Can Someone Help Me Understand Delegation

[mollysn]

I am a nursing student graduating next Dec. and I am an aide as well. The BON came to our ethics class and talked briefly about delegation. In the booklet it explains there is a process for delegation that includes 5 Rights for delegation which are

1. Right Task

2. Right Person

3. Right Direction/communication

4. Right Supervision

5. Right Circumstances

So this is what I am not understanding. Since the aide and lpn and rn have individual job responsiblities the RN does not actually individually and personally chose to delegate tasks... that is just the aide or lpn's job. And where I work the RN has an lpn that takes half of her/his patients and the will have several different aides because aides are not teamed per nurse.

So the delegation just automatically happens because the lpn or aides job. The nurse does not actually get to chose what tasks are delegated to which person-- so what happens when you have to work with an aide who does not do his/her job. What happens when something goes wrong, everyone makes mistakes. The BON assumes you went through the delegation process concerning your liscense and supervision. And if your really busy do you have time to supervise and communciate with your aides and lpn's? How do you keep track of everyone when you have several different aides?

Have I got this all mixed up?

Thanks in advance!

[suzanne4, RN]

Only RNs can delegate, this is per the BON. An LPN can request that a CNA help them or to do what-ever for them, but they cannot legally delegate.

To make it easier to understand, you are the CEO of your company, you are going to be delegating some things to others to do for you, but you are still ultimately responsible for what they do, they are acting on your behalf. Same thing actually occurs when a nurse gets floated to a unit that he or she is not familiar with or has the skills for, such as having another nurse read their telemetry strips. If a problem were to occur, the nurse that assigned to the patient is ultimately responsible.

There are specifics as to what only an RN can do, what requires at least an LPN license to do, and what can be delegated to the CNA to do for you.

Another thing that you may find interesting, CNAs are actually supposed to report to the RN that they are working under and get their report from them, and not the CNA that they are following. At least in CA, it is under the BON specifics. Per the law here, if a CNA is assigned to do a glucose check, and they are unable to do so at that time, for whatever reason, they are supposed to notify the RN, not just ask another CNA to do it for them.

Hope that this helps clear up something for you.

[SFCardiacRN]

This is part of the "critical thinking" process that separates an RN from others in the health care team. We do not have to verbally direct every task and every person for every circumstance as long as everything is being done correctly. We do supervise and communicate direction when the situation calls for it. Most LPNs, CNAs and Techs know their jobs very well and do not have to be "micro-managed".

[suzanne4, RN]

But from the BON viewpoint, it is still the RN that is doing the delegating of responsibilities, and no one can do it other than the RN per state law, at least in most states. Even though the others know their jobs very well, it is the responsibility of the nurse to know what the LPN can do and cannot do, as well as the CNA per the statutes of the BON of your state.

[1BlessedRN]

But from the BON viewpoint, it is still the RN that is doing the delegating of responsibilities, and no one can do it other than the RN per state law, at least in most states. Even though the others know their jobs very well, it is the responsibility of the nurse to know what the LPN can do and cannot do, as well as the CNA per the statutes of the BON of your state.

I agree somewhat but when I was an LPN I worked as charge nurse in a longterm care facility and I delegated task to CNA's NA's etc..and they was to report to me under any circumstances not each other...but you are correct whenever an RN was present she/he delegated the tasks to LPN's, CNA's, NA's each state has different laws.

[suzanne4, RN]

Delegation is still not the word to use, if you are going according to what the BONs state. It is restricted to RNs only, you will even see questions about that on the NCLEX exam.

You were considered the supervising nurse there, that is different. I know that it is a matter of semantics but to delegate in any state and using that word specifically requires the RN after the name.

Making assignments and being responsible for the shift is still not delegation.

[mollysn]

Thank you all for your responses. It is more clear to me now. Some RN's will give you report even when you have gotten report from the other CNA. It seems like so much to be responsible for thank god there are so many wonderful lpn's and cna's who do their jobs remarkably.