You probably count on unlicensed assistive personnel (UAPs) to help you care for your patients. As an RN or LPN, however, you're ultimately responsible for your patients, even when you've delegated some of their care to a UAP.
To delegate legally, safely, and effectively, you need to know a few rules. Before handing off duties to UAPs, check the following five points to make sure you're meeting your responsibilities.
State laws. Make
sure you know the scope of your own practice. The laws that govern
your practice as a licensed nurse are the legal foundation for any
decisions you make about delegating work to others. Contact the
state board of nursing to find out what laws govern nursing
practice where you're working. In general, you can't legally
delegate activities that require advanced education to a UAP;
similarly, activities that require a judgment based on analysis of
data are beyond a UAP's scope of practice. When delegating to a
UAP, put the emphasis on tasks, not thought processes.
Policies and procedures. Review your facility's
written policies on delegation and compare its expectations with
the legal requirements of the nurse practice act. They should be in
agreement, but if you find a conflict, seek clarification. To keep
your license safe, remember that the nurse practice act supersedes
employer policy.
Make sure you have answers to these questions:
UAPs. Get to know
your UAPs as individuals. Learning each person's abilities will
help you delegate safely and effectively.
Patients. Whether or not a task can be
appropriately delegated may depend on your patient's condition
rather than the task itself. For example, you might reasonably ask
a UAP to help a stable, ambulatory patient to the bathroom. But
asking him to assist an unstable patient by himself wouldn't be
appropriate.
In general, simple, routine tasks such as making
unoccupied beds, supervising patient ambulation, assisting with
hygiene, and feeding meals can be delegated. But if the patient is
morbidly obese, recovering from surgery, or frail, work closely
with the UAP or perform the care yourself.
Your judgment is always key because whether or not
delegating care is appropriate isn't always obvious. A patient may
appear to be independent, yet still need care from someone skilled
in communication. For example, a patient with newly diagnosed
diabetes will benefit from the teaching and support you can offer
while performing hands-on care you might otherwise delegate.
Although delegating this “bed and bath” to a UAP is legal and safe,
it may not be in this patient's best interest.
Delegation and leadership. How do you motivate the
UAPs who are assigned to you? One of the best ways is to assess how
well they meet the current standards of care. By observing UAPs as
they complete their tasks, you can determine whether they need
additional training to meet the standards of care. If they're doing
fine, make sure you let them know. (See A Little Praise Goes a Long
Way.)
Although you need to maintain standards, you should also be flexible. Acknowledge that some things can be done more than one way. You'll foster cooperative attitudes if you act as a guide and teacher, rather than a dictator.
Just as you need to trust the UAPs assigned to you, the UAPs need to trust you. The end result will be better patient care—the one goal shared by everyone on staff.
DELEGATION
Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.
A little praise goes a long way
Here are a few ways to motivate a UAP on your staff:
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