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chapter 9 | Delegation of Client Care 119 CikguOnline
technician for dinner and breaks, and a second RN Hansten & Jackson, 2004; Huber, Blegan, &
may be able to assign staff to dinner and breaks. McCloskey, 1994). As the nursing shortage
Next, Linda needs to look at the needs of each becomes more critical, there is a greater need for
client on the unit and prioritize them. She is now institutions to recruit the services of UAPs (ANA,
ready to delegate to her staff effectively. 2002). A survey conducted by the American
Some activities must be done at a certain time, Hospital Association revealed that 97% of hospi-
and their timing may be out of one’s control. tals currently employ some type of UAP. Because a
Examples include medication administration and high percentage of institutions employ these per-
clients who need special preparation for a sched- sonnel, many nurses believe they know how to
uled procedure. The following are some tips for work with and safely delegate tasks to them. This
organizing work on personalized worksheets to is not the case. Therefore, many nursing organiza-
help establish client priorities (Tappen, Weiss, & tions have developed definitions for UAP and cri-
Whitehead, 2004): teria regarding their responsibilities. The ANA
defines UAP as follows:
■ Plan your time around these activities.
■ Do high-priority activities first. Unlicensed assistive personnel are individuals
■ Determine which activities are best done in a who are trained to function in an assistive role
cluster. to the registered nurse in the provision of
■ Remember that you are responsible for activities patient/client care activities as delegated by and
delegated to others. under the supervision of the registered professional
■ Consider your peak energy time when schedul- nurse. Although some of these people may be certi-
ing optional activities. fied (e.g., certified nursing assistant [CNA]), it is
important to remember that certification differs
This list acts as a guideline for coordinating client
from licensure. When a task is delegated to an
care. The nurse needs to use critical thinking skills
unlicensed person, the professional nurse remains
in the decision-making process. Remember that
personally responsible for the outcomes of these
this is one of the ANA nurse-related principles of
activities (ANA, 2005).
delegation (ANA, 2005). For example, activities
that are usually clustered include bathing, changing As work on the UAP issue is ongoing, the ANA
linen, and parts of the physical assessment. Some has recently updated its position statements to
clients may not be able to tolerate too much activ- define direct and indirect patient care activities that
ity at one time. Take special situations into consid- may be performed by UAP. Included in these
eration when coordinating client care and deciding updates are specific definitions regarding UAP and
who should carry out some of the activities. technicians and acceptable tasks.
Remember, however, that even when you delegate, Use of the RN to provide all the care a client
you remain accountable. needs may not be the most efficient or cost-effective
Figure 9.1 is an example of a personalized work- use of professional time. More hospitals are moving
sheet. (See Chapter 11, Time Management, for a away from hiring LPNs and utilizing all RN
complete discussion.) staffing with UAP.For this reason,the nursing focus
is directed at diagnosing client care needs and car-
The Need for Delegation rying out complex interventions.
The ANA cautions against delegating nursing
The 1990s brought rapid change to the health-care activities that include the foundation of the nursing
environment. Several forces came together at one process and that require specialized knowledge,
time, including the nursing shortage, health-care judgment, or skill (ANA, 1996, 2002, 2005). Non-
reform, an increased need for nursing services, and nursing functions, such as performing clerical or
demographic trends. These changes continue to receptionist duties, taking trips or doing errands off
have an impact on the delivery of nursing care, the unit, cleaning floors, making beds, collecting
requiring institutions to hire other personnel to trays, and ordering supplies, should not be carried
assist nurses with client care (Zimmerman, 1996). out by the highest paid and most educated member
Health-care institutions often use UAP to per- of the team. These tasks are easily delegated to
form certain client care tasks (Habel, 2001; other personnel.