Problem Statement
Over the years I’ve had this ongoing challenge of getting licensed vocational nurses LVNs) to understand the importance of knowing and understanding their scope and standards of practice related their level of licensure and delegation responsibilities. On occasion they have been argumentative about their ability to delegate to others. While working on another project, the issue or misunderstanding became clear. LVNs are taught about delegation in the broadest context while they are in school and preparing to take the National Council Licensure Examination (NCLEX). They do not know and/or study their state Nursing Practice Act (NPA).
Defining Delegation
By definition delegation says ‘a person who is authorized to perform another’s duties under a contract (Merriam-Webster). In nursing delegation is more narrowly defined and the parameters are more clearly delineated. For starters the American Nurses Association (ANA) defines delegation generally, and involves assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. It tells us that the Registered Nurse (RN) cannot delegate responsibility related to making nursing decisions to Unlicensed Assistive Personnel (UAPs). This includes assessment and evaluation of the impact of interventions on care provided to the patient (ANA’s Principles of Delegation p. 5-6).
The National Council of State Boards of Nursing (NCSBN) also address delegation. Like the ANA, their perspective is national and addresses delegation across all level of nursing licensure. In their position paper they make a clear distinction between delegation and assignment. Assignment is defined as ‘the routine care, activities and procedures that are within the authorized scope of practice of the RN or License Practical Nurse/License Vocational Nurse (LPN/LVN) or part of the routine functions of the UAP (NCSBN p 2-3). This definition supports the coursework that is taught in the individual course of study or education of the LVN/LPN.
Know What your State Says
It becomes clear why a nurse must look to their state’s NPA, rules and regulations to determine how delegation criteria is utilized in their state for delivery of safe patient care. The purpose of delegation is to protect the health, safety and welfare of the public. RNs often verbalize their reluctance to delegate to UAPs citing that they can’t trust that the task will be done appropriately. Though delegation is taught in nursing school, it seems that LVNs believe they delegate when they are making assignments. They do not recognize that the authority comes from the RN. It is especially seen from nurses in long term care who believe that because they are charge nurses, by title they are authorized to delegate to UAPs.
In Texas, delegation is clearly defined as going from the RN to the UAP. The rules provide a clear purpose statement. It says in part that ‘assessment of the nursing needs of the client, the plan of nursing actions, implementation of the plan, and evaluation are essential components of professional nursing practice and are therefore the responsibilities of the RN (rule 224.3)
Delegation responsibility starts at the top of an organization. It must also address the nursing needs of the client. Actions by the RN must be consistent with what a reasonable and prudent RN would do under similar circumstances. The LVN’s role is to make assignments. The RN especially in LTC settings, is responsible for the hiring and verification of the UAP’s skills and abilities. The RN follows the 5 principles of delegation which includes supervision of the UAP.
Finally
I encourage every LVN to review their NPA as well the rules and regulations to determine their role and scope related to delegation. As you review this information, be alert that delegation is more than semantics. Delegation is a legal practice nursing issue. To safeguard your license, remember you do not delegate – you make assignments.