What Can a Nurse Delegate to a CNA and Other Staff Members? - Nurse Money Talk (2022)

Nurses must know when they can delegate tasks and to whom they can delegate them.

The certified nursing assistants (CNAs) working on your unit are there to help both you and the patients, but you must know how to best utilize their unique knowledge and skillsets.

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What Can a Nurse Delegate to a CNA?

The tasks registered nurses or licensed practical nurses can delegate to CNAs include turning patients, giving bed baths, and helping patients ambulate. The tasks delegated by nurses to CNAs vary from state to state and from facility to facility.

In short CNAs are unlicensed assistive personnel who can take care of many of the hands-on patient care tasks during each shift. and get tasks delegated to them that falls within their job description and competency level.

How Can Nurses Best Utilize the CNAs on Their Units?

CNAs are on your unit to help both you and the patients.

By taking care of some of the minor details and some of the hands-on tasks that can be huge drains on your time, CNAs free you up to perform some of the tasks that no one else can do for you such as intravenous medication administration and charting.

(Video) Nurses: How to Delegate Gracefully

CNAs most frequently provide basic patient care, such as help with bathing, ambulating, and feeding.

While nursing assistants are often seen as the primary caregivers in long-term care facilities, they are seen more as the hands and feet of the nurse in hospitals.

Regularly delegating tasks to CNAs when appropriate can help licensed nurses (RNs and LPNs) provide more focused care, use their time more efficiently and ensure patients and their family members are completely satisfied with the level of care they are receiving.

On busy shifts, I depended on my nursing assistant to help me accomplish the particularly time-consuming tasks, such as bed baths and linen changes.

What Is Delegation?

What Can a Nurse Delegate to a CNA and Other Staff Members? - Nurse Money Talk (1)

A simple search for the meaning of delegation when it comes to nursing will uncover a wide variety of definitions.

However, the basic definition reveals that delegation involves handing off the responsibility for a task to another individual but maintaining the responsibility to assess the outcomes of that task.

The American Nurses Association and the National Council of State Boards of Nursing have listed five rights of delegation that can help nurses know how to delegate correctly and safely.

1. Right Task

Appropriate tasks should be chosen based on state and facility-specific rules.

2. Right Circumstance

The nurse must determine whether the CNA has the resources needed to do the task and if the time and situation is appropriate for delegation. This will include evaluating the patient's specific needs and concerns.

(Video) Delegation Nursing NCLEX Questions Review: RN/LPN/UAP Duties, Scope of Practice

3. Right Person

The nurse must determine if the CNA has the knowledge and skills to perform this particular task. This will include knowing what type of training the CNA has previously had and what his or her job description is.

4. Right Supervision

According to nurse practice acts, all tasks that a nurse delegates must be appropriately supervised. At the completion of the task, the nurse must also evaluate the outcome.

5. Right Direction and Communication

The nurse must also be clear when delegating a task and ensure that the CNA understands what is expected.

State Board Approval, Job Description, and Competency

These are the three areas that determine what a CNA can do.

First, the state board of nursing determines what CNAs are allowed to do in that state. This is the broadest determining factor under which all other qualifications fall.

Second, the health care facility may have more specific rules that apply to its CNAs. These limitations may bar the CNA from passing medications even if the state allows it. Often, these limitations are put into place to protect both the CNA and the patients.

Third, the CNA's competency level in each task will determine what he or she is capable of doing. As the nurse, you will need to know what the CNA has already proven competency in, what the CNA still needs to work on with supervision and what the CNA feels uncomfortable doing altogether. The level of supervision you provide will be guided by your evaluation of these matters.

Related: CNA vs LPN vs RN

Can Nurses Delegate to Other Nurses?

Nurses can delegate to nurses with higher scopes of practice as well as to those with lower scopes of practice.

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Delegating to those with a higher scope of practice could happen if the nurse needs another set of eyes to help with a patient assessment or if the nurse needs to consult with a nurse practitioner when a patient treatment is needed.

For example, when I struggled with reading an EKG because of a lack of knowledge, I could reach out to my charge nurse or even to the house supervisor nurse for help.

Delegating to those with a lower scope of practice happens more frequently and is what occurs when you ask a CNA to complete a specific task.

For example, as a registered nurse, I could ask a licensed vocational nurse to pass medications or to perform a dressing change. However, whether you're delegating to a nurse with a higher or lower scope of practice, you are still ultimately responsible for your assigned patient.

Check out this video guide (below) to learn more about how you can delegate with kindness and fairness.

Can a Nurse Delegate Medication Administration?

Medication administration is one of the most important tasks nurses do because it's one that has the greatest potential for detrimental errors.

As the licensed nurse, it's important you take care of this task yourself whenever possible. However, over 30 states do allow for delegation if a CNA has received specialized training in medication administration.

In some cases, this could also include injections. As the nurse, you will still be responsible for supervising this task and for evaluating the outcomes for your patient.

Related: What is the Chain of Command in Nursing?

(Video) The CNA and the health care team

What Tasks Cannot Be Delegated by an RN?

The key item identified by the American Nurses Association as being unable to be delegated is the nursing process itself.

This means that even if you delegate a specific task or series of tasks to unlicensed assistive personnel, such as a CNA, you are still in charge of the key facets of nursing care for the patient, including assessment, planning, and nursing treatments.

This also notably includes any task that requires nursing judgment (or critical judgments) or decision making.

Specifically, some of the tasks that cannot be delegated depending on the state and the facility could include the following:

  • Intravenous medication administration
  • Certain portions of charting
  • Most invasive treatments
  • Wound care
  • Foley catheter insertions
  • Tube feedings

However, certain tasks that are not allowed in many states are perfectly legal for CNAs to do in other states. This could include passing oral medications, providing oxygen, removing foley catheters, drawing blood, and taking blood sugar readings.

The video below will help you learn more about what CNAs are allowed and not allowed to do.

Of course, making the decision of what to delegate safely also requires critical thinking and nursing judgment on your part. This is why you should think of delegating as a skill you will learn and develop over the years.

Always reach out to your charge nurse or to nurse managers on your unit if you are unsure what you can delegate. This is especially true if you're moving to a new health care facility in a different state where CNAs have different task parameters.

Final Thoughts

Let's delegate safely.

(Video) A Patient Dies.. Is It The Nurses Or CNAs Fault? The All Too Common Blame Game | Life As A #Nurse

Delegation is a task that requires you to use your critical thinking skills so that your patients are kept safe at all times. Comment below to let us know what you are allowed to delegate to CNAs in your facility and your state.

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Frequently Asked Questions

FAQs

What can a nurse delegate to another nurse? ›

An LPN may delegate tasks such as ambulating or feeding a patient to the CNA. The question of when a nurse should delegate is dependent on many factors. Usually, nurses delegate when they need help to prevent patient care delay.

What can you delegate to a nursing assistant? ›

In general, simple, routine tasks such as making unoccupied beds, supervising patient ambulation, assisting with hygiene, and feeding meals can be delegated. But if the patient is morbidly obese, recovering from surgery, or frail, work closely with the UAP or perform the care yourself.

What does it mean for the nurse to delegate a task to the CNA? ›

Delegated Responsibility: A nursing activity, skill, or procedure that is transferred from a licensed nurse to a delegatee. Delegatee: One who is delegated a nursing responsibility by either an APRN, RN, or LPN/VN (where state NPA allows), is competent to perform it, and verbally accepts the responsibil- ity.

What tasks Cannot be delegated to a CNA? ›

Regardless of how the state/jurisdiction defines delegation, as compared to assignment, appropriate delegation allows for transition of a responsibility in a safe and consistent manner. Clinical reasoning, nursing judgement and critical decision making cannot be delegated.

What are the 5 Rights of delegation in nursing? ›

The 5 rights of delegation serve to guide appropriate transfer of responsibility for the performance of an activity or task to another person. These "rights" are defined as having the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation.

Which nursing team members Cannot delegate? ›

The Nursing Assistant Working in Long Term Care
QUESTIONANSWER
A nurse can delegatetasks
Which nursing team members cannot delegate?nursing assistants
Before a nurse delegates a task to you, the nurse must know what?what tasks your state allows nursing assistants to perform.
42 more rows

Which action may the nurse delegate to a nursing assistant? ›

Which task could a staff nurse delegate to a certified nursing assistant (CNA)? Feeding a stroke patient who has minimal dysphagia is an appropriate delegation of a nursing intervention to a CNA.

What are the nurse's responsibilities when delegating tasks? ›

the nurse assigned to the clients is responsible for the delegation process of communication, supervision/monitoring, and evaluation of the performance of the task/activities. the nurse also maintains accountability for the decision to delegate and the provision of safe nursing care.

What are 3 tasks an RN can delegate to LPN? ›

Initiate, administer, and titrate both routine and complex medications. Perform education with patients about the plan of care. Admit, discharge and refer patients to other providers.

When you receive a delegation What are two of the things you are responsible for? ›

When you receive a delegation what are two of the things you are responsible for? Performing the delegated task according to the instructions, Observing the client for medication side effects.

What factors are most important for the nurse to consider when delegating responsibilities? ›

Although geographic factors may be considered when tasks are delegated, these are not the most significant criteria to consider. The client's acuity, not diagnosis or length of time in the hospital, is the most important client factor to consider when appropriate staff members are assigned to provide care.

Does a nurse have to delegate a task to you? ›

Does a nurse have to delegate a task to you? A. Yes, if the task is in your job description.

What tasks Cannot be delegated? ›

Tasks You Should Never Delegate
  • Work That Takes Long to Explain. Imagine spending 3 hours explaining something that you could've done in 30 minutes yourself. ...
  • Confidential Jobs. Certain matters just cannot be put into the hand of the employees. ...
  • Crisis-Management. ...
  • Boring Tasks. ...
  • Very Specific Work.

Who can delegate nursing tasks to the nursing assistant quizlet? ›

A licensed practical nurse (LPN) can delegate tasks to a nursing assistant. What is one of the things a delegating RN is responsible for in the delegating process?

Why is it important for a CNA to know the 5 rights of delegation? ›

The Five Rights of Delegation, identified in Delegation: Concepts and Decision-making Process (National Council, 1995), can be used as a mental checklist to assist nurses from multiple roles to clarify the critical elements of the decision-making process.

What are the 3 elements of delegation? ›

Every time you delegate work to a teammate, three inescapable core elements of delegation are in play. Authority, responsibility, and accountability form an integrated process and must be applied by you as a unified whole.

What are the 4 steps of delegation? ›

4 Steps to Effective Delegation Are:
  • Clearly define the task. Setting expectations is key to effectively delegating a task to an employee. ...
  • Provide proper training. The reason many business owners do not delegate is the amount of up-front effort it takes. ...
  • Use project management tools. ...
  • Define level of authority.
Dec 7, 2018

What is an example of delegation in nursing? ›

What are some common examples of delegation? A nurse who works in the community could delegate the administration of heparin by injection to an unregulated care provider who is providing care in the client's home. In this example, the nurse has delegated the controlled act of “administering a substance by injection.”

Can a CNA refuse an assignment? ›

There is nothing to prevent your employer to assign you where and how best needed, including serving as a CNA. Refusing an assignment without a valid patient safety reason can put your job in jeopardy and can be considered unprofessional.

What are the five rights of delegation in nursing quizlet? ›

Terms in this set (5)

The right tasks to delegate are ones that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk (e.g., simple specimen collection, ambulating a stable patient, preparing a room for patient admission).

What is an example of delegation in nursing? ›

What are some common examples of delegation? A nurse who works in the community could delegate the administration of heparin by injection to an unregulated care provider who is providing care in the client's home. In this example, the nurse has delegated the controlled act of “administering a substance by injection.”

What are 3 tasks an RN can delegate to LPN? ›

Initiate, administer, and titrate both routine and complex medications. Perform education with patients about the plan of care. Admit, discharge and refer patients to other providers.

What are the types of delegation? ›

Types of Delegation of Authority
  • General or Specific Delegation. It is based on the job assigned.
  • Formal or Informal Delegation. It is based on the process of giving authority.
  • Top to bottom or bottom to top Delegation. It is based on the hierarchy.
  • Lateral Delegation. It requires a group or team to work in parallel.

What is an example of delegation? ›

Some examples of delegation in the workplace with varying levels of trust and autonomy include: Giving directions to a subordinate and telling them exactly what to do. Assigning someone to compile research, gather feedback, and report back to you so you can make informed decisions.

What does a delegating nurse do? ›

RNs are accountable for the decision to delegate and for the adequacy of nursing care provided to the healthcare consumer. The delegating RN retains accountability for the patient outcomes associated with nurse delegation, provided the person to whom the task was delegated performed it as instructed.

Why is delegation important in nursing? ›

The primary benefit of delegation in nursing is that it allows a qualified healthcare worker, like an RN, to transfer routine and low-risk duties to nursing assistive personnel. This frees up the RN's time to address more pressing matters, including critical patients and tasks.

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