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