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.
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.
Delegation Overview RN’s (Registered Nurses) LPN’s (Licensed Practical Nurses) UAP’s (Unlicensed Assistive Personnel)
RN’s (Registered Nurses)
It is within an RN’s scope of practice to:
Tasks that an RN may, therefore, perform include the ability to:
LPN’s (Licensed Practical Nurses)
It is within an LPN’s scope of practice to:
Tasks that an LPN may, therefore, perform include the ability to:
With further education and certification only, LPN’s may administer:
It is not within an LPN’s scope of practice to:
UAP’s (Unlicensed Assistive Personnel)
It is within a UAP’s scope of practice to:
It is not within a UAP’s scope of practice to: