3.2 Delegation and Chain of Command
Key Takeaways
- Delegation means a licensed nurse assigns a task while retaining responsibility for nursing judgment.
- The CNA is responsible for accepting only tasks within training, scope, and facility policy.
- Clear directions include what to do, what to report, and when to report back.
- Use the chain of command when a resident risk is not addressed.
- Never ignore a serious concern because one person seemed busy.
Delegation In CNA Practice
Delegation is not dumping work. A nurse decides which tasks can be assigned to a CNA based on the resident condition, the task, the CNA's training, and the available supervision.
The CNA must understand the assignment and report back. If instructions are unclear, ask before doing the task.
The Five Rights Of Delegation
| Right | CNA Question |
|---|---|
| Right task | Is this appropriate for a CNA? |
| Right circumstance | Is the resident stable enough? |
| Right person | Am I trained and competent? |
| Right direction | Do I know exactly what to do? |
| Right supervision | Is help or follow-up available? |
Chain Of Command
The normal chain starts with the charge nurse or supervising nurse. If a serious safety issue is not addressed, continue upward according to facility policy.
A typical path is:
- Assigned nurse or charge nurse.
- Nursing supervisor.
- Director of Nursing.
- Administrator or designated reporting system.
- Outside agency for reportable abuse or immediate danger.
What To Report Immediately
Do not wait for end-of-shift charting when you observe:
- Fall or injury.
- Chest pain or trouble breathing.
- New confusion or weakness.
- Refusal of essential care or meals.
- Signs of abuse, neglect, or exploitation.
- New bleeding, vomiting, seizure, or severe pain.
- Abnormal vital signs by facility policy.
- Unsafe equipment or environment.
Teamwork Boundaries
CNAs support each other, but you cannot delegate your assignment to another CNA and assume it is done. If you ask for help, communicate clearly and verify critical care was completed.
On the exam, the safe answer usually includes reporting to the nurse, staying within scope, and following policy.
A nurse asks a CNA to perform a task the CNA has never been trained to do. What is the best response?
Which observation should be reported immediately?