4.3 The Healthcare Team and Delegation
Key Takeaways
- CNAs work within an interprofessional team and report to the charge nurse in the chain of command
- Delegation follows the Five Rights: Right Task, Right Circumstance, Right Person, Right Direction, Right Supervision
- Only licensed nurses can delegate tasks — CNAs cannot delegate to other CNAs
- The nurse retains accountability; the CNA is responsible for performing the delegated task correctly
- CNAs should refuse tasks outside their scope of practice, politely and professionally
- If a concern is not addressed by the immediate supervisor, go up the chain of command
The Healthcare Team and Delegation
As a CNA in Illinois, you work as part of an interprofessional healthcare team. Understanding each team member's role, the chain of command, and the rules of delegation is essential for providing safe, effective care and staying within your scope of practice.
Healthcare Team Members
| Team Member | Role | CNA Interaction |
|---|---|---|
| Physician (MD/DO) | Diagnoses conditions, orders treatments | Follow orders as directed by the nurse |
| Registered Nurse (RN) | Assesses patients, creates care plans, administers medications | Primary supervisor; report changes to the RN |
| Licensed Practical Nurse (LPN) | Provides skilled nursing care under RN direction | May supervise CNAs; follow instructions |
| CNA | Provides basic direct care under nurse supervision | Perform delegated tasks within scope |
| Physical Therapist (PT) | Develops mobility and exercise programs | Assist with PT-directed exercises per care plan |
| Occupational Therapist (OT) | Helps residents regain daily living skills | Reinforce OT techniques during ADL care |
| Speech-Language Pathologist (SLP) | Addresses swallowing and communication disorders | Follow SLP diet orders; report swallowing difficulties |
| Dietitian/Nutritionist | Plans therapeutic diets | Follow diet orders; report food intake |
| Social Worker | Addresses psychosocial needs, discharge planning | Report resident/family concerns |
| Activities Director | Plans recreational and therapeutic activities | Encourage participation; assist with activities |
| Chaplain/Clergy | Provides spiritual support | Accommodate religious preferences |
Chain of Command in Illinois Facilities
The typical chain of command in an Illinois long-term care facility:
- CNA → Reports to the charge nurse
- Charge Nurse (RN or LPN) → Manages the unit or shift
- Unit Manager (RN) → Oversees the nursing unit
- Director of Nursing (DON) → Leads all nursing staff
- Administrator → Manages the entire facility
- Medical Director (MD) → Oversees medical care
Important: If your immediate supervisor does not address a concern, you have the right to go up the chain of command. If the concern involves resident safety, you may also contact IDPH directly.
Understanding Delegation
Delegation is the process by which a licensed nurse assigns specific nursing tasks to a CNA. In Illinois, delegation follows specific rules:
| Delegation Principle | Explanation |
|---|---|
| The Five Rights of Delegation | Right task, right circumstance, right person, right direction, right supervision |
| Only nurses can delegate | CNAs cannot delegate tasks to other CNAs |
| Accountability | The nurse retains accountability; the CNA is responsible for performing the task correctly |
| Within scope | Only tasks within the CNA scope of practice can be delegated |
| Competency | The CNA must be trained and competent to perform the task |
The Five Rights of Delegation
| Right | Question | Example |
|---|---|---|
| Right Task | Is this task within the CNA's scope? | Vital signs = Yes; Medication = No |
| Right Circumstance | Is the situation appropriate for this task? | Stable resident = Yes; Acute emergency = Nurse should handle |
| Right Person | Is this CNA trained and competent? | Experienced CNA = Yes; New CNA not yet trained = No |
| Right Direction | Were clear instructions given? | Specific time, method, and reporting requirements |
| Right Supervision | Is appropriate supervision available? | Licensed nurse accessible for questions |
When to Refuse a Delegated Task
You should refuse (politely and professionally) if:
- The task is outside your scope of practice (e.g., administering medications)
- You are not trained on the specific procedure
- The situation is unsafe for you or the resident
- There is no supervision available
- The task conflicts with facility policy
How to refuse professionally:
- State clearly: "I'm not able to do that because it's outside my scope of practice"
- Offer an alternative: "I can help you find the nurse to do that"
- Document the situation if you feel it's necessary
- Report the concern to the DON if it continues
A nurse asks you to administer an oral medication to a resident because the nurse is busy with another patient. What should you do?
Which of the Five Rights of Delegation asks, "Is the CNA trained and competent to perform this task?"