Nurse Reporter Summer 2007 - Wyoming State Board of Nursing

The Meaning of DelegationIn the last issue of The Reporter, anarticle proposed expanding the role ofthe certified nursing assistant/nurse aideto include more advanced skills. Thistopic is being considered because of the nursing shortage andthe need to have an assistant for the licensed nurse, so thatmore time can be spent performing those responsibilities thatrequire the education of a licensed practical nurse or a registerednurse. It is a known fact that each level of care provider,registered nurse, licensed practical nurse, or certified nursingassistant completes a specified curriculum. The new level ofcertified nursing assistant/nurse aide would complete a new curriculumthat is now being developed for approval, just as thecurrent certified nursing assistant/nurse aide completes anapproved curriculum. All levels of care providers completetheir education in an educational institution (or a healthcarefacility for a Nurse Aide Training and Competency Evaluationprogram) and practice within the scope of practice or scope offunctions for a certified nursing assistant determined by theWyoming State Board of Nursing. In reality, it is the registerednurse (RN) that holds the responsibility and accountability forthe provision of nursing care, regardless of who performs thenursing function. However, the RN may delegate componentsof care.The American Nurses Association and the NationalCouncil of State Boards of Nursing have clearly stated thatdecisions related to delegation are based on the fundamentalprinciples of protection of the health, safety, and welfare of thepublic. The RN is the one responsible and accountable for theprovision of nursing practice. Direction of care is made by theRN, and the RN determines the appropriate utilization of anyassistant involved. The nursing process, commonly brokendown into assessment, nursing diagnosis, implementation, andevaluation, requires nursing judgment that precludes delegation.These functions cannot be delegated. It is components ofcare that may be delegated based upon the RN’s judgment ofthe condition of the patient, competence of those members onthe nursing team, and the degree of supervision that will berequired of the RN if a task is delegated. Before delegation canoccur, the RN must know the level of training the nursing assistant/nurseaide has, the cultural competence, and experience.The nursing assistant/nurse aide must be able to articulate backto the RN what expectation the RN has for the performance ofa task and must be willing to accept the responsibility for completingthe task. Communication must be an open channelgoing both directions so that explanations can be given andquestions asked. A task or function that has been delegated bythe licensed nurse to a certified nursing assistant cannot be redelegatedto another by the certified nursing assistant.The RN applies five Rights of Delegation. These are theright task, under the right circumstance, to the right person,with the right directions and communication, and under theright supervision and evaluation. Professional judgment andcritical thinking are the essence of making the process of delegationlead to efficiency and the best utilization of members ofthe nursing team. The RN remains accountable for the nursingcare to ensure patient safety; decision to delegate; verificationof the delegatee’s competency to perform the tasks; providingdirection; performance of the delegated task; and evaluation ofthe effectiveness of the delegated nursing task or interventionsperformed.In order for delegation to work, there must be standards onwhich to base the concept of delegation. The first standard isthat the RN must assess the needs and condition of the patient,potential for harm, stability of the patient’s condition, complexityof the task, predictability of the outcomes, ability of the staffto whom the task is delegated, and the context of other patientneeds.Administration must understand and abide by the principlethat nursing assistants/nurse aides may complement theRN/LPN in performing nursing functions, but not substitute forthe licensed personnel. The delegating nurse shall be readilyavailable either in person or by telecommunication. One of thegoals of increasing the skills of a Level II certified nursing assistant/nurseaide is to increase the one-on-one time of theRN/LPN and patient. The assessment, nursing diagnosis, planning,implementation, and evaluation that only the RN can dorequires time that might be made available if those tasks thatcan be properly and safely performed by the nursingassistant/nurse aide are delegated. Licensed personnel and nursingassistants/nurse aides should work as a team, within theirscope of practice, to give the highest level of patient care forthe protection of the health, safety, and welfare of the public.W Y O M I N G N U R S E R E P O R T E R 15