Which nursing action may be delegated to an unlicensed assistive personnel UAP working on the medical unit?

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UAP delegation: A step-by-step process
Learning Outcomes
Test Taking Tip
Video Rationale
Introduction
Issues of Concern
Clinical Significance
Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel UAP )? Quizlet?
Which task would be appropriate for the nurse to assign to an unlicensed assistive personnel UAP?
Which task may the nurse delegate to unlicensed assistive personnel UAP?
Which tasks are appropriate for the unlicensed assistive personnel?
Which task may be safely delegated to unlicensed assistive personnel UAP )?
Which task would be appropriate for the nurse to assign to an unlicensed assistive personnel UAP?
Can UAP do daily weights?
Which task is appropriate for the nurse to delegate to the assistive personnel?

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Legal Checkpoints

UAP delegation: A step-by-step process

Sheehan, Joanne P. RN, BSN, JD

Author Information

About the author: Joanne P. Sheehan is a nurse-attorney at Friedman, Newman, Levy, Sheehan, Carolan, p.c., Attorneys-at-Law, Fairfield, Conn. She's also a member of The American Association of Nurse Attorneys, Pensacola, Fla.

Nursing Management (Springhouse): April 2001 - Volume 32 - Issue 4 - p 22

Abstract

Question

The nursing student is reviewing tasks that are appropriate to delegate to unlicensed assistive personnel (UAP). Which of the following tasks does the student correctly choose? Select all that apply.

Índice

Learning Outcomes
Test Taking Tip
Video Rationale
Introduction
Issues of Concern
Clinical Significance
Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel UAP )? Quizlet?
Which task would be appropriate for the nurse to assign to an unlicensed assistive personnel UAP?
Which task may the nurse delegate to unlicensed assistive personnel UAP?
Which tasks are appropriate for the unlicensed assistive personnel?

Answers

Taking vital signs on a client who is 2 days post-op
- Rationale:
  This is the correct answer because a client who is two days post-op is considered stable and, therefore, this is an appropriate task to delegate to UAP. It would not be appropriate to delegate vital signs to the UAP if the client had recently returned from surgery. UAP can take vital signs on stable clients, and they can assist with activities of daily living, hygiene needs, linen changes, positioning, and other simple tasks
Picking up a client’s prescription for metoprolol from the pharmacy
- Rationale:
  This is the correct answer because retrieving a non-controlled drug from the pharmacy is a simple task that UAP are qualified to perform. Appropriate tasks to delegate to UAPs include uncomplicated, non-sterile tasks. UAP can take vital signs on stable clients, and they can assist with activities of daily living, hygiene needs, linen changes, positioning, and other simple tasks
Taking vital signs on a client that just returned from PEG tube placement
- Rationale:
  This is not the correct answer because a client that just returned from PEG tube placement is not considered stable. The registered nurse should obtain the first set of vital signs after a procedure.
Recording the intake and output on a client with a Foley catheter
- Rationale:
  This is the correct answer because recording intake and output on a client with a Foley catheter is within the scope of practice for UAP. UAP can measure and record intake and output. However, UAP are not expected to evaluate the findings (i.e. determine that the client may be experiencing fluid overload due to a significantly higher intake than output).
Assigning lunch times to the staff working on the floor for the day
- Rationale:
  This is not the correct answer because assigning lunch times to the staff working on the floor is not a role that the UAP should fill. This is a management duty and should be performed by the unit manager or charge nurse, both of whom are qualified to make assignments to the floor staff.

Overview

The student correctly chooses appropriate tasks to delegate to UAP including taking vital signs on a client that is 2 days post-op, picking up a client’s prescription for metoprolol, and recording the intake and output on a client with a Foley catheter.

Learning Outcomes

Appropriate tasks to delegate to UAPs include uncomplicated, non-sterile tasks. UAP can take vital signs on stable clients, and they can assist with activities of daily living, hygiene needs, linen changes, positioning, and other simple tasks. It is not appropriate to delegate vital signs on a client that just returned from a procedure to UAP. The first set of vital signs should be obtained by the registered nurse and continuing assessments can be obtained by the practical nurse. It is also not appropriate to delegate management tasks. Assigning lunch times to staff should be handled by the charge nurse or unit manager.

Test Taking Tip

UAPs can perform many non-invasive and non-sterile tasks. However, they should not be assigned vital signs on a client that may not be stable, and they are not assigned managerial duties.

Video Rationale

Introduction

Many definitions for delegation exist in professional literature. One of the most commonly cited definitions of the word was jointly established by the American Nurses Association and the National Council of State Boards of Nursing. These groups describe delegation as the process for a nurse to direct another person to perform nursing tasks and activities. Delegation involves at least two individuals: the delegator, and the delegatee. The delegator is a registered nurse who distributes a portion of patient care to the delegatee.

Essential Components of Delegation

Responsibility

Based on individual states’ nurse practice acts, registered nurses have a professional duty to perform patient care tasks dependably and reliably.

Authority

Authority refers to an individual’s ability to complete duties within a specific role. This authority derives from nurse practice acts and organizational policies and job descriptions.

Accountability

Accountability within the nursing context refers to nursing professionals’ legal liability for their actions related to patient care. During delegation, delegators transfer responsibility and authority for completing a task to the delegatee; however, the delegator always maintains accountability for the task's completion. The registered nurse is always accountable for the overall outcome of delegated tasks based on each state's nurse practice act provisions.

Possible legal and ethical constraints arise regarding delegation in nursing. Therefore, the American Nurses Association developed the five rights of delegation to assist nurses in making safe decisions.

Five Rights of Delegation

Right task
Right circumstance
Right person
Right supervision
Right direction and communication[1]

Issues of Concern

Five Rights of Delegation Case Study Approach

Mark is a new graduate registered nurse who has recently completed nursing orientation. He is now on his second week of non-precepted practice on a busy medical-surgical unit. During the middle of his busy night shift, Mark has several tasks that need to be completed quickly. These tasks include a linen change for a patient who just vomited, an assessment of a possibly infiltrated intravenous line, and the administration of intravenous pain medication for a patient who rates her pain 10 out of 10. Mark also needs to make hourly rounds within the next few minutes, and he is very behind on his charting. He knows he must delegate some of the tasks to his coworkers. However, Mark is unsure what he can delegate and to whom. He decides to use the five rights of delegation to help with his delegation decisions.

Right tasks

First, Mark needs to determine which tasks are right to delegate. Some questions he may ask at this time would include (1) which tasks are legally appropriate to delegate and (2) can I delegate these tasks based on this organization’s policies and procedures? Correctly answering these questions will require familiarity with institutional and nurse practice act guidance. Generally, registered nurses are responsible for assessment, planning, and evaluation within the nursing process. These actions should not be delegated to someone who is not a registered nurse.[2]

Right circumstances

After determining the right tasks for delegation, Mark considers the right circumstances of delegation. In so doing, Mark may ask the following questions: (1) are appropriate equipment and resources available to perform the task, (2) does the delegatee have the right supervision to accomplish the task, and (3) is the environment favorable for delegation in this situation? To appropriately answer these questions, it is imperative that Mark completes an assessment on each client. Patients who are or may become unstable and cases with unpredictable outcomes are not good candidates for delegation. For example, it may be appropriate for unlicensed assistive personnel to feed patients requiring assistance with the activities of daily living. However, if a patient has a high risk for aspiration and a complicated specialty diet, delegation of feeding to unlicensed assistive personnel may not be safe.

Right person

If a task and circumstance are right for delegation, the next “right” of delegation is the right person. Mark needs to consider if the potential delegatees have the requisite knowledge and experience to complete delegated tasks safely, especially concerning the assessed patient acuity. Before delegating a task, the registered nurse must know the delegatee’s job description and previous training. Mark may be unsure about his potential delegatee’s qualifications. Therefore, he might ask the following questions before delegating a task: (1) have you received training to perform this task, (2) have you ever performed this task with a patient, (3) have you ever completed this task without supervision, and (4) what problems have you encountered in performing this task in the past?

Right supervision

The right supervision must be available in all delegation situations. Nurse practice acts require the registered nurse to provide appropriate supervision for all delegated tasks. In the case study, Mark must be sure that the delegatee will provide feedback after the task is complete. Following task completion, Mark is responsible for evaluating the outcome of the task with the patient. Registered nurses are accountable for evaluation and the overall patient outcomes.

Right direction and communication

Finally, the delegator must give the right direction and communication to the delegatee. All delegators must communicate performance expectations precisely and directly.[3] Mark should not assume that his delegatee knows what to do and how to do it, even for routine tasks. Mark must consider whether the delegatee understood the assigned task, directions, patient limitations, and expected outcomes before the delegatee assumes responsibility for it. The delegatee also must comprehend what, how, and when to report back after the delegated task is complete. Delegatees also need a deadline for task completion for time-sensitive tasks.[4]

Using the five rights of delegation, Mark appropriately took care of his patients’ needs. Mark delegated the linen change to trained unlicensed assistive personnel, and he entrusted his hourly rounds to his shift charge nurse. Mark opted to assess the patient with a possibly infiltrated intravenous site first. Upon finding the site infiltrated, he assessed his patient, removed the intravenous line, and placed a warm compress on the patient’s elevated extremity. He then administered another patient’s requested pain medications after delegating new intravenous catheter placement to an intravenous-certified coworker for the patient with the infiltration. Mark was able to complete all his documentation requirements by the end of his shift.

Clinical Significance

Reasons Delegation is Necessary for the Modern Health Care Environment

If delegation decisions are so challenging and legally charged, why should nurses delegate? Fiscal constraints, nursing shortages, and increases in patient care complexity have cultivated an environment in which delegation is necessary. If appropriately used, delegation can significantly improve patient care outcomes.

Improper Delegation

Improper delegation can negatively impact patient care while also potentially exposing the delegator to legal action.[5] All members of the health care team have valuable contributions to make toward safe, effective patient care.

Essentials of Communication

While employing the five rights of delegation in nursing practice, it is important to remember that the way the delegator asks the delegatee to perform a task can make a big difference. The delegator must use direct, honest, open, closed-loop communication to encourage teamwork and safe task performance.[6] Of the five rights of delegation, the right communication and direction are arguably the most important in ensuring good quality and safety outcomes.[7] Common delegation deficiencies for registered nurses occur when delegating tasks to unlicensed assistive personnel. These include unclear delegation directions from the registered nurse, a lack of retained accountability and follow-through, and the failure of the registered nurse to obtain the agreement of the unlicensed assistive personnel.[8]

References

Neumann TA. Delegation-better safe than sorry. AAOHN J. 2010 Aug;58(8):321-2. [PubMed: 20704120]

McMullen TL, Resnick B, Chin-Hansen J, Geiger-Brown JM, Miller N, Rubenstein R. Certified Nurse Aide scope of practice: state-by-state differences in allowable delegated activities. J Am Med Dir Assoc. 2015 Jan;16(1):20-4. [PubMed: 25239017]

Siegel EO, Young HM. Communication between nurses and unlicensed assistive personnel in nursing homes: explicit expectations. J Gerontol Nurs. 2010 Dec;36(12):32-7. [PubMed: 20669856]

Bittner NP, Gravlin G. Critical thinking, delegation, and missed care in nursing practice. J Nurs Adm. 2009 Mar;39(3):142-6. [PubMed: 19590471]

Gravlin G, Phoenix Bittner N. Nurses' and nursing assistants' reports of missed care and delegation. J Nurs Adm. 2010 Jul-Aug;40(7-8):329-35. [PubMed: 20661063]

Weydt AP. Defining, analyzing, and quantifying work complexity. Creat Nurs. 2009;15(1):7-13. [PubMed: 19343844]

Hopkins U, Itty AS, Nazario H, Pinon M, Slyer J, Singleton J. The effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction: a systematic review. JBI Libr Syst Rev. 2012;10(15):895-934. [PubMed: 27820462]

Kalisch BJ. The impact of RN-UAP relationships on quality and safety. Nurs Manage. 2011 Sep;42(9):16-22. [PubMed: 21873843]

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel UAP )? Quizlet?

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Tell the UAP to check the amount, color, and consistency of the client's urine output.

Which task would be appropriate for the nurse to assign to an unlicensed assistive personnel UAP?

Which tasks can the nurse delegate to the unlicensed assistive personnel (UAP)? 2. & 5. Correct: Measurement of intake and output and oral hygiene for the older client are tasks that the UAP can perform, and these tasks may be delegated.

Which task may the nurse delegate to unlicensed assistive personnel UAP?

Routine tasks, such as taking vital signs, supervising ambulation, bed making, assisting with hygiene, and activities of daily living, can be delegated to an experienced UAP. The charge nurse appropriately delegates the routine task of feeding to the UAP.

Which tasks are appropriate for the unlicensed assistive personnel?

Typical UAP Tasks Common ADLs include bathing and grooming, feeding, dressing, toileting, ambulating, and continence.

Which task may be safely delegated to unlicensed assistive personnel UAP )?

Documenting intake/output, assisting with activities of daily living, and performing other routine client care tasks can be safely delegated to the UAP.

Which task would be appropriate for the nurse to assign to an unlicensed assistive personnel UAP?

Can UAP do daily weights?

The nursing action that can be delegated to a UAP on the medical unit is to obtain daily weights for several clients with class IV heart failure. Daily weight assessment is included in the role of the nursing assistant, who will report the weights to the RN.

Which task is appropriate for the nurse to delegate to the assistive personnel?

Which is an appropriate task for the nurse to delegate to a nursing assistant? 3. Toileting a patient on a routine basis is appropriate to delegate to a nursing assistant. The activities that can be delegated include activities that are repetitive and do not require much supervision.