PRINCIPLES FOR DELEGATION

Introduction
Registered nurses are accountable to the public for providing culturally competent, safe
and effective nursing care for patients in a variety of settings across the continuum of health
care. These settings may include hospitals, long-term care facilities, nursing homes, community
and public health centers, home health agencies or schools. In each setting, RNs function as
essential members of health care teams that include the consumer and may include other
licensed professionals and paraprofessionals as well as assistive health care workers and
informal caregivers. Consumers, who may desire to direct their own care, also may seek
consultation from RNs.
RNs are accountable for supervising those to whom they have delegated tasks. RNs
often delegate nursing tasks to other team members, and they are accountable for the decision
to delegate and for the adequacy of nursing care to the patient, provided the person to whom
the task was delegated performed the task as instructed and delegated by the delegating RN.
The RN retains accountability for the outcome of delegation.
Definitions
Accountability: The state of being responsible or answerable. Nurses, as members of a
knowledge-based health profession and as licensed health care professionals, must answer to
patients, nursing employers, the board of nursing and the civil and criminal court system when
the quality of patient care provided is compromised or when allegations of unprofessional,
unethical, illegal, unacceptable or inappropriate nursing conduct, actions or responses arise.
Amenities: Hospitality services including delivering food, meal setup, making beds, cleaning
the care environment. Assignment: The distribution of work that each staff member is
responsible for during a given work period.
Critical thinking: A rational reasoning process that involves applying knowledge, skills,
attitudes and values for the purpose of making a decision that affects patient care. Critical
thinking uses clinical and professional judgment in each phase of the nursing process.
Delegation: The transfer of responsibility for the performance of a task from one individual to
another while retaining accountability for the outcome. Example: the RN, in delegating a task to
an assistive individual, transfers the responsibility for the performance of the task but retains
professional accountability for the overall care.
Nursing Assistive Personnel (NAP): Individuals who are trained to function in an assistive role
to the licensed registered nurse in providing patient care activities as delegated by the RN
regardless of the title of the individual to whom nursing tasks are delegated. The term includes,
but is not limited to, nurses aides, medication aides, orderlies and attendants or technicians.
Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LPN): Most Licensed
Practical Nurses (LPNs) are generalists who work in all areas of health care, although
some LPNs specialize in a particular setting, such as home health care. LPNs work
under the supervision of registered nurses or physicians. In some settings, such as
nursing care facilities, LPNs may supervise nursing aides and orderlies.

Educational Preparation:
Most training programs, lasting about 1 year, are offered by vocational or
technical schools or community or junior colleges. LPNs must be licensed to
practice. Successful completion of a practical nurse program and passing an
examination are required to become licensed.
Certified Nursing Assistant (CNA): Certified nursing assistants (CNAs), also known as
nurses aides, orderlies, patient care technicians, and home health aides, work under the
supervision of a nurse and provide assistance to patients with daily living tasks. Working
closely with patients, CNAs are responsible for basic care services such as bathing,
grooming and feeding patients, assisting nurses with medical equipment, and checking
patient vital signs. CNAs give patients important social and emotional support and also
provide vital information on patient conditions to nurses.
Educational Preparation:
Federal nurse aide training regulations are mandated in the Omnibus Budget
Reconciliation Act of 1987 (OBRA 1987). State-approved training programs must
be a minimum of 75 hours and include 16 hours of supervised clinical training.
Aides who complete the program are known as certified nurse assistants (CNAs)
or State Tested Nurse Aid (STNA) and are placed on the State registry of nursing
aides. To maintain certification, all nurse aides must complete 12 hours of
continuing education annually.
Unlicensed Assistive Personnel (UAP) provides hands-on care and performs routine
tasks under the supervision of nursing and medical staff. Specific tasks vary, with aides
handling many aspects of a patients care.
Nursing process: The professional, systematic approach to ensuring complete care. The
process consists of various steps including assessing, diagnosing, planning, implementing and
evaluating the care provided.
Supervision: The active process of directing, guiding and influencing the outcome of an
individuals performance of a task. Supervision is generally categorized as on-site (the RN being
physically present or immediately available while the task is being performed) or off-site (the RN
has the ability to provide direction through various means of written and verbal
communications). Individuals engaging in supervision of patient care should not be construed to
be managerial supervisors on behalf of the employer.
Principles
The following principles have remained constant since the early 1950s.
Overarching Principles:
The nursing profession determines the scope of nursing practice.
The nursing profession defines and supervises the education, training and utilization for
any assistant roles involved in providing direct patient care.
The RN takes responsibility and accountability for the provision of nursing practice.
The RN directs care and determines the appropriate utilization of any assistant involved
in providing direct patient care.
The RN accepts aid from nursing assistive personnel in providing nursing care for the
patient.

Nurse-related Principles:

The RN may delegate elements of care but does not delegate the nursing process itself.
The RN has the duty to answer for personal actions relating to the nursing process.
The RN takes into account the knowledge and skills of any individual to whom the RN
may delegate elements of care.
The decision of whether or not to delegate or assign is based upon the RNs judgment
concerning the condition of the patient, the competence of all members of the nursing
team and the degree of supervision that will be required of the RN if a task is delegated.
The RN delegates only those tasks for which she or he believes the other health care
worker has the knowledge and skill to perform, taking into consideration training, cultural
competence, experience and facility/agency policies and procedures.
The RN uses critical thinking and professional judgment when following The Five Rights
of Delegation:
1. Right task
2. Right circumstances
3. Right person
4. Right directions and communication
5. Right supervision and evaluation (NCSBN 1995).
The RN acknowledges that there is a relational aspect to delegation and that
communication is culturally appropriate and the person receiving the communication is
treated respectfully.
Chief nursing officers are accountable for establishing systems to assess, monitor, verify
and communicate ongoing competence requirements in areas related to delegation, both
for RNs and delegates.
RNs monitor organizational policies, procedures and position descriptions to ensure
there is no violation of the nurse practice act, working with the state board of nursing as
necessary.

Delegation Model

The RN assesses the patient and the person to whom the task will be delegated (delegatee)
before delegating a task:
Will the patient receive quality nursing care if the task is delegated? Should the task be
delegated? How much supervision will the person doing the task require?
Is the person to whom the task is being delegated competent to do the task? Is she or
he functionally able to perform the task based on other assignments? Can the person
perform the task without adverse patient occurrence?
The RN communicates clearly the task being delegated, in a concise manner, for a specific
patient. Communication includes both written and oral components.
The RN has the responsibility for clinical supervision of the person doing the task. If the RN
identifies that the task to be delegated requires too much supervision, then the task should not
be delegated.
The RN monitors the patient and evaluates the outcome of the delegated task and anticipates a
potential change of plan based on clinical judgment.
The RN considers barriers and benefits to delegating a specific task. If the task is technical or
includes primarily provision of daily amenities such as delivery of meals, there is a benefit to
delegation, so the RN is then able to complete other professional duties and manage her or his
time more effectively doing what only an RN can do.
The RN considers cultural barriers staff or patients might have cultural biases that need to be
addressed in order to complete the delegated task. The task being delegated by an RN must be
a function that is of a technical assistive nature (a clinical task that can be taught, such as
drawing blood on stable patients, feeding or ambulating patients) or provides amenities to the
patient (such as hospitality services, including delivering food, setting up meals, making beds,
cleaning the care environment) and must not require critical thinking or professional judgment.
The RN holds the delegatee responsible for completing the task and for reporting any changes
in the patients condition.
The RN does not delegate the nursing process. However, selected components of the nursing
process may be delegated as follows:
Component

Can it be delegated?

Assessment
Diagnosis
Planning
Intervention
Evaluation

No, input is solicited

No
No, input is solicited
Yes, with supervision
No, input is solicited

The RN is accountable for the delegation decision, the process and the ongoing monitoring of
the outcomes of nursing care.

SPECIFIC DISCUSSIONS ON DELEGATION

PROFESSIONAL NURSING

As an RN you will be held accountable and responsible for your actions. The RN has a
responsibility for a level of performance which must be carried out and cannot be delegated,
including health care teaching, initial assessment, and the administration of IV medications.

The signing of a consent form for surgery or an invasive procedure may be delegated to the
LVN/LPN, and in some facilities a ward clerk may obtain the consent. Informed consent is
the responsibility of the physician; however, most facilities allow nurse and other health care
workers to witness the clients signature on the consent form after an explanation has been
provided by the physician. The signature of the witness indicates only that he or she
obtained the clients signature on the form. The RN is still responsible for ensuring that the
client understands what the procedure is, including potential complications. If the client is
unsure of the procedure, the physician needs to be notified to reexplain the procedure until
the client understands.

NURSING PROCESS

The RN is responsible for implementing the nursing process an all aspects of client care.
LVN/LPNs may be assigned to carry out tasks within the nursing process, such as
assessing clients after the initial assessment and executing interventions based on the client
care plan. The RN, however, is ultimately responsible for client care, developing the plan of
care, and ensuring that the plan is followed.

The LVN/LPN may assist the RN in planning and updating the plan of care, but may not be
responsible for this action.

MANAGING CLIENT CARE: DOCUMENTATION AND DELEGATION

The RN must complete the initial assessment, develop the client care plan, and develop the
teaching plan. These activities cannot be delegated to any other health care team workers.

Tasks which require judgment or the need to assess outcomes of the task may not be
delegated to other health care team workers.

Charting basic care modalities such as hygienic care can be assigned to CNAs and UAPs
when flow sheets are used. These caregivers cannot be assigned to complete narrative
charting.

LVNs/LPNs are responsible for charting using all formats: narrative, flow sheets, problemoriented, and computer-assisted charting.

RNs are responsible for the data entry in charts for all unlicensed health care workers.

COMMUNICATION AND NURSE- CLIENT RELATIONSHIP

Evaluation of cultural diversity and spiritual issues should be completed by either the RN or
LVN, not by a nursing assistant (NA).

A full history completed by the RN or LVN.

Care plan objectives relating to communication, spiritual issues and cultural differences
completed by the RN or checked by the RN if completed by the LVN.

ADMISSION, TRANSFER, AND DISCHARGE

Delegation tasks for the admission of a new client may be divided into three task areas:

A CNA may assist the client into bed, their personal items in a designated area, describe the
room environment including the use of telephone, television, and nurse summon controls,
visiting hours, mealtimes, and other hospital routines. The CNA may also take vital signs
and obtain height and weight measurements.

The LVN/LPN may complete a health history form, obtain admission data required by the
hospital, witness consent forms, and complete the same tasks identified above.

The RN is responsible for the complete health history and reviewing the data obtained by
other health care workers, initiating client care plan (nursing diagnosis, goals, and
intervention), and beginning the discharge plan in collaboration with the health care team.

An LVN/LPN may complete discharge teaching following the established discharge teaching
plan.

Escorting a client out of the hospital can be delegated to a volunteer, CNA, or LVN/LPN.

CLIENT EDUCATION AND DISCHARGE PLANNING

RNs must develop the teaching and discharge plans based on the assessment of client
needs. The Nurse Practice Act sets the standards for who assesses and plans client care.
Multidisciplinary team input is critical and a major component of both plans. The nurse is
usually the coordinator of most clients care plans and teaching plans.

Once the teaching and discharge plans have been developed, other members of the health
care team may participate in implementing them.

LVN/LPN follows the guidelines established in the teaching plans. They can assist with the
discharge plans; however an RN must write the discharge referral summary and
communicate with the referring agency.

SAFE CLIENT ENVIRONMENT AND RESTRAINTS

Before nursing staff is assigned to care for clients requiring restraints, the team leader
and/or charge nurse must ensure they have been properly educated in the legal
requirements as well as in the applications of restraints.

All personnel must be aware of environmental and clients risks for injury. Remind staff to
notify RN of risks.

Nurses must help identify clients at high risk for injury and must be familiar with agency plan/
protocol for the prevention of injury.

Nurse must individualize restraint implementation.

BATHING, BEDMAKING, AND MAINTAINING SKIN INTEGRITY

All personnel interacting with clients must report any client risk behaviors or signs or
symptoms that are unusual or new. Since activities of bathing or bedmaking have
predictable outcomes and do not require judgment, they are usually delegated to CNAs or
UAPs. When these activities of daily living are delegated to a CNA or unlicensed personnel,
the professional nurse remains responsible for total client care and should receive a
complete report from the staff member assigned to the client.

Even though unlicensed personnel are qualified to complete many tasks that involve
activities of daily living, if the client is critically ill or unstable, the RN or LVN/LPN should be
assigned to such a client. The professional nurse may observe the clients total condition,
thereby avoiding complications caused by missed parameters.

VITAL SIGNS

Taking vital signs for clients may be assigned to any health care worker provided they have
been assessed for competency in the procedure. This includes LPN/LVN, CNA, UAP, and
EMT.

The registered nurse must identify parameters for which the health care worker is to notify
the nurse; i.e., blood pressure above or below a certain reading, pulse rate, or irregular
pulse.

The nurse must provide detailed explanations and/or demonstrate alterations in the
procedure or specific methods of obtaining the vital signs to CNA, UAP, or EMTs.

Obtaining peripheral pulses by use of the Doppler is the responsibility of the RN or

LPN/LVN. A CNA or UAP is not responsible for using the Doppler.

The CNA or UAP may monitor the blood pressure using the noninvasive monitoring device;
however, the CNA or UAP is not responsible for initiating the procedure or setting the
alarms.

The registered nurse must evaluate all abnormal or changed vital signs identified by the
health care workers. The nurse maintains total responsibility for client care even though
someone else performs the task of taking vital signs.

PERSONAL HYGIENE

The staffing patterns today often require that the Certified Nursing Assistants (CNAs) or
Unlicensed Assistive Personnel (UAPs) complete personal hygiene activities for most clients
because these activities have a predictable outcome and do not require nursing judgment.

PHYSICAL ASSESSMENT

RNs must complete the admission assessment and document the findings. They cannot
delegate this activity to anyone else on the team.

LVNs/LPNs may complete focus assessments each shift; however, any change in
assessment findings must be reported and verified with the RNs.

Unlicensed assistive- personnel may not perform assessments on clients.

BODY MECHANICS AND POSITIONING

All levels of health care workers can be assigned to move and turn clients, and provide
assistance with transfers.

Positioning clients in bed can be assigned to all levels of health care workers.

Frequently, the physical therapist is assigned to work with postoperative clients or clients
requiring special transfer techniques or ambulation until clients are released to nursing.

Before assigning staff to logroll a client or use the Hoyer lift for moving client out of bed,
ensure they have been properly instructed in the procedures and safety issues associated
with these activities.

EXERCISE AND AMBULATION

Range of motion is usually performed by or under the supervision of a licensed physical

therapist. If this staff member is not available, the nurse or health care worker must
understand the principles of the skill before performing it on the client. Range of motion is
important for the client who is immobilized or on long- term bedrest, so if the skill is ordered
more than once per day, it will probably be delegated to a nurse, CNA, or UAP.

Ambulation may be done by any health care worker and is often assigned to a CNA or UAP.
However, the first time client is ambulated, an assessment is very important for safety
reasons and this should be performed by an RN or LVN/LPN. RNs performing this task will
minimize the possibility of orthostatic hypotension occurring, because assessment and vital
signs are an important part of the skill.

Crutch walking is a skill often performed initially with specialized personnel such as the
physical therapist. However, the nurse should understand the principles of crutch walking so
that he or she may reinforce the correct steps of the procedure whether the client is in the
hospital or in the home setting.

INFECTION CONTROL

LVNs/LPNs and CNAs may be assigned to clients requiring infection control precautions
and barriers.

It is the RNs responsibility to make assignments that take into account the type of isolation
precautions and potential cross- contamination of other clients in the care of the health care
worker. For example, the same health care worker should not take care of a client in contact
isolation and an immunosuppressed client.

PAIN MANAGEMENT

Noninvasive pain management techniques can be delegated to any staff member who feels
comfortable performing and/or has experience in using touch (massage) or relaxation
technique. If TENS is used for pain control, the nurse must understand the basic principles
of how this method works.

RN or LVN/LPN is the primary individual who is responsible for pain management. He or

she does this through the nurse- client relationship by becoming the clients advocate.
Therefore, a professional nurse must manage the clients pain in order to identify the
intensity, codify the degree, and evaluate the response to pain medication, and intervene as
necessary with the physician to change the medication protocol.

Administration of epidural narcotic analgesia must be done by an RN and, in many

hospitals, the nurse must have special certification. This skill may not be delegated to a
nonprofessional staff member.

Initial administration of a PCA must be done by an RN or experienced LVN/LPN. It may not

be delegated to a UAP, nor may the UAP administer a booster dose.

PCA may be managed and taught to the client by an RN or LVN/LPN if two parameters
exist: (1) The Nurse Practice Act and agency protocol in the state allows it, and (2) The
nurse has the information and experience to qualify the client and teach the procedure
(under physicians order). Nonprofessional staff may not perform this skill.

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ALTERNATIVE THERAPIES AND STRESS MANAGEMENT

Stress assessment should be completed by an RN and LVN/LPN with experience evaluating

stress in clients and one who understands Selyes model of stress.

An LVN/LPN assigned to a client who needs coping strategies for stress should check the
care plan with an RN or team leader.

Teaching a client body relaxation, controlled breathing, or medication should be done by an

experienced nurse--- RN or LVN/LPN.

MEDICATION ADMINISTRATION

RNs and LVNs are responsible for administering oral and parenteral medications to clients.

Unlicensed assistive personnel are not trained (or expected) to obtain and interpret essential
client data necessary for decision making when administering medications.

NUTRITIONAL MANAGEMENT AND NG INTUBATION

The professional nurse is responsible for the clients basic nutritional assessment (an
evaluation tool) if a dietician is not available. An unlicensed (CNA or UAP) is not trained to
assess this information.

The UAP should not be allowed to feed or assist in feeding the dysphagic client. The
licensed professional should monitor and evaluate the UAPs adherence to client- specified
instructions.

Generally, serving a food tray or feeding a client is assigned to the unlicensed staff.

Insertion of an NG tube is performed by a physician, an RN, or an LVN/LPN. A CNA or UAP

may measure and record drainage from an NG tube and provide oral hygiene.

Enteral feedings should be given by professional nurse.

If medication is administered through a (double lumen) tube, it is only an RN or LVN/LPN

who may administer medication.
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SPECIMEN COLLECTION

CNAs can be assigned to obtain specimens that are nonsterile and noninvasive. Examples
of these specimens include urine and stool collections.

UAPs and CNAs are not allowed to take blood measurements using Accu- Check and
Glucometer machines as these are considered invasive.

LVN/LPN can obtain most specimen collections except withdrawing blood.

DIAGNOSTIC PROCEDURES

LVNs/LPNs and RNs may both be assigned to care for clients undergoing diagnostic tests.

When invasive procedures such as liver biopsy and paracentesis are performed on the
nursing unit, either an LVN/LPN or RN is assigned to assist the physician.

Preprocedure and postprocedure interventions are assigned to the LVN/LPN or RN for

direct responsibility. A CNA may assist the nurse by taking vital signs.

Only RNs can transport clients who have received conscious sedation for a procedure.

URINARY ELIMINATION

CNAs may document intake and output findings on flow sheets.

UAPs may apply condom catheters and provide catheter care.

LVN/LPNs are assigned to care for clients requiring catheterization, and instillation of
medication into the bladder and irrigating a closed urinary system with a physicians order.

LVN/LPNs may be assigned to clients with urinary diversion. They may change pouches
and empty continent ileostomies.

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BOWEL ELIMINATION

A CNA or UAP may be assigned o administer disposable enema or tap water. They are not
allowed to administer enemas with medications or a Harris flush.

An LVN/LPN may be assigned to insert a rectal tube, administer enemas, and perform
colostomy care.

A CNA cannot be assigned to perform a fecal impaction removal because of the risk of a
vagal response during the procedure.

HEAT AND COLD THERAPIES

RNs may assign LPN/LVNs to perform any of the skills/procedure in this topic. For example,
they may set up a sterile field for a dressing change, apply heat or ice to an extremity, set up
a hypothermia blanket or give a sitz bath.
Assessment before delegation and evaluation of the clients response during and following
therapy is required of a licensed delegate.
Systemic cooling or heating therapies are indicated for critically ill clients in special care
settings who may be sedated or pharmacologically paralyzed. Theses clients are generally
monitored and cared for exclusively by licensed personnel.
CNAs and UAPs may be assigned to do procedures in this topic with supervision. They are
not trained to do sterile dressing and should not be assigned to use infant radiant warmers
or cooling blankets without special guidance and supervision.

WOUND CARE AND DRESSING

Assessment and evaluation of wounds and their management modalities are only RN
functions and may not be delegated to other healthcare workers. The RN in collaboration
with the physician develops a plan of care for clients requiring wound management.
An LVN/LPN may be assigned to complete a sterile dressing change following instructions
from the RN and in accordance with the wound care protocol established for the individual
client.
An LVN/LPN may remove staples and sutures after instruction and return demonstrations
have been documented.
A CNA may apply dressing, but may not perform sterile procedures.

RESPIRATORY CARE

The nurse should ensure that regular turning and deep breathing are encouraged by the
CNA/UAP to promote ventilation and prevent complications of immobility in bedfast clients.
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The CNA/UAP should be familiar with appropriate client positioning to promote airway
patency and reduce risk for aspiration of oral intake.
Unlicensed personnel should be informed that aspiration is an ever- present danger for the
client with tracheostomy tube.
Clients who require O2 administration may be unable to perform ADLs independently. The
CNA/UAP providing basic care should be instructed to assist the client with these activities
(e.g., set up food tray, provide bed or partial bed bath)
The CNA/UAP usually performs routine vital signs assessment and documentation
(including respiratory rate)
The CNA/UAP should know to report any changes in the clients breathing status or
tolerance to activity. The character and amount of sputum production should also be
reported and saved for the nurses inspection and documentation.
While the nurse or respiratory care practitioner is responsible for suctioning clients, the CNA/
UAP must recognize the clients need for such and report immediately.

INTRAVENOUS THERAPY

Daily weighing of clients is usually assigned to the CNA/UAP. The RN should verify that
weights are taken in the morning before breakfast, using the same scale each time. The
client should urinate before weighing for accuracy.
CNAs and UAPs report vital data to the professional nurse by monitoring vital signs. This
skill can be delegated for the pre-, intra-, and post-blood transfusion, and results should be
given immediately to the nurse.
The CNA/UAP providing personal hygiene must understand that the IV system is a closed
one and must be able to give care without disrupting this system. The components of the
system must never be disconnected for the convenience of care (e.g., changing gown). The
CNA/UAP should receive training in changing the clients gown without disrupting the IV
system.
It is the nurses responsibility to monitor and document intravenous fluid volume
administered.
It is the nurses responsibility to evaluate the clients total balance of intake and output and
to investigate significant imbalances for further decision making.
While the professional nurse monitors the IV infusion site regularly, the CNA/UAP must
communicate observations of swelling, client reports of concern (e.g., pain), and infusion
device signals that prompt the professional to further assess the client.
The nurse must ensure that CNA/UAPs know to report any unusual fluid loss the client is
experiencing (e.g., vomiting). It is the nurses responsibility to evaluate alterations in fluid
loss (e.g., vomiting, scant urine output) and act upon these findings accordingly. Knowledge
and judgment cannot be delegated.
It is the nurses responsibility to document vital client information on the Transfusion Record,
which is placed into the clients hospital chart.

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CIRCULATORY MAINTENANCE

All health care workers are trained in Basic Cardiac Life Support or CPR and Heimlich
maneuver; therefore, anyone can initiate CPR or perform Heimlich maneuver.

CENTRAL VASCULAR ACCESS DEVICES

All nurses must be aware of the many physical hazards associated with IV therapy.
Central catheter management must be done by an RN.
TPN and lipids may be administered only by an RN according to specific physician orders.
For the client with CVAD allowed to shower, the RN should disconnect infusion lines, place
a dry sterile gauze (4 x 4) over the dressed site and exposed tubing (s), then cover all with a
large transparent dressing for waterproofing. Post- shower removal of the covering and
inspection of the dressing should also be performed by an RN.
While the professional monitors the IV infusion site regularly, the CNA/UAP provides vital
data to the professional nurse by immediately reporting:
o Observation of redness or swelling around the CVAD insertion site (signs of possible
infiltration, hematoma, sepsis)
o Presence of crepitus (bubble-wrap feeling) on the clients chest (sign of possible
subcutaneous emphysema that can lead to respiratory distress.
o Observation of respiratory distress in any client with recent (24 hours) placemenet of
a central line (symptoms of possible pneumothorax).
o Any client complaint of arm, shoulder, or neck pain (symptom of possible thrombosis
or infiltration)
o Temperature elevation (fever---sign of possible catheter related infection if otherwise
unexplainable).
o Infusion device alarms to prompt the professional to further assess the client.
o Presence of blood backup in the catheter.
o A loose or soiled/wet dressing.

PERIOPERATIVE CARE

RNs and LVN/LPNs can complete routine preoperative teaching care. Anything out of the
ordinary would be the responsibility of the RN.
Postanesthesia Room staffs are usually RNs because they need to make quick decisions
and use nursing judgment in times of crisis.
Postoperative care of clients may be provided by both RNs and LVN/LPNs.
Clients undergoing conscious sedation may be monitored by RNs if the clients are in ASA
categories 1 (a normally healthy client) and 2 (a client with mild systemic disease).
Conscious sedation is characterized by: client is drowsy and may sleep throughout
procedure, responds purposefully to verbal commands; airway remains patent with
spontaneous ventilation, and cardiovascular status is maintained.
CNAs can be delegated to take vital signs and do routine hygienic care for clients once they
are stable.

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ORTHOPEDIC INTERVENTIONS

All health care workers can be assigned to clients with orthopedic conditions for nursing
tasks associated with activities of daily living.

END- OF- LIFE CARE

Assisting the client to deal with grief may be delegated to any member o the staff who has
had experience in working with grief and who has a working relationship with the client. For
example, a CNA on the staff may have been a hospice or church worker who has had
experience dealing with the grieving process. Assigning staff to work with a dying client will
involve similar parameters, with the additional criteria that the nurse or nonprofessional
assistant has worked through their own feelings about dying and can deal directly with the
subject of death. If a client wishes to discuss dying or fears of dying, the nurse must be able
to listen and appropriately interact with the client. The nurse or CNA/UAP assigned to care
for the dying client should be aware of the importance of the family in terms of support and
communication.
The nurse is responsible for checking the advance directives in the clients chart for organ
donation or the living will before assigning a nonprofessional member of the team to care for
the client.
Postmortem care may be completed by any of the staff. However, if there are organs to be
donated, the professional nurse is responsible for carrying out the hospital policies and/or
orders necessary to preserve the organs for organ transplant.
It is the responsibility of the professional nurse to provide the family with opportunities to
discuss the condition of the client and plans (for organ donation), and for the future care of
the client (perhaps hospice care). It would be inappropriate for nonprofessional staff to be
assigned these activities.

ADVANCED NURSING SKILLS

In advanced care settings, the RN simultaneously assesses, analyzes, makes decisions,

intervenes, and evaluates clients on a continual basis. Detection and interpretation of subtle
areas of change in the clients status require the knowledge and skill of the professional
nurse.
The CNA/UAP must know to leave arterial catheter site uncovered for easy observation.
The CNA/UAP must not move tubing drainage receptacles (e.g., pleurevac) without
supervision.
The CNA/UAP must understand that IVs, drainage systems, and ventilator circuits and
systems are closed and must be able to give care without disrupting system integrity or
disconnecting components for the convenience of care (e.g., as in changing gown or
position)
The UAP has a limited role in the care of the clients who require invasive monitoring. They
can offer valued assistance in moving/positioning clients and providing personal hygiene
and comfort measures under the direction of the professional nurse.

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