3.2 The Healthcare Team & Delegation
Key Takeaways
- The RN assesses, plans care, delegates, and evaluates; the LPN carries out treatments and may supervise CNAs; the CNA performs delegated direct care and reports back.
- Delegation transfers a task to the CNA while the licensed nurse keeps accountability for the nursing judgment and the resident outcome.
- The Five Rights of Delegation are right task, right circumstance, right person, right direction/communication, and right supervision/evaluation.
- A CNA may and should refuse a task that is unsafe, untrained, outside scope, or assigned for an unstable resident, using a professional explanation and the chain of command.
- The Florida chain of command runs CNA to charge/supervising nurse to nursing supervisor to Director of Nursing to administrator, with the Florida Abuse Hotline for suspected abuse.
Working Within The Nursing Team
No single person meets every resident need, so Florida facilities use a layered, licensed team. Knowing each role lets you report to the right person, stay in scope, and avoid wasting the nurse's time with the wrong question.
| Team Member | Main Role | CNA Interaction |
|---|---|---|
| Registered Nurse (RN) | Assessment, care planning, medications, supervision, evaluation | Receives CNA reports; delegates tasks; remains accountable |
| Licensed Practical Nurse (LPN/LVN) | Treatments, many medications, wound care | Often the CNA's direct supervisor |
| Physician / Nurse Practitioner | Diagnosis and orders | CNA's observations reach them through the nurse |
| Therapists (PT, OT, ST) | Mobility, daily-living skills, swallowing/diet texture | CNA reinforces plans and follows precautions |
| Registered Dietitian / Social Worker | Nutrition, discharge planning, resources | CNA reports intake and psychosocial concerns |
The key takeaway is the reporting line: a CNA almost never reports directly to a physician. You tell the nurse, the nurse assesses, and the nurse contacts the provider. Skipping the nurse to call a doctor yourself is both out of scope and a safety risk because no assessment has occurred.
What Delegation Means
Delegation is the process by which a licensed nurse assigns a specific task to a CNA while keeping accountability for the nursing judgment and the resident outcome. Two ideas matter:
- The nurse can only delegate the implementation of a task. Assessment, nursing diagnosis, planning, and evaluation can never be delegated — those are the nurse's specialized judgment.
- Accountability stays with the nurse; responsibility for correct performance is shared with the CNA. The nurse is accountable for the decision to delegate; the CNA is responsible for doing the accepted task correctly and reporting back.
The Five Rights Of Delegation
The National Council of State Boards of Nursing (NCSBN) names five checks the nurse uses before delegating — and the CNA can use the same list to decide whether to accept.
| Right | Question The CNA Should Confirm |
|---|---|
| Right task | Is this an approved, delegable task for a Florida CNA? |
| Right circumstance | Is the resident stable enough for me to do it right now? |
| Right person | Am I trained and checked off on this specific skill/equipment? |
| Right direction/communication | Do I know exactly what to do, what to watch for, and what to report? |
| Right supervision/evaluation | Is the nurse available to follow up, and will the outcome be evaluated? |
If any "right" fails, the task should not proceed as delegated. For example, a task may be a right task in general (taking a blood pressure) but the wrong circumstance if the resident is acutely unstable and the nurse should be assessing instead.
Accepting Or Refusing A Task
Before you accept, confirm the task is in scope, you are trained, the resident is stable, and the 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 and protects your certification.
Good refusal language: "I haven't been trained or checked off on that lift. Can you do it, or show me first?" What you must not do: silently skip the task, attempt it anyway to look cooperative, or quietly hand it to another CNA without telling the nurse. Any of those can harm the resident and is the wrong answer on the exam.
| Situation | CNA's Correct Move |
|---|---|
| Task you were never trained on | State the gap; request training or reassignment |
| Resident suddenly unstable | Decline that delegated task; alert the nurse to assess |
| Order is unclear | Ask the nurse to clarify before starting |
| Task is clearly out of scope (e.g., IV) | Decline and route to the nurse |
The Florida Chain Of Command
When a serious safety concern is not addressed, you escalate up a defined chain rather than giving up. A typical Florida path:
- Assigned, charge, or supervising nurse
- Nursing supervisor
- Director of Nursing (DON)
- Administrator or the facility's reporting system
- Outside reporting — the Florida Abuse Hotline (1-800-962-2873 / 1-800-96-ABUSE) 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 actually addressed. Suspected abuse, neglect, or exploitation is a special case: every CNA in Florida is a mandatory reporter and can report directly to the Abuse Hotline — you do not need permission from the chain of command first, and no one may retaliate against you for a good-faith report.
Why The Team Structure Protects You
Staying inside this structure is how a CNA avoids liability. If you report an observation accurately and the nurse decides what to do, the nursing judgment — and its accountability — sits with the nurse. The moment a CNA acts on their own interpretation (treating a symptom, calling a provider, changing a plan), they have stepped into nursing practice without a license. The team exists so that the right professional makes each decision: the CNA supplies the observation, the nurse supplies the judgment, and the provider supplies the order.
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 retains accountability for the nursing judgment behind a delegated task?
A CNA suspects a resident is being financially exploited by a visitor. Under Florida rules, what is true about reporting?