When delegating what is safe?

[vfahnholz]

1) In my employment setting, RNs are receiving increasing pressure to delegate tasks to unskilled unlicensed assistive personnel who have minimal competency. The employer has written policy about delegation and delegation duties are included in the RNs job descriptions. When RNs choose not to delegate, they are asked to justify why they do not want to delegate tasks to the unlicensed assistive personnel. Can employers force RNs to delegate?

2) What is the RN's responsibility when s/he supervises unlicensed assistive personnel, and the physician is delegating to the unlicensed assistive personnel? May a RN delegate to and from another agency with which you do not have supervisory authority?

[JaneyW]

What is it you are being asked to delegate? It is an RN function to delegate tasks that are within others' scope and competence. I do it all of the time. You cannot delegate RN duties like assessment.

[suzanne4, RN]

If you have an agency CNA on your unit you have supervisory control, the same way that you do with those that are on staff. They are there to function under the supervision of an RN.

[vfahnholz]

Some facilities are asking the LPNs, LVNs, to do IV push meds. Do you feel safe with this delegation? Doctors have their assistants stitch incisions shut is this safe? Many new practices seem risky and will my licence be put in jeopardy because of these delegation?

[SouthernLPN2RN, MSN, RN, APRN, NP]

I don't know about the suturing. I recently talked with a classmate of mine who is also an LPN and she has been pushing her own meds. There ain't enough money in the world to make me do that! I have dealt with many a snotty nurse who didn't want to push meds for me and wouldn't answer their pages, but I never did it myself. In my opinion, if it makes you uncomfortable, I wouldn't do it. If TPTB continue to push this process, I'd get the heck out of there! They are setting themselves up for disaster and could drag you along with them!

[control]

Delegation to UAPs is meant to be task oriented, standard, and direct patient care activities (i.e., help with ADLs, tidying the client's room/area, vital signs (in some cases), transporting patients, etc). I like to put it this way:if there is any assessment, diagnosis, planning (with few exceptions), or evaluation going on, then they are not allowed to perform that activity. Implementation of activity is allowed as long as it meets the criteria listed above. UAPs are also to report the results of their work to licensed personnel/professionals (LPNs, RNs).

If a doctor delegates something to a UAP that they are unable to legally perform or you are uncomfortable with the UAP performing (e.g., checking blood glucose for a sliding scale insulin dose), then it's the nurse's responsibility to not allow the UAP to do so. It is quite possible that the doctor doesn't realize that the UAP is a UAP, or that he may not understand exactly what UAPs do....

No one can make you delegate. If I had to justify why I would not delegate a task to a UAP, I would say that the task requires assessment (or whatever part of the nursing process it requires) and assessment should be performed by the LPN or RN.