1. Delegation
Chapter 2

2. Delegation Principles
To authorize another person to perform a nursing task in a certain situation
Nursing Task:
Procedure, activity or work that does not require an RN’s professional knowledge or judgement.
Example:
MA-C has been administering medications to Mr. Snuffy, however he has recently developed swallowing problems.
What do you do?
What is the MA-C role?

3. NACs and MA-Cs cannot delegate
Who can delegate?
RNs and LPNs can only delegate tasks within their scope of practice
The delegating nurse is legally accountable for the nursing task
RNs can delegate nursing tasks to LPNs, NACs and MA-Cs.
LPNs can delegate nursing tasks to NACs
Delegation must protect the patients health and safety.
NACs and MA-Cs cannot delegate

4. Delegation Process
The nurse decides whether or not a task can be delegated to you.
Each situation or circumstance is an independent….a task that is delegated to you once may not be delegated to you in the future
The delegating nurse will decide what is best for the patient at that given time.
Patient’s circumstances are central factors in the delegation process

5. Delegation Process (continued)
Assess and Plan:
Performed by nurse
Nurse must understand patient’s needs as well as the MA-Cs knowledge skills and job description

6. Delegation Process (continued)
Communication:
Performed by both the nurse and MA-C
Nurse provide the MA-C with clear and complete directions about:
How to perform the task
What observations to report and record
What specific patient & resident concerns to report
Priorities for nursing tasks
What to do if the patient’s conditions or needs change
Before performing a delegated task be sure to discuss the task and ask any questions
After completing the task the MA-C must report and record the care given, including any observations

7. Delegation Process (continued)
Surveillance & Supervision:
Surveillance:
To keep a close watch over someone or something
Supervise:
To oversee, direct or manage
The delegating nurse will oversee the care that the MA-C provides as well as the patient’s condition and their response to the MA-Cs care.
Nurses will make observations based upon:
Patient’s health status & needs
If the patient is stable or unstable
If the nurse can predict the patient’s response & risk to care
Setting where nursing task occurs
Resources & support available
Complexity of nursing task

8. Delegation Process (continued)
Evaluation & Feedback
Completed by the nurse
Determines if the delegation was successful

9. 5 Rights of Delegation Right Task Right Circumstance Right Person
Right Directions & Communication
Right Supervision

10. Your Role in Delegation
Remember:
YOU perform delegated nursing tasks for or on a person.
YOU must protect the person from harm
YOU have 2 choices…..
Accept the delegated task
Refuse the delegated task

11. Accepting the Task
When you agree to perform a task, you are responsible for your own actions
YOU MUST COMPLETE THE TASK SAFELY
What you do or fail to do can harm the person
Ask for help when you are unsure or have questions
Report to nurse what you did & your observations

12. Refusing a Task You have the right to say “NO”
Sometimes refusing to follow the nurse’s direction is your right and duty
Refuse a task when it is:
Beyond your legal limits or unethical
Not in your job description
Not properly trained
You could harm the person
Directions are against agency policy
Directions are unclear or incomplete
No nurse supervision
Never ignore an order or request, rather communicate your concerns with the nurse

13. Delegating to MA-Cs
The actual task of giving certain drugs may not require a nurse’s judgement, hence nurses are able to delegate the task of giving such drugs. HOWEVER……. The nurse cannot delegate the nursing actions and judgements needed before and after a drug is given.

14. MA-Cs Role in Medication Administration Process
A new or continued drug order is written. The drug is ordered based on the person’s need
Drug order is sent to the pharmacy
Pharmacy fills the drug order and delivers it to the nursing unit. The drug is stored on the nursing unit
Nurse plans to give the drug
Nurse delegates giving the drug to the MA-C
MA-C gives the drug (Delegating nurse supervises the drug administration process)
Nurse monitors the person’s response to the drug
Person’s continued need for the drug is evaluated
An order is written to discontinue the drug
MA-Cs Role in Medication Administration Process

15. Delegating to MA-Cs (continued)
MA-Cs roles is to give the drug
This is only one step in the process
Nurse cannot delegate any other step in the process
Steps that cannot be delegated to the MA-C
Assessing patient’s need for a drug
Determining the need for PRN drugs
Recognizing allergic RXNs
Assessing & evaluating side effects
Assessing & evaluating immediate desired effects
Recognizing when the person no longer needs the drug
Recognizing when continued use may be harmful