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Delegation
to unlicensed assisted personnel
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The
use of unlicensed personnel increases rather than relieves
the nurse of responsibility for client safety. In
addition, newer nurses lack the experiences from which
experienced nurses develop judgments - different from
skills and task orientations- to know what to observe both
directly and through others to evaluate patient status and
responses. Even the most experienced UAP
is NOT equivalent to a new nurse. |
Nursing presence means focusing on patient responses, not just
on tasks or
skills of the nurse or any UAP. Frequent "walking
rounds" with direct patient assessment creates that
presence. Contextual presence, or seeing the patient in the
contexts of time, setting, and emotional and physical
conditions, is the core of nursing.
Safe delegation includes interpreting information or cues
reported by the UAP. Professional nurses organize directions to
the UAP by thinking in terms of "cue sets" based on
clinical knowledge about specific conditions, actual and
potential problems for each patient and that patient’s
profile, e.g., age, history. The nurse must use that clinical
knowledge to determine, in advance, cue sets from which to
direct the UAP to observe and report patient change. Cues also
suggest specific questions for the nurse taking report from a
UAP.
The UAP can observe but the RN interprets, using critical
thinking based on professional education and experiences. The RN
listens carefully and asks specific questions of the UAP -
taking mini-reports - for cues that indicate need for in depth
assessments. (A short summary of an article by M. Boucher
entitled Delegation Alert! Am J. Nursing, 1998;98(2):26-32)
The
following premises constitute the basis for the delegation
decision-making process. [From Delegation:
Concepts and Decision-Making Process, National
Council Position Paper, 1995]
- All decisions related to delegation of nursing tasks must
be based on the fundamental principle of protection of the
health, safety and welfare of the public.
- Boards of Nursing are responsible for the regulation of
nursing. Provision of any care which constitutes nursing or
any activity represented as nursing is a regulatory
responsibility of Boards of Nursing.
- Boards of Nursing should articulate clear principles for
delegation, augmented by clearly defined guidelines for
delegation decisions.
- A licensed nurse must have ultimate responsibility and
accountability for the management and provision of nursing
care.
- A licensed nurse must be actively involved in and be
accountable for all managerial decisions, policy making and
practices related to the delegation of nursing care.
- There is a need and a place for competent, appropriately
supervised, unlicensed assistive personnel in the delivery
of affordable, quality health care. However, it must be
remembered that unlicensed assistive personnel are equipped
to assist--not replace--the nurse.
- Nursing is a knowledge-based process discipline and cannot
be reduced solely to a list of tasks. The licensed nurse's
specialized education, professional judgment and discretion
are essential for quality nursing care.
- While nursing tasks may be delegated, the licensed nurse's
generalist knowledge of patient care indicates that the
practice-pervasive functions of assessment, evaluation and
nursing judgment must not be delegated.
- A task delegated to an unlicensed assistive person cannot
be redelegated by the unlicensed assistive person.
- Consumers have a right to health care that meets legal
standards of care. Thus, when a nursing task is delegated,
the task must be performed in accord with established
standards of practice, policies and procedures.
- The licensed nurse determines and is accountable for the
appropriateness of delegated nursing tasks. Inappropriate
delegation by the nurse and/or unauthorized performance of
nursing tasks by unlicensed assistive personnel may lead to
legal action against the licensed nurse and/or unlicensed
assistive personnel.
A
Learning Exercise:
Delegation:
What it Means to the Practicing RN and LPN
Unlicensed
assistive personnel (UAP) are providing care in a growing number
of health care facilities as the need for accessible,
affordable, quality health care increases. Nurses are qualified
to promote health for their patients because of their nursing
education and experience. Nurses need to be involved in making
health care policies and decisions about the delivery of nursing
care. Therefore nurses must take responsibility of delegation of
nursing tasks to others.
Scenario:
Jane is a new RN practicing in an extended care skilled nursing
facility, Heavenly Health Care Nursing Home (HHCNH). Jane is one
of four registered nurses who are responsible for the care of 50
residents who have varying health care needs. The facility also
employs six licensed practical nurses (LPN) and a number of
unlicensed assistive personnel (UAP) all of whom provide care
for the 50 residents 24 hours a day and seven days a week.
The director of nursing, Margaret M., has indicated that when
Jane RN is in charge she has been clocking in too much overtime
on her time card. Margaret states that Jane must delegate more
nursing tasks to the UAPs so that Jane can complete her duties
in a timely manner. Jane discusses the issue with the other RN
on duty and asks what else can the UAP do besides empty bedpans
and give residents their morning shower. What is meant by
delegation?
While this scenario may seem simplistic, the concerns related
to delegation of responsibilities for patient care are numerous
and complex.
The exercise above is an excerpt from an accredited 1 contact
hour nursing ceu
course entitled "Delegation: What it Means to the
Practicing RN and LPN". To read the entire course and
receive credit register
here, click on Nursing, click on "Ethical, Legal,
Compliance Issues In Nursing" to select this course.
For
More Information
-
Nurse
Practice Acts and Regulations
-
Links
to State Boards of Nursing
-
Avoiding
Malpractice: 10 Rules, 5 Systems, 20 Cases- A
lawsuit
for malpractice is emotionally devastating for a nurse
practitioner, and
obviously arises out of a tragedy for a patient. I believe
there is a place
for preventive law, just like there is a place for
preventive medicine. I would rather work on preventing
malpractice than litigating it....
-
The
Health Care Provider's Guide to Facing the Malpractice
Deposition-Designed to equip those in the health
care industry with the tools necessary to come out of a
malpractice deposition with as few 'bruises' as possible.
Topics include law and legal thinking, standard of care,
preparing for the deposition, and common forms of
interrogation.
-
Nursing
Malpractice : Liability and Risk Management-Students
and professional nurses at any level of clinical practice
will find this book to be a vital resource on the basic
legal concepts and principles of malpractice, liability, and
risk management, and their implications for the profession.
The book also provides detailed strategies for dealing with
these issues.
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NURSING LEGAL ISSUES
