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How to delegate to UAPs

Cox, Susan S. RN, CNS, MSN

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Susan S. Cox is a member of the Huron School of Nursing's nursing faculty in East Cleveland, Ohio.

You probably count on unlicensed assistive personnel (UAPs) to help you care for your patients. As an RN or LPN, however, you're ultimately responsible for your patients, even when you've delegated some of their care to a UAP.

To delegate legally, safely, and effectively, you need to know a few rules. Before handing off duties to UAPs, check the following five points to make sure you're meeting your responsibilities.

1. State laws. Make sure you know the scope of your own practice. The laws that govern your practice as a licensed nurse are the legal foundation for any decisions you make about delegating work to others. Contact the state board of nursing to find out what laws govern nursing practice where you're working. In general, you can't legally delegate activities that require advanced education to a UAP; similarly, activities that require a judgment based on analysis of data are beyond a UAP's scope of practice. When delegating to a UAP, put the emphasis on tasks, not thought processes.

2. Policies and procedures. Review your facility's written policies on delegation and compare its expectations with the legal requirements of the nurse practice act. They should be in agreement, but if you find a conflict, seek clarification. To keep your license safe, remember that the nurse practice act supersedes employer policy.Make sure you have answers to these questions:

* What hiring policies does the facility have for UAPs? For example, if state-tested nursing assistants (STNAs) are available in your state, does the facility hire only STNAs?

* How are new UAPs oriented to their job? For example, is a UAP observed and evaluated for her ability to perform assigned tasks? Are follow-up evaluations scheduled? If so, at what intervals?

* What resources are available if a UAP needs more training?

* Are all UAPs expected to have the same responsibilities for patient care or do responsibilities differ by unit, experience, or training?

* Is a union involved? If so, what are its requirements and expectations regarding delegation?

3. UAPs. Get to know your UAPs as individuals. Learning each person's abilities will help you delegate safely and effectively.

4. Patients. Whether or not a task can be appropriately delegated may depend on your patient's condition rather than the task itself. For example, you might reasonably ask a UAP to help a stable, ambulatory patient to the bathroom. But asking him to assist an unstable patient by himself wouldn't be appropriate.In general, simple, routine tasks such as making unoccupied beds, supervising patient ambulation, assisting with hygiene, and feeding meals can be delegated. But if the patient is morbidly obese, recovering from surgery, or frail, work closely with the UAP or perform the care yourself.Your judgment is always key because whether or not delegating care is appropriate isn't always obvious. A patient may appear to be independent, yet still need care from someone skilled in communication. For example, a patient with newly diagnosed diabetes will benefit from the teaching and support you can offer while performing hands-on care you might otherwise delegate. Although delegating this “bed and bath” to a UAP is legal and safe, it may not be in this patient's best interest.

5. Delegation and leadership. How do you motivate the UAPs who are assigned to you? One of the best ways is to assess how well they meet the current standards of care. By observing UAPs as they complete their tasks, you can determine whether they need additional training to meet the standards of care. If they're doing fine, make sure you let them know. (See A Little Praise Goes a Long Way.)

Although you need to maintain standards, you should also be flexible. Acknowledge that some things can be done more than one way. You'll foster cooperative attitudes if you act as a guide and teacher, rather than a dictator.

Just as you need to trust the UAPs assigned to you, the UAPs need to trust you. The end result will be better patient care—the one goal shared by everyone on staff.

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DELEGATION

Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

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A little praise goes a long way

Here are a few ways to motivate a UAP on your staff:

* Remind him how important he is to you and how much you depend on him. A simple “thank you” at the end of each shift, or a specific “I really appreciated it when you…” shows him how important he is to you.

* Put something in writing for his supervisor or employment file (and his next evaluation) to document a job well done.

* Follow through on what he tells you. For example, he may be the first person a patient tells about a new symptom.

* Add a personal touch. Birthday cards, cakes, or other celebrations not only are fun, but they can also help establish a sense of teamwork.

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SELECTED REFERENCES

Cohen, S. Managers' fast track. Delegating vs. dumping: Teach the difference. Nursing Management. 35(10):14,18,52, October 2004.

National Council of State Boards of Nursing: Delegation: Concepts and Decision-Making Process. National Council Position Paper, 1995. Accessed online at http://www.ncsbn.org/regulation/uap_delegation_documents_delegation.asp, April 18, 2006.
National Council of State Boards of Nursing: Delegation Decision-Making Tree. 1997. Accessed online at http://www.ncsbn.org/pdfs/delegationtree.pdf, April 18, 2006.
Whitman, MM. Professional development. Return and report: Establishing accountability in delegation. American Journal of Nursing. 105(3):97, March 2005.

Williams JK and Cooksey MM. Navigating the difficulties of delegation. Nursing2004. 34(9):32hn12, September 2004.

© 2006 Lippincott Williams & Wilkins, Inc.

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