Susan S. Cox is a member of the Huron School of Nursing's nursing faculty in East Cleveland, Ohio. Show
You probably count on unlicensed assistive personnel (UAPs) to help you care for your patients. As an RN or LPN, however, you're ultimately responsible for your patients, even when you've delegated some of their
care to a UAP. To delegate legally, safely, and effectively, you need to know a few rules. Before handing off duties to UAPs, check the following five points to make sure you're meeting your responsibilities.
Your judgment is always key because whether or not delegating care is appropriate isn't always obvious. A patient may appear to be independent, yet still need care from someone skilled in communication. For example, a patient with newly diagnosed diabetes will benefit from the teaching and support you can offer while performing hands-on care you might otherwise delegate. Although delegating this “bed and bath” to a UAP is legal and safe, it may not be in this patient's best interest. Although you need to maintain standards, you should also be flexible. Acknowledge that some things can be done more than one way. You'll foster cooperative attitudes if you act as a guide and teacher, rather than a dictator. Just as you need to trust the UAPs assigned to you, the UAPs need to trust you. The end result will be better patient care—the one goal shared by everyone on staff. DELEGATIONTransferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation. A little praise goes a long wayHere are a few ways to motivate a UAP on your staff:
SELECTED REFERENCESCohen, S. Managers' fast track. Delegating vs. dumping: Teach the difference. Nursing Management. 35(10):14,18,52, October 2004. National Council of State Boards of Nursing: Delegation: Concepts and Decision-Making Process. National Council Position Paper, 1995. Accessed online at http://www.ncsbn.org/regulation/uap_delegation_documents_delegation.asp, April 18, 2006. National Council of State Boards of Nursing: Delegation Decision-Making Tree. 1997. Accessed online at http://www.ncsbn.org/pdfs/delegationtree.pdf, April 18, 2006. Whitman, MM. Professional development. Return and report: Establishing accountability in delegation. American Journal of Nursing. 105(3):97, March 2005. Williams JK and Cooksey MM. Navigating the difficulties of delegation. Nursing2004. 34(9):32hn12, September 2004. Which care setting are more suitable for unlicensed nursing personnel?Extended care and long-term care settings are more suitable for unlicensed nursing personnel (UNP). Acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals.
What factors must the nurse consider before delegating?In deciding when and what to delegate, RN's must take a number of factors into account, including the scope of practice required for the task, the complexity and predictability of the task, the potential for harm, and level of critical thinking required to perform the task.
Which task is appropriate for the RN to delegate to the unlicensed assistive personnel?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.
Which delegation actions may be performed by unlicensed nursing personnel while caring for a client select all that apply?Unlicensed nursing personnel (UNP) can delegate simple and straightforward client teaching, such as asking the client to wash his or her hands before meals and wear footwear while walking. Complex and multifaceted teaching, such as detailing the care plan to the client, cannot be delegated to a UNP.
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