Competencies and Objectives (2 competencies)
1. Demonstrate leadership in the coordination of health care
Objectives – the registered nurse will:
- Exercise professional judgment when assigning interventions to other members of the health care team (e.g. RNs, LPNs and CCAs)
- Exercises professional judgment when delegating to unregulated healthcare providers
2. Practise in a manner consistent with assignment/delegation accountabilities
Objectives – the registered nurse will:
- Accept accountability for own actions and decisions when assigning
- Employ the decision-making factors specific to assignment as outlined within the decision-making framework for assignment
- Accept accountability for own actions and decisions when delegating
- Employ the decision-making factors specific to delegation as outlined within the decision-making framework for delegation
Synopsis of Information
RNs have responsibilities and accountabilities requiring them to know the processes involved for assignment and delegation. It is especially important as assigning and delegating to unregulated healthcare providers is becoming an increasing part of nursing practice in Nova Scotia.
Assignment means the allocation of clients or client care responsibilities or interventions that are within the care provider’s scope of practice and/or scope of employment.
Decisions about assignment are evaluated and adjusted as the healthcare team works together to meet the changing needs of clients. Registered nurses determine assignments according to the:
- client’s condition (complexity, variability and acuity)
- scope of practice of the health provider’s profession
- individual scope/competence of the individual performing the intervention
- scope of employment/agency policy
- context of practice.
Delegation means transferring the responsibility to perform a function or intervention to a care provider who would not otherwise have the authority to perform it. Registered nurses delegate health care activities to unregulated health care providers consistent with levels of expertise, education, job description/agency policy, legislation and person needs. Unregulated healthcare providers may include continuing care assistants (CCAs), youth health workers (YHW), personal care workers (PCWs), home support workers (HSWs), care team assistants (CTAs), orderlies, and others.
RNs do not delegate to LPNs. The knowledge that differentiates an RN’s practice from an LPN’s practice cannot be delegated away. RNs are accountable for the overall development and coordination of the nursing plan of care whereas, the LPN and other care providers contribute to the nursing care plan. Knowledge and the decision-making used to determine that care (i.e., the assessment, evaluation, and judgment of the RN) cannot be delegated.
Delegation does not involve transferring accountability for the outcome of the function or intervention although the delegated provider is responsible to successfully perform the intervention or task. Delegation is client specific, meaning that the delegation applies only to a designated client.
When delegating, the registered nurse is accountable for:
- assessing the client’s needs to inform the appropriateness of delegation
- the decision to delegate and to whom
- determining if the individual is competent to perform the delegated intervention
- supervision; and
- evaluating the overall outcome
The unregulated healthcare professional is accountable for:
- having sufficient knowledge, skills and judgement to accept the delegation
- refusing to accept delegation for those acts which s/he is not competent
- following agency policy and procedure
- performing the intervention safely, effectively and ethically
- documenting the care provided as per agency policy
- reporting observations and client information to the registered nurse
The employer is accountable and responsible for:
- providing adequate staff
- education processes to establish competence
- written policies and procedures related to delegation