A registered nurse can't provide every single element of care that a patient requires; she requires assistance in the form of a health care multidisciplinary team that consists of other medical professionals. Licensed vocational nurses (LVN’s) also known as licensed practical nurses (LPN’s) in some states, certified nurse assistants (CNA's), and unlicensed assistive personnel (UAP's) aid the registered nurse (RN) in providing patient care.
The RN must understand her own responsibilities and scope of practice in patient care. Accordingly you must be familiar with state laws that apply to your practice. Assign the right tasks. Don’t overstep your boundaries of nursing practice or assign tasks outside of assistive personnel’s boundaries.
According to the article “Five Rights of Delegation” by Kathy Quan, “Typically tasks which can be delegated frequently recur in the day-to-day care of patients on the unit. The tasks are not complex, and do not require critical thinking or application of the nursing process.”
Kathy Quan states in Principles of Delegation that "The task being delegated by an RN...must not require critical thinking or professional judgment" and the patient must be stable. For example, a certified nurse assistant can record a patient’s blood pressure, respiratory rate, heart rate and temperature, but only under the right circumstances.
If the patient is experiencing a medical emergency or is very unstable, assessment and evaluation of vital signs is necessary, and assistive personnel are not qualified to perform this task. Rescind orders if a change in circumstances necessitate it.
The LVN is qualified to perform some tasks that CNA’s cannot. Delegate the right person for each task. Communicate with personnel and determine their degree of competency or comfort in performing the task. Ensure that assistive personnel possess the knowledge, skills and resources to accomplish the task.
Ensure that assistive personnel understand the assigned task. Ask the assistant if he understands the directions and whether or not he has any questions. Provide detailed instructions when necessary. “Data to be collected, methods of collecting specimens, and timeframe for accomplishing task” must be clarified, according to the “Five Rights of Delegation.”
The RN is ultimately responsible for accomplishment of assigned task; therefore she must ensure that the assignment has been completed, evaluate the outcome of the delegated task and correctly document the results.
According to the “Five Rights of Delegation,” although some states allow LPN’s to delegate tasks to CNA’s and UAP’s, “Anyone to whom a task has been delegated may not reassign the task to anyone else.”
Also prior to delegation “The RN assesses the patient and the person to whom the task will be delegated” to ensure patient safety and personnel competency according to “Principles of Delegation” (reference 2, p. 13).