What do nurse managers delegate to RN and UAP?

Been there,done that, ASN, RN · Sep 19, 2020

Hello, welcome to allnurses. What is a UAP?

Long Term Care Columnist / Guide · Sep 19, 2020

Unlicensed Assistive Personnel

chare · Sep 19, 2020

1 hour ago, Been there,done that said:

Hello, welcome to allnurses. What is a UAP?

Unlicensed assistive personnel.

4 hours ago, beccasto01 said:

[...]

What are some examples of a typical nurse manager delegation to another staff RN and a nurse manager to an UAP?

Thank you so much for helping.

Why don't you start by telling us what you think?

JKL33 · Sep 19, 2020

Start by asking yourself what duties are involved in the nurse manager role. What types of things are they responsible for? Are there any of these responsibilities that are carried out (or assisted by) other roles, such as the staff nurse role?

Look forward to your answers.

beccasto01, ADN · Sep 19, 2020

Honestly not sure. The text book and my online search didn't provide any examples of nurse manager specific delegation.

All I have so far is what I've seen nurse managers do in my limited time as a nurse. So I used the examples of a nurse manager delegated mentorship of new RNs to another RN or charge nurse on the unit and a nurse manager delegating to one UAP (unlicensed assistive personnel) to pick up another UAP bed baths assignment due to unforeseen circumstances.

Are these good examples of delegations nurse managers actually do?

Thank you for your response and continued help on this.

JKL33 · Sep 19, 2020

Yes, you're definitely on the right track especially with your first example! Your second example is okay-ish but it is a delegation that would be more likely to be made by a charge nurse, staff nurse or even as a simple teamwork decision made by the UAPs themselves. It doesn't usually require management involvement.

The second part, delegation by NM directly to UAP is a little more difficult and is more easily understood with experience seeing the kinds of duties UAPs do. Much of what they do is considered (at least formally) as being delegated by the RN caring for a particular patient. For example, if they bathe Mrs. Smith or check Mrs. Smith's blood sugar, that is an action formally considered to be done under the delegation of Mrs. Smith's RN (even if it wasn't spoken as an individual directives such as "please give Mrs. Smith a bath" or "Would you please check Mrs. Smith's blood sugar before lunch?")

Besides the direct care of this patient or that patient, there are numerous duties that must get done in order to keep a nursing unit functioning, and the NM doesn't perform all of these him/herself, and neither do the nurses (although they may and often do)...can you think of some of these?

beccasto01, ADN · Sep 19, 2020

Thank you glad to know I am on the right track with the first example.

The second example is what I have struggled with the most. As a new RN on the floor most of my time with UAPs was delegating to them directly patient care within their scope, ie vital signs, bed baths, showers, sitting the patient up in the chair, meals etc. But this is staff RN to UAP delegation. Not nurse manager to UAP delegation.

I still am not really sure what a nurse manager would delegate directly to a UAP without first going through another RN? Many nurse manager roles cannot be done by a UAP because they involve critical thinking which is outside UAP scope, so I am at a loss.

I only know UAP roles in relation to patient care. Could you tell me what other roles it is you speak of?

Thank you so much.

JKL33 · Sep 19, 2020

I understand why this part is trickier.

Any direct care that is performed by the UAP should be understood to have been delegated by the RN present at the point of care, not the NM. For this reason I believe that the answers to your question must include duties and tasks performed by the UAP that are not really patient-specific. These are the kinds of things that are more likely to be considered as delegated by management and not individual RNs.

Do your UAPs participate in tasks and duties to keep the unit itself running? I bet they do....

I will give you an example and then maybe you can think of more:

Glucometers require QC checks every 24 hrs in a lot of places, in order to ensure that they are functioning properly to be used for assessment of patients' blood glucose levels. I believe it could be said that checking an individual patient's blood glucose is a task that may be delegated to the UAP by the RN. But the task of performing a QC check on the glucometers every morning may be a nursing unit task that is delegated to the unit's UAPs by the nurse manager as a general daily task they are to perform--and the nurse manager retains the responsibility of making sure they are properly educated to do the task, etc.

beccasto01, ADN · Sep 19, 2020

Thank you. I had not thought of this. In our facility the QC Glucometer checks are done by the night nurse LVN/RN staff. Would checking other equipment fall under NM to UAP delegation as well? Such as checking vital sign machines for damages and reporting those damages to the NM?

Thank you.

JKL33 · Sep 19, 2020

Yep.

When I worked as a CNA prior to/during nursing school, the DON delegated to us that all of our wheelchairs must be cleaned and checked for proper function on the night shift, for example. I would consider this a nursing-related task that was delegated by management rather than individual licensed RNs. It was our nightly task as told to us by our NM.

Another example: At some places, UAPs have a standing delegation from the NM to keep rooms stocked with a standard list of supplies. The NM is active in deciding which items will be stocked, and (perhaps in consultation with a committee or just as an individual decision) makes the decision that the UAPs are capable of performing this task and then assigns it to them.

I believe (and hope) that these will be acceptable types of answers to your question, as I have already given my rationale that direct patient care tasks are more appropriately considered to be delegated by the patient's RN and are not a direct delegation from the NM to the UAP.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Sep 19, 2020

1 hour ago, beccasto01 said:

Thank you. I had not thought of this. In our facility the QC Glucometer checks are done by the night nurse LVN/RN staff. Would checking other equipment fall under NM to UAP delegation as well? Such as checking vital sign machines for damages and reporting those damages to the NM?

Thank you.

Policies vary by facility. As an RN, you will find that tasks such as glucometer checks, checking vital signs, etc., are sometimes done by the LPN/LVN/RN because it takes less time to run the checks yourself than to hunt down the UAP and listen to excuses. Some are actually bold enough to say, "by the time you came to me, you could have already done it yourself". I'm just saying...

For the purposes of school, don't let what is done on the job guide your answers on paper. It's not always as adequate reflection. ?