Delegation and Assignment of Nursing Activities Position Statement

Delegation and Assignment of Nursing Activities

  • Delegation and assignment are crucial for licensed nurses (RN and LPN).
  • Licensed nurses can assign/delegate to other licensed nurses and unlicensed assistive personnel (UAP).
  • Assignment/delegation decisions are based on:
    • Nurse's license level.
    • Client's status.
    • Competence of personnel.
    • Practice setting variables.
    • Employer's policies/procedures.
  • Nurses need access to RN-validated competencies for each individual before delegating.
  • Activities delegated to UAP, including medication administration, must meet the NCBON Decision Tree criteria.
  • Specific guidance for medication administration delegation to UAP is in the Position Statement.
  • Nurses can also delegate non-nursing tasks to UAP.
  • Specific direction by the nurse to UAP when assisting with a task under direct visual supervision is not considered delegation, still nurse bears full responsibility and accountability.

Definitions

  • Authority: The source of power to act.
  • Accountability/Responsibility: Being answerable for actions or inactions of self and others.
    • The licensed nurse retains accountability for appropriate assignment/delegation.
    • The person assigned/delegated is accountable for carrying out the task correctly.
  • Assigning: Designating responsibility to a competent, licensed person.
    • RN assigns to RNs and LPNs.
    • LPN assigns to LPNs.
  • Delegating: Transferring authority to a competent individual to perform a nursing activity.
    • The nurse retains accountability.
    • RN and LPN delegate to UAP.
  • Supervision: Guidance, direction, evaluation, and follow-up by the licensed nurse.
    • LPN supervision is limited to validating task completion according to standards.
  • UAP (Unlicensed Assistive Personnel): Any unlicensed personnel participating in patient care activities via delegation.
    • Examples: Nurse Aide I, Nurse Aide II, Medical Office Assistant, Medical Assistant, etc.

Position Statement Context

  • A Position Statement is not a regulation or law.
  • It provides direction to licensees for safe nursing practice.
  • Addresses issues of concern to the Board, relevant to public protection.
  • Reviewed regularly for relevance and accuracy.

RN Role in Assignment and Delegation

  • Assigns to other RNs and LPNs; delegates to UAP.
  • Maintains overall accountability for coordination and delivery of nursing care.
  • Maintains responsibility for the decision to assign or delegate.
  • Assesses client's status, develops care plan, determines personnel competence, and identifies setting variables.
  • Provides education, training, and competency validation for RNs, LPNs, and UAP (initial and ongoing).
  • Indicates appropriate tasks for each level of personnel via policy, procedure, and plans of care.
  • Communicates and assesses understanding of assignments and delegation.
  • Provides appropriate supervision, on-site if necessary, and follow-up to verify task completion.
  • Evaluates the effectiveness of the nursing plan of care and modifies.

LPN Role in Assignment and Delegation

  • Assigns to other LPNs and delegates to UAP following RN assessment and care plan.
    • Requires RN-validated competence of staff.
    • Requires continuous RN supervision, on-site if necessary.
    • Assigning nursing activities to an RN is beyond LPN scope of practice.
  • Maintains accountability for all assignments and delegations.
  • Communicates and assesses understanding of assignments and delegations to LPNs and UAP.
  • Evaluates care effectiveness and proposes interventions for RN review.
  • May alter assignment/delegation or temporarily suspend LPNs/UAP per agency policy until RN determines personnel action.
  • Supervision limited to monitoring and validation of task completion according to standards.
  • Broader supervisory/management activities are beyond the LPN scope of practice.

UAP Role

  • Affirm acceptance and understanding of delegation based on competence.
  • Perform delegated activities correctly.
  • Seek clarification as needed.
  • Request additional training and guidance as needed.
  • Report care results to the nurse in a timely manner.

Criteria for Delegating to UAP

  • Before delegating to UAP (including medication administration), tasks must meet ALL criteria in the Decision Tree:
    • Frequently recur in daily care.
    • Performed according to an established sequence of steps.
    • Involve minimal modification from one client to another.
    • May be performed with a predictable outcome.
    • Do not inherently involve ongoing assessment, interpretation, or decision-making.
    • Do not endanger client’s life or well-being.
    • UAP have been properly trained and validated as competent by the RN.
    • Agency policies and procedures permit the task.
    • The nurse provides appropriate supervision.

Delegation of Medication Administration

  • Nursing laws and rules permit RN and LPN delegation of technical medication administration tasks to UAP via permitted routes.
  • Provided the criteria meet state and federal regulations, agency policies/procedures, and the NCBON Position Statement.
  • The Position Statement provides specific information regarding the delegation.

Delegation of Non-Nursing Functions

  • Technical tasks supporting client care that do not require a nurse’s professional judgment are generally considered non-nursing activities.
  • May be delegated to UAP as allowed by agency policy/procedures, state/federal regulations, and the Decision Tree.
  • Examples:
    • Laboratory functions (capillary blood glucose analysis, phlebotomy).
    • EKG procedure.
    • Use of Automated External Defibrillator (AED).
    • Pulse oximetry and transcutaneous CO_2 monitor.
    • Handing instruments.
    • X-ray procedures.
    • Audiometric screening.
    • Vital signs.
    • Set up and use of simple durable medical equipment (lifts, wheelchairs, etc.).
  • Client care activities that do not meet ALL Decision Tree criteria shall be performed by the licensed nurse (RN or LPN).

Notes

  • Each individual is responsible for performing only activities within their competence and scope of practice.
  • Delegation is client and situation-specific.
  • The nurse must consider all components of the delegation process for each decision.
  • The nurse must implement the steps of delegation as provided in the Decision Tree.

Development of Delegation Skills

  • Effective delegation requires development.
  • Initial nursing education programs provide content, but true delegation opportunity is limited for students.
  • Employers need to provide opportunities for nurses (RN and LPN) to gain knowledge, skill, and competency for safe assignments and delegations within their legal scope of practice.
  • An agency’s chief nursing officer is responsible for establishing policies, procedures, practices, and communication channels to provide a framework for safe assignment and delegation.

References

  • G.S. 90-171.20 (7) (d) & (i) and (8) (d) Nursing Practice Act
  • 21 NCAC 36.0224 (a) (d) (i) & (j) Components of Practice for the Registered Nurse (RN Rules)
  • 21 NCAC 36.0225 (a) (d) (1) (F),(2) (A-E) Components of Practice for the Licensed Practical Nurse (LPN Rules)
  • 21 NCAC 36.0221 - License Required
  • 21 NCAC 36.0401 - Roles of Unlicensed Personnel
  • NCBON Decision Tree for Delegation to UAP
  • NCBON Position Statement - Delegation of Medication Administration to UAP