please explain delegation to me?

[esunada]

So RNs can delegate but LPNS can't. However, what is delgation exactly? WHen I think of delegation I think of telling a CNA to give this patient a bath or have them check their glucose or tell them to ambulate them. However, I know LPNS can do that so what do they mean then by LPNS can't delegate? Does delegation refer to less common tasks that CNAs can do like give medication if trained?

Also when are we accountable. Like if a CNA gives the wrong med am I as an RN held accountable even though they were trained on it, can legally pass meds in the state, and were the ones who made the mistake?

[TopazLover, BSN, RN]

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.

[llg, PhD, RN]

I'm not aware of any law that says LPN's can't delegate. That misunderstanding may be the route of your confusion. Delegation is the assignment of tasks to someone when you are in a position of authority or supervision over someone. There are times when an LPN may be supervising someone, and in those situations, an LPN may be able to delegate. It depends on the particular employment situation and the task involved.

[VivaLasViejas, ASN, RN]

In Oregon, only a registered nurse may delegate. It's a formal process that requires documentation and periodic reviews personally conducted by the RN. Usually the delegated task is something like insulin preparation/administration, straight catheterization and certain types of wound care, all of which are beyond the scope of most caregivers/CNAs unless they have been specially trained and supervised in their performance by the delegating nurse.

The paperwork is horrendous, I must say, and I try to limit the number of staff I delegate things to because of that. :icon_roll But in a busy ALF or RCF where there's only one nurse for 40-100 residents or more, there is no other way to ensure that the care is being given.

[classicdame, MSN, EdD]

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

[Larrythenurse]

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.