126 unit 2 | Working Within the Organization
Inherent in today’s health-care environment is
the safety of the client. The quality of client care
and the delievery of safe and effective care are cen-
tral to the concept of delegation. RNs are held
accountable when delegating care activities to oth-
ers. This means that they have an obligation to
intervene whenever they deem the care provided is
unsafe or unethical. It is also important to realize
that a delegated task may not be “sub-delegated.”
In other words, if the RN delegated a task to the
LPN, the LPN cannot then delegate the task to the
UAP, even if the LPN has decided that it is within
the abilities of that particular UAP. There may be
legal implications if a client is injured as a result of
inappropriate delegation. Take the following case:
In Hicks v. New York State Department of Health,
a nurse was found guilty of patient neglect because
of her failure to appropriately train and supervise
the UAP working under her. In this particular
situation, a security guard discovered an elderly
nursing home client in a totally dark room
undressed and covered with urine and fecal materi-
al. The client was partially in his bed and partially
restrained in an overturned wheelchair. The court
found the nurse guilty on the following: the nurse
failed to assess whether the UAP had delivered
proper care to the client, and this subsequently led to
the inadequate delivery of care (1991).Quality-of-Care Issues
Nurses have expressed concern over the quality of
client care when tasks and activities are delegated
to others. Remember Nightingale’s words earlier in
the chapter, “Don’t imagine that if you, who are in
charge, don’t look to all these things yourself, those
under you will be more careful than you are.” She
added that you do not need to do everything
yourself to see that it is done correctly. When you
delegate, you control the delegation. You decide to
whom you will delegate the task. Remember that
there are levels of acceptable performance and that
not every task needs to be done perfectly.Assigning Work to Others
Assigning work can be difficult for several reasons:
1.Some nurses think they must do everything
themselves.
2.Some nurses distrust subordinates to do things
correctly.
3.Some nurses think that if they delegate all the
technical tasks, they will not reinforce their
own learning.
4.Some nurses are more comfortable with the
technical aspects of client care than with the
more complex issues of client teaching and
discharge planning.
Families and clients do not always see professional
activities. Rather, they see direct client care
(Keeney, Hasson, McKenna, & Gillen, 2005).
Nurses believe that when they do not participate
directly in client care, they do not accomplish any-
thing for the client. The professional aspects of
nursing, such as planning care, teaching, and dis-
charge planning, help to promote positive out-
comes for clients and their families. When working
with LPNs, knowing their scope of practice helps
in making delegation decisions.Models of Care Delivery
Functional nursing, team nursing, total client care,
and primary nursing are models of care delivery that
developed in an attempt to balance the needs of the
client with the availablity and skills of nurses. Bothtable 9-1
Direct and Indirect Client Care Activities
Direct Client Care Activities Indirect Client Care Activities
Assisting with feeding and drinking Providing a clean environment
Assisting with ambulation Providing a safe environment
Assisting with grooming Providing companion care
Assisting with toileting Providing transportation for noncritical clients
Assisting with dressing Assisting with stocking nursing units
Assisting with socializing Providing messenger and delivery services
Adapted from American Nurses Association. (2002). Position Statement on Utilization of Unlicensed Assistive Personnel.
Washington, DC: American Nurses Association.