Only RNs can delegate tasks of nursing care. Only the task is delegated; assessment and judgment cannot be delegated.
A. Assessment Components:
- Client’s condition is stable and predictable.
- Consider the setting and circumstances.
- Assess the task:
- Complexity.
- Risks involved.
- Skills necessary to safely perform.
- How often does the task need to be reassessed?
- Can the task be safely performed without direct RN supervision?
- Assess the caregiver:
- Determine whether an unlicensed person can perform the task safely without direct supervision of a RN.
- Evaluate the skills, ability and willingness of the unlicensed person (caregiver).
- How often do the caregiver’s skills need to be reassessed?
B. Teaching Components:
- Explain why the task is important to the client’s wellbeing.
- Teach the proper procedure/technique.
- Observe the caregiver perform the task on the client until you are sure competency is achieved.
- What are the risks associated with the task?
- Observe the client's response to the task.
- What are the signs and symptoms that the client may be experiencing side effects?
- What are the appropriate responses to a side effect?
- How is the caregiver to document that he/she has done the task?
C. Written Instructions: Leave procedural guidance for the caregiver that includes:
- A specific, detailed outline of how the task of nursing is to be performed, step-by-step.
- Signs and symptoms to be observed
- Guidelines for what to do if negative signs and symptoms do occur.
- That the caregiver understands the risk involved in performing the task and knows the plan for dealing with the consequences.
- To whom the caregiver reports negative signs and symptoms or concerns.
D. Documentation Components:
- The stability of the client’s condition based on your nursing assessment.
- Skill, ability and willingness of unlicensed person.
- That the task was taught and the caregiver is competent. (How do you know? Was there a return demonstration?)
- The written instructions (procedural guidance).
- Evidence that the caregiver was instructed that the task is client specific and not transferable to other clients or caregivers.
- How frequently the client is to be assessed by the Registered Nurse.
- How frequently the caregiver is to be supervised and reevaluated.
- That the RN takes responsibility for delegating the task to the caregiver.
- Your rationale for delegating this task.
E. Periodic Inspection, Supervision, and Re-evaluation:
- You must periodically reassess the client to determine if their condition remains stable and predictable.
- Must periodically observe the competence of the caregiver to perform the task on the resident. Is the caregiver still capable and willing to safely perform the nursing task?
- Initial inspection must occur within 60-days of the delegation with frequency based on client's condition and caregivers' continued competence with the task.
- Subsequent inspections at your discretion, with frequency based on client's condition and caregivers' continued competence with the task, but no longer than 180 days between inspections.