Delegation: How Nurses & Cnas Work As A Team

When work is delegated to a CNA by a nurse, what does that really mean? Here's the definition of delegation:

Delegation is when a nurse entrusts the performance of a selected nursing task to someone who is qualified, competent and able to perform that task.

Every state's Board of Nursing has regulations about which tasks may be delegated by nurses to nursing assistants. Most states have certain tasks that can be delegated without first assessing each individual client. These tasks include routine things like weighing, repositioning or feeding a client.

However, in most cases, nurses follow a five step delegation process. In this process, the nurse:

1. Assesses each client thoroughly before delegating any tasks to a CNA.

2. Plans how the task should be performed, based on the client's individual needs.

3. Trusts the nursing assistant with the task, but because the CNA is working under the nurse's license, the nurse remains responsible for the task.

4. Gives the CNA clear instructions and adequate supervision.

5. Follows up to see how the task was performed and how the client responded.

As you can see, delegation is a decision-making process that requires knowledge and skill. For example, it's not just the task involved but also the client's condition that determines if a task can be delegated.

Consider this situation:

Sally is a nurse on a medical-surgical unit. She has three patients who need help with their personal hygiene:

Mr. Smith is 68 and is recovering from a massive heart attack. He is very weak and his blood pressure drops whenever he changes position.

Mrs. Campbell is 49 and is recuperating from a knee replacement surgery that went very well.

Mr. Taylor, age 26, was in a car accident a week ago and suffered several third degree burns on his arms and upper body. He is able to stand without assistance.

Should Sally delegate the responsibility for bathing these clients to the nursing assistant? She assesses each client individually and decides that Mr. Smith is unstable and she wants to observe how he responds to repositioning during a bed bath. And, even though Mr. Taylor is ambulatory, she needs to assess and treat his burns during bath time. Sally decides that Mrs. Campbell is the only patient whose bath she should delegate to the CNA.

When tasks are delegated to nursing assistants, they have the right to expect that:

The task assigned to them is one for which they have been trained and is an approved task in their state and at their workplace.

No client's health will be jeopardized by what the nurse aides have been asked to do.

In the past, their performance of this same task has met the standards of their workplace.

The CNAs have been given all the details they need (either orally or in writing) to perform the task safely-and they understand what is expected of them.

A nurse will be available (either in person or by phone) should the nursing assistant have questions about any aspect of the task.

If you are a CNA and have an issue with any task that is delegated to you, it is your responsibility to speak up. Remember...your client's health may depend on it!