What can I delegate?

There are several resources that you can use to determine this. First of all, you need the job descriptions for the people who work under you along with your own. Find out if your facility has a specific policy regarding delegation. Second, your board rules will usually give you some information regarding what can be delegated. Third, there are certain things that you can delegate with approval of your institution such as blood glucose testing if your hospital has a plan and program in place to teach CNA's how to do this procedure and how to check them off. LPN's are a bit different and part of what they can do is determined by your hospital policy. As a general rule however, CNA's cannot insert or pull any kind of tube or line under any circumstances, give or regulate any medications, IV's or blood, or perform any invasive procedures. LPN's usually cannot start IV's and can usually not hang blood. They may not be able to do an admit assessment and may not be able to administer IV medications. When in doubt, don't delegate it. And it does not matter if they did it in their last job or not. That does not mean that can do it in their current job. If you deligate something to someone who does not know how to do it and they do it wrong YOU will be held accountable for their actions, even if they told you they knew how to do the procedure. It is a very delicate area and I urge you to make sure you get this clarified from your hospital/ manager/ risk manager. Good Luck.

probably will not find specifics. Delegation requires professional nursing judgement, which can vary with the situation and with the person to whom you are delegating. There is a decision tree on the Texas NPA. Just search for it at www.tbon.state.tx.us

We don't have CNAs all the time, but when we do, we can delegate:

Collecting/running urine

Vitals

Applying the EFM

Getting a pt up/ambulating

And that's really about all we delegate.

I agree that this is a delicate issue. Where I worked as a CNA, after 6 months of employment, we were eligible to be trained to draw blood and d/c IVs and foleys. Prior to this we could only do ADLs, empty drains, and perform Accuchecks, hemoccults and gastroccults (which we had been trained to do upon hire). Some hospitals in my area trained all CNAs during orientation to draw blood, while others would only allow CNAs to do ADLs and empty catheters, no matter what their experience may be. I think it depends greatly on your facility and what your assistants have been taught during orientation. The best person to talk to would probably be your supervisor.

You cannot delegate any assessment. Putting on a fetal monitor includes assessing the strip, so do that yourself.

Your hospital should have job descriptions of what kind of things can be done by the various levels of personnel. In my current hospital, the P&P manual has a list of who (RN,LPN, Tech1, Tech 2, etc) can perform each procedure listed. There is also a job description for each level that lists what things they can do.

Hmmm...very hospital specific. For instance, at my facility, LPNs CAN start IVs, and even give some select IVP meds. LPNs can not work Newborn Nursery (but can do Mother/Baby...what? I don't get it...but there you go) or Labor. We don't have Techs, but when we had dedicated OB Scrub techs, they could place foleys, clipper prep pts for the OR, dc iv locks, draw any labs not from an existing line, and do our stocking/ordering/charges.

Sorry it's not more cut-and-dried, but when in doubt, don't covers it. OB is way too litigation prone to lose it because of one too many delegated tasks.

HTH

T