3.2 The Healthcare Team & Delegation
Key Takeaways
- The RN assesses, plans care, and delegates; the LPN carries out treatments and may supervise CNAs; the CNA performs delegated direct care.
- Delegation transfers a task to the CNA while the licensed nurse keeps accountability for the nursing judgment and outcome.
- The CNA is responsible for accepting only tasks that are within scope, training, and facility policy.
- A CNA may and should refuse a task that is unsafe, untrained, or outside scope, using a professional explanation and the chain of command.
- The Florida chain of command runs CNA to charge or supervising nurse to nursing supervisor to Director of Nursing to administrator.
Working Within The Nursing Team
No single person meets every resident need, so Florida facilities use a licensed team. Knowing each role helps you report to the right person and stay in scope.
| Team Member | Main Role | CNA Interaction |
|---|---|---|
| Registered Nurse (RN) | Assessment, care planning, medications, supervision | Receives CNA reports; delegates tasks |
| Licensed Practical Nurse (LPN) | Treatments, medications, wound care | May directly supervise CNAs |
| Physician or Nurse Practitioner | Diagnosis and orders | CNA reports observations through the nurse |
| Therapists (PT, OT, ST) | Mobility, daily living, swallowing | CNA reinforces plans and follows precautions |
| Social Worker / Dietitian | Discharge, resources, nutrition | CNA reports concerns and intake |
What Delegation Means
Delegation is when a licensed nurse assigns a specific task to a CNA while keeping accountability for the nursing judgment and the resident outcome. The nurse remains responsible for the decision to delegate; the CNA is responsible for performing the accepted task correctly and reporting back.
The Five Rights Of Delegation
| Right | Question The CNA Should Confirm |
|---|---|
| Right task | Is this an approved task for a Florida CNA? |
| Right circumstance | Is the resident stable enough for me to do it? |
| Right person | Am I trained and checked off on this? |
| Right direction | Do I know exactly what to do and what to report? |
| Right supervision | Is the nurse available for follow-up or questions? |
Accepting Or Refusing A Task
Before accepting, confirm the task is in scope, you are trained, the resident is stable, and instructions are clear. You should refuse, professionally, when a task is unsafe, untrained, outside scope, or the resident is unstable. A correct refusal is not insubordination; it protects the resident.
Good refusal language: "I have not been trained or checked off on that. Can you do it or show me?" Do not silently skip the task and do not hand it to another CNA without telling the nurse.
The Florida Chain Of Command
When a serious safety concern is not addressed, escalate. A typical path:
- Assigned, charge, or supervising nurse
- Nursing supervisor
- Director of Nursing
- Administrator or facility reporting system
- Outside reporting (such as the Florida Abuse Hotline) for suspected abuse, neglect, or exploitation
Never stop at "I told someone" if a resident is still at risk. Keep moving up the chain until the concern is addressed.
An LPN delegates a transfer task to a Florida CNA who has never been trained on the mechanical lift involved. What should the CNA do?
In delegation, who keeps accountability for the nursing judgment behind a delegated task?