important for both practical and academic reasons. It is a core “real world” nursing skill, and it is also a major focus of the NCLEX-RN exam.

RN’s (Registered Nurses)

It is within an RN’s scope of practice to:

Independently assess, monitor and revise the nursing plan of care for patients of any kind
Initiate, administer, and titrate both routine and complex medications
Perform education with patients about the plan of care
Admit, discharge and refer patients to other providers
Delegate appropriate tasks to both LVN’s and UAP’s

Tasks that an RN may, therefore, perform include the ability to:

Initiate and administer blood to a patient
Administer high risk medications, including heparin and chemotherapeutic agents
Give IV medications and medications administered via IV push
Independently monitor and titrate medications
Perform any tasks that may be performed by LVN’s or UAP’s

LPN’s (Licensed Practical Nurses)

It is within an LPN’s scope of practice to:

Assist the RN by performing routine tasks with predictable outcomes
Assist the RN with collecting data and monitoring client findings
Reinforce an RN’s patient teaching, but not perform independent patient education or assessments
Perform any of the tasks that UAP’s (Unlicensed Assistive Personnel) are permitted to perform (see below)
Delegate tasks to UAP’s (Unlicensed Assistive Personnel)

Tasks that an LPN may, therefore, perform include the ability to:

Administer medications that are not high-risk
- For example, LPN’s may administer standard oral medications, but not medications such as heparin or chemotherapeutic agents
- Note: some states do not permit LVN’s to administer intravenous medications of any kind
Administer a nasogastric (NG) tube feeding
Perform wound dressing changes
Monitor blood products
- LPN’s may not, however, initiate the infusion of blood products; only an RN may initiate the infusion
Do tracheostomy care
Perform suctioning
Check nasogastric tube patency
Administer enteral feedings
Insert a urinary catheter

With further education and certification only, LPN’s may administer:

Maintenance IV fluids
IV medications via piggy-back
Monitor infusions of IV fluids

It is not within an LPN’s scope of practice to:

Administer high risk medications of any kind (such as Heparin and chemotherapeutic medications)
Administer IV push medications of any kind
Titrate medications of any kind
Independently provide patient education (about medications, disease processes, etc.)
Perform or chart admissions of patients, or to discharge patients

UAP’s (Unlicensed Assistive Personnel)

It is within a UAP’s scope of practice to:

Assist patients with activities of daily living (ADL’s), including:
- Eating
- Bathing
- Toileting
- Ambulating
Perform routine procedures that do not require clinical assessment or critical thinking, such as:
- Phlebotomy (except for arterial punctures)
- Take vital signs
- Monitor intake and output (of food and drink, urine, etc.)

It is not within a UAP’s scope of practice to:

Perform assessments
Delegate tasks
Perform patient education
Perform tasks that require clinical expertise, including ‘routine’ tasks such as:
- Administering medications
- Administering tube feedings
- Performing wound care or dressing changes