Key Takeaways
- Delegation is the transfer of task performance while retaining accountability
- The Five Rights of Delegation are: Task, Circumstance, Person, Direction, Supervision
- Nurses remain accountable; CNAs are responsible for task performance
- CNAs should refuse tasks outside their scope or competency
- Effective supervision requires clear communication and appropriate oversight
Delegation and Supervision
Delegation is the process by which a licensed nurse assigns appropriate tasks to CNAs. Understanding how delegation works protects both you and your patients.
What is Delegation?
Delegation means transferring the performance of a task to another person while retaining accountability for the outcome. Key points:
- Nurses delegate tasks to CNAs
- Nurses remain accountable for patient outcomes
- CNAs are responsible for performing tasks correctly
- Tasks must be appropriate for CNA scope of practice
The Five Rights of Delegation
Nurses use these five rights when delegating to CNAs:
| Right | Question | Example |
|---|---|---|
| Right Task | Is this appropriate for a CNA? | Vital signs - Yes; IV medications - No |
| Right Circumstance | Is the patient stable enough? | Stable patient vs. critical patient |
| Right Person | Is this CNA competent? | New CNA may need more supervision |
| Right Direction | Were clear instructions given? | "Take BP now and report if over 160" |
| Right Supervision | Will appropriate oversight occur? | Nurse available for questions |
CNA Responsibilities in Delegation
When a task is delegated to you, you must:
- Confirm you understand the task and expectations
- Ask questions if anything is unclear
- Perform the task as instructed
- Report completion and any findings
- Document appropriately
- Notify the nurse immediately of any problems
When to Refuse a Delegated Task
You should refuse to perform a task if:
- It's outside your scope of practice (you're not authorized)
- You're not competent to perform it (you lack training)
- The patient's condition is unstable (beyond CNA capability)
- Proper equipment is not available
- You cannot complete it safely
How to refuse appropriately:
"I'm not comfortable doing that because [reason]. Can you help me or show me how?"
Levels of Supervision
Supervision varies based on task complexity and CNA experience:
| Level | Description | Examples |
|---|---|---|
| Continuous | Nurse present throughout | New procedures, high-risk activities |
| Intermittent | Nurse checks periodically | Routine care, stable patients |
| Available | Nurse available if needed | Experienced CNA, routine tasks |
Accountability vs. Responsibility
Understanding the difference protects everyone:
| Term | Definition | Who Has It |
|---|---|---|
| Accountability | Answerable for outcomes | The delegating nurse |
| Responsibility | Required to perform task | The CNA |
Example: If a nurse delegates vital signs and the CNA records them incorrectly:
- The CNA is responsible for the incorrect recording
- The nurse is accountable for the patient outcome
- Both may face consequences if harm occurs
Working with Supervision
To work effectively with your supervisor:
Do:
- Ask questions when unsure
- Report changes promptly
- Complete tasks as assigned
- Follow instructions carefully
- Document accurately
Don't:
- Assume you know what to do
- Hide mistakes
- Ignore abnormal findings
- Skip steps to save time
- Perform tasks you're unsure about
Who retains accountability when a task is delegated to a CNA?
Which is NOT one of the Five Rights of Delegation?
When should a CNA refuse a delegated task?