please explain delegation to me?

An RN can delegate the task but the responsibility for the task remains with the RN. So if you delegate a bath and the bath is not done or done correctly, yes, it does come back to you. A CNA carries a certification that requires they perform the work the way they were taught. Failure to do this comes back to their certification.

In Texas only RN's may delegate. RN's may never delegate their own responsibilties (duties requiring RN scope of practice). RN's may not "assign" to non-licensed people and CNA's cannot give meds (at least not in acute care). In delegation the RN maintains full responsibility for the outcome. That means the RN must know what the unlicensed person is capable of doing, then expect to give clear instructions and get clear feedback. Cannot have CNA check blood sugar and hope the CNA knows enough to tell you if it is out of range. If you go to the Texas BON website there is an algorithim on delegation. May not help if your NPA differs, but worth a try. www.bon.state.tx.us

Excellent comment. Indeed, in Oregon there is a specific section in our nursing rules, Division 47, that covers Delegation. Other intricacies include that the RN must individually observe the staff's performance, within 60 days of the initial delegation and no more than 180 days thereafter. And the BoN is very clear that the observation must be done individually for each task performance. So, for example, if in an ALF and the delegated staff is doing insulin on a dozen folks, the RN must observe each one. Now, CBG can be trained, so it does not require as intensive a supervision process. Indeed, for task performance, the BoN has told me that when delegating for G-tube medication administration the RN must observe the actual med being administered; using a placebo or water is not acceptable.