Assignment vs. Delegation

[SHarbi]

I have a quick question regarding assignments vs. delegation to LPNs.

I understand that delegation is the transfer of responsibility for a certain task but that accountability remains with the delegator. Assignment is the transfer of both responsibility and accountability among RNs (per my book). My book does not address assigning in regards to LPNs.

So my question is, can an RN assign an LPN to complete an aspect of patient care and, if so, is accountability transferred to the LPN as well as responsibility?

[AliNajaCat]

Short answers, an RN can assign pt care to an LPN or CNA. On an administrative level, and LPN can assign an RN, too. Delegation is different. My emphasis below. Suggest you go to the links and read them both, which might help.

Caveat, this is from MA. Your state probably has similar resources at your DPH website; they are likely to be very similar if not identical, but others may respond c different info.

From my state BoN regs:

Five Rights of Delegation

and

The Licensed Practical Nurse in the Charge or Supervisor Nurse Role

Advisory:

It is within LPN scope of practice to function in the charge or supervisor nurse role. This role may include, but is not limited to: making patient care assignments; creating schedules; contributing to personnel evaluations; budgetary management; and educating others to organizational policy and procedure. To make a patient care assignment” means to appoint or designate a Registered Nurse (RN), LPN or unlicensed person (UP) the responsibility to implement an established nursing care planfor a designated group of patients for a designated period of work time. The patient care assignment must be consistent with the assignee's scope of practice and/or competency, the assignee's job description, and the employing agency's policies. The job description of charge nurse or supervisor must include the duties and responsibilities of its administrative role. The charge nurse or supervisor directs nursing service personnel to comply with the organization's policies and procedures.

The non-clinical, administrative functions of the supervisor or charge nurse roles, such as making a patient care assignment, differs from the clinical function of delegation (see Table 1).

Table 1

[TABLE=width: 680]

[TR]

[TD=width: 151] [/TD]

[TD=width: 276]Making a Patient Care Assignment[/TD]

[TD=width: 253]Delegation[/TD]

[/TR]

[TR]

[TD=width: 151]Definition[/TD]

[TD=width: 276]Distribution of work that each RN, LPN or UP is responsible for during a given period of work time[1][/TD]

[TD=width: 253]The authorization by a licensed nurse to a UP to provide selected nursing services[2][/TD]

[/TR]

[TR]

[TD=width: 151]Who may initiate[/TD]

[TD=width: 276]RN or LPN[/TD]

[TD=width: 253]RN or LPN[/TD]

[/TR]

[TR]

[TD=width: 151]Who is recipient[/TD]

[TD=width: 276]RN, LPN or UP[/TD]

[TD=width: 253]UP[/TD]

[/TR]

[TR]

[TD=width: 151]Functional area[/TD]

[TD=width: 276]Administrative[/TD]

[TD=width: 253]Clinical[/TD]

[/TR]

[/TABLE]

Delegation is the authorization by a RN or LPN to an UP to provide selected nursing activities. The licensed nurse retains responsibility and accountability for these delegated activities. Neither LPNs nor RNs delegate nursing activities to other licensed nurses. (my emphasis)

All nurses are responsible and accountable for their individual clinical assessments (determining care needs based on data), nursing judgments (reaching a clinical decision based upon analysis of the evidence or data), performance of nursing activities, and competency[3]. Respectful collaboration is encouraged to coordinate nursing services, ensuring that the patient's total plan of care is maintained.

The job description of charge nurse or supervisor must include the duties and responsibilities of its administrative role.

Concurrent with administrative duties and responsibilities, the LPN in the charge or supervisor role may also provide nursing care to a designated group of patients for a designated period of work time.

Determining supervision for purposes of administrative oversight is an employer prerogative and not within the authority of the Board.

---

[1] Adapted from the American Nurses Association and the National Council of State Boards of Nursing Joint Statement on Delegation

[2] 244 CMR 3.05(1)

[3] the application of knowledge and the use of affective, cognitive, and psychomotor skills required for the role of a nurse licensed by the Board and for the delivery of safe nursing care in accordance with accepted standards of practice – 244 CMR 9.02 Competency