Delegation of Tasks in Nursing

• Delegation of task is also known as transfer of function

Assigning and Delegating

• Registered Nurses are responsible for assigning, authorizing and delegating tasks to another HCP to complete.
• More information about BCCNM standards can be found at https://www.bccnm.ca/RN/PracticeStandards/Pages/delegating.aspx
• Assigning: The required task must fall within the HCA's scope of practice or scope of employment
• LPN's can assign tasks but not delegate them.
• HCAs have knowledge and training to carry out the specific task or tasks within their assignments
• Tasks can only be delegated for stable clients
• Tasks are delegated as part of patient's normal routine. Examples are suctioning of a long term trach in home care, replacing ties, in and out catheterization, tube feeds, and medications.
• HCAs cannot delegate to another HCA.
• RN must be confident that the HCA understands the responsibility of their task, knows who to ask for assistance, and who to report to.
• What is done for one client cannot be done for another, and training is required for each patient or client.
• Delegation: A Registered Nurse can authorize an HCA (unregulated care provider) to perform tasks deemed "Controlled Acts" or tasks out of their scope of practice
• The Health Care Provider and Employers must be aware of what tasks can and can't be delegated.
• Task-ADLs is a function, procedure or activity that the HCA assists the client with or performs for the client, such as performing personal care to a resident or trimming fingernails
• IADL's are Instrumental Activities of Daily Living, such as administering medication, shopping, taking vitals, or meal preparation.
• "Controlled Acts” are tasks that health care providers (nurses) have skills, knowledge and training to perform
• They are considered harmful if performed by unqualified individuals and are usually "inside" the body.
• Examples include Insulin Administration, insertion of catheters, flushing an IV line, suctioning a trach, etc.
• If a "Controlled Acts" is part of the clients “regular routine ADL's or IADLS” it may be delegated provided there is written authorization in the Care Plan

Who can delegate

• Delegation depends on the legislation in each providence and territory.
• Delegation is the responsibility of an RN (Regulated Health care providers)
• Clients' health & safety is always first and foremost
• The RN remains accountable for properly following all the steps involved in delegation. You must be knowledgeable about the scope of practice for HCAs before deciding to delegate a task.
• The HCA is accountable to the employer and client and must ensure the task is done correctly and safely.

The Delegation Process

• The nurse must ascertain the following:
• What tasks your Province/Territory allows HCAs to perform
• Tasks included in your job description
• What you were taught in your program
• What skills you have learned and how they were evaluated
• Your work experience
• To ensure the health and safety of clients and prior to making the decision to delegate a task to an HCA, the following needs to be taken into consideration:
• Is it appropriate that an HCA perform the task considering the client's condition, associated risks and environmental support? An RN will do a Risk Assessment.
• Will the HCA be performing the tasks frequently enough to maintain competence?
• Can the HCA be adequately supervised in the setting (Acute, Home or LTC)?
• Is a nurse available to help if the client's condition changes or problems arise?
• Is this a task that can be delegated to an HCA and is it included in their job description?

Delegation of Task - Community

• Each Health Authority has Home Support Agencies employ Health Care Assistants to provide care to clients within their homes.
• These agencies employ RNs, LPNs, and Educators.
• When a client requires a task that they or a family member cannot carry out for them, a referral is made to the Home Health Service Line if the resident isn't already known to Home Health and already receiving services (HCA - for personal care etc. or Home Care Nurse for wound care for example)
• If the client already has a Long-Term Case Manager assigned to them, great! If not, then one will be assigned, and he/she will assess this client in their home (long assessment process)
• If deemed appropriate, a DOT will be completed for the task (ex: eye drops)
• The DOT will be faxed to the appropriate Home Support Agency
• The RN at the Home Support Agency will review the DOT
• The RN contacts the client/family and completes a “Risk Assessment". Examples that can be included are... -What is the client's current health condition?
• Has the client ever received assistance with the particular task before? What was his response? Agree or disagree, trying to ascertain if client has any behavioral issues, does he have Dementia etc. Does this need to be a 2 person job because of any of these factors?
• Will the client allow the HCA to carry out the task? Yes or No
• The RN or the Educator will contact the HCA(s) looking after the client depending on the Home Support Agency.
• The DOT will be reviewed with the HCA(s)
• Education will be provided on how to safely and competently complete the task from start to finish
• The RN will meet the HCA at the client's home and supervise the HCA administering the eye drops. The goal is to make sure the HCA is able to competently carry out the task safely, ensure the resident is safe, is accepting the task, and to ensure proper documentation post task

HCA Role Accepting a Task

• The HCA is responsible for their actions
• The HCA has responsibilities when asked to perform delegated tasks
• When accepting a task you are accountable for your own actions
• What you do or fail to do can harm the client
• Completing the task safely is your goal
• You should speak up and ask for help if you are unsure or if you have questions about the task.
• Report/document what you did and your observations

HCA Role Refusing a Task

• You have the right to refuse to do the delegated task as long as there's a valid reason
• If there's a good reason for not doing the task, refusing is both your right and your duty.
• Always communicate your concerns with the Nurse, as solutions can be found when working together.
• You cannot refuse the delegated task because you do not like or want to, you could potentially put the client at risk for harm and may risk losing your job.

Five Rights of Delegation

• Use the 5 rights of Delegation as a guide and protect clients and yourself.
• Can what I’m doing be done safely for the client?
• Right task (can it be delegated)
• Right circumstance (is it is part of their regular routine)
• Right person (are they stable)
• Right directions and communication (clear directions given and expected outcome written and/or discussed)
• Right supervision and evaluation (Can you contact someone if something goes wrong)

Health Care Assistants

• Are healthcare assistants regulated? No
• Work is in progress for regulating HCAs in BC.
• All HCAs in Alberta are now regulated.
• There is Legislation and laws that they must abide by just like RNs, RPNs, NPs and LPNs
• HCAs are accountable to their employer to follow their contract of employment, but are not registered with a professional body.
• Employers have a responsibility to train and supervise HCAs and have oversight of their HCAs.
• This continues until the competence of the HCA has been shown.