DELEGATION TO UNLICENSED ASSISTIVE PERSONNEL

[This section is taken from F.A.C. 64B9-14, Delegation to unlicensed assistive personnel.]

Registered nurses and LPNs must follow the rules from the F.A.C. when delegating tasks to unlicensed assistive personnel (UAPs). UAPs are defined as persons who do not hold licensure from the Division of Health Quality Assurance of the Department of Health but who have been assigned to function in an assistive role to registered nurses or licensed practical nurses in the provision of patient-care services through regular assignments or delegated tasks or activities and under the supervision of a nurse. Examples of UAPs are CNAs and home health aides.

When the RN or LPN is delegating, they must use nursing judgment to consider the suitability of the task or activity to be delegated. Factors to weigh in selecting the task or activity include:

  • Potential for patient harm
  • Complexity of the task
  • Predictability or unpredictability of outcome, including the reasonable potential for a rapid change in the medical status of the patient
  • Level of interaction required or communication available with the patient
  • Resources (e.g., equipment, personnel) available in the patient setting

Factors to weigh in selecting and delegating to a specific delegate include:

  • Normal assignments of the UAP
  • Validation or verification of the education and training of the delegate

The delegation process shall include communication to the UAP that identifies the task or activity, the expected or desired outcome, the limits of authority, the time frame for the delegation, the nature of the supervision required, verification of delegate’s understanding of assignment, verification of monitoring, and supervision.

Initial allocation of the task or activity to the delegate, periodic inspection of the accomplishment of such task or activity, and total nursing care responsibility remains with the qualified nurse delegating the tasks or assuming responsibility for supervision.

Delegation of Tasks Prohibited

The registered nurse or licensed practical nurse, under direction of the appropriate licensed professional as defined in F.S. 464.003(3)(b), shall not delegate:

  • Those activities not within the delegating or supervising nurse’s scope of practice
  • Nursing activities that include the use of the nursing process and require the special knowledge, nursing judgment, or skills of a registered or practical nurse, including:
    • The initial nursing assessment or any subsequent assessments
    • The determination of the nursing diagnosis or interpretations of nursing assessments
    • Establishment of the nursing care goals and development of the plan of care
    • Evaluation of progress in relationship to the plan of care
  • Those activities for which the UAP has not demonstrated competence
    (FLDOS, 2010d)
CASE

Sabrina is an RN in a busy medical-surgical department at a hospital in Miami. She is in the middle of passing morning medications when her new post-op patient, Mr. Winters, rings in complaining of severe pain. When she arrives to Mr. Winters’ room, Sabrina performs a focused assessment of his surgical dressing and finds everything within normal limits. Sabrina consults the electronic medication administration record (eMAR) and sees that Mr. Winters has IV morphine ordered for severe pain. She also recalls the report from the PACU nurse stating that Mr. Winters’ blood pressure was running low.

In reviewing the tasks at hand, Sabrina knows she needs to continue with medications for her other patients, to get a new set of vitals on Mr. Winters to be sure his blood pressure won’t drop with a new dose of IV morphine, and then to administer the pain medication to Mr. Winters. In order to accomplish her tasks in a timely manner, Sabrina determines that it is necessary to delegate a task to the appropriate assistive personnel. She remembers that Martha, a CNA, has also been assigned to her patients.

Sabrina contacts Martha to see if she is available to take Mr. Winters’ blood pressure, knowing that taking patients’ vitals is within Martha’s education and training and is part of her normal assignment as a CNA. Sabrina indicates to Martha that she will continue passing medications while Martha gets the patient’s vitals, which she should carry out right away. Sabrina informs Martha that she will be with the patient in the next room by the time Martha has the vital signs. Martha agrees and begins to take Mr. Winters’ blood pressure.

Martha finds Sabrina as she is coming out of the room next door and reports that Mr. Winters’ blood pressure is 118/58, which presents no contraindication to administering the IV morphine. Sabrina goes to the department’s med room to obtain the pain medication and administers the morphine, relieving Mr. Winters’ pain. She thanks Martha for her help and then returns to her other patients.