Delegation to unlicensed
assistive personnel
Delegation Guidelines
• The Nurse Practice Act establishes the
standard that each licensed nurse is
accountable for the safety of nursing care
s/he delivers
• The Board’s regulations hold that the nurse
is also responsible for all the nursing care
that a patient receives under his/her
direction
Delegation Guidelines
• RN retains ultimate responsibility,
accountability and legal liability for
delegation
• Supervision- directing, guiding or
influencing the outcome of another’s
performance
Appropriate activities for
Delegation
• Delegated tasks must be performed
according to established
guidelines/protocols
• Have little to no modification from one
situation to another
• Never involve assessment, interpretation or
decision-making which can’t be separated
from the task
Never Delegate
• Nursing assessment or formulation of
nursing care plans
• Evaluation of patients response to care
• Health teaching and counseling
• Administration of medications (micostatin
or albuterol)
• O2 therapy
Questions to consider before
delegating
• Have I assessed this patient
• Would a reasonable and prudent nurse
delegate this activity
• Documentation of competency of PCT/NA
• Ability of RN to provide supervision
Questions to consider before
delegating
• What information do I need to give the PCT/NA to
insure they understand what they are being asked
to do
• How will I document the hand-off to PCT/ NA
• Should the PCT/NA use a ‘scut sheet’ to document
the task request
• Does the PCT/NA understand their responsibility
in documenting when the task is completed
Questions to consider before
delegating
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Patient condition
Complexity of assignment/Intricacy of task
Custodial nature of task
Infection control/safety issues
Potential for harm
Amount of technology used
Vignette #1
• Mrs. D. is recovering from a total
abdominal hysterectomy. The MD ordered
removal of the urethral catheter. The PCT
has documented competencies in removing
indwelling catheters.
Vignette #1
• Is this a reasonable activity to delegate?
• What factors would go into your decision to
delegate or not delegate?
• If this were Mr. D. who is due to have the
urinary catheter removed after successful
cholecystectomy what factors would go into
your decision to delegate or not?
Vignette # 2
• Mrs. W. has been identified as an aspiration
risk. She has orders to begin oral feeding.
• Should this task be delegated?
• What factors would go into your decision to
delegate or not?
• Are there safety precautions you would put
at the bedside?
Vignette # 3
• Mr. P. is in the cardiac unit and has been on
oxygen therapy for 3 days. He has a new
order to increase his O2.
• Is this a task that can be delegated to a
PCT/NA?
• What factors go into your decision to
delegate or not?