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.
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?
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.
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.
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.
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.
Let’s delegate safely.
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.