I am the charge nurse at a medical inpatient unit of a hospital. I work with registered nurses (RNs) and licensed practical nurses (LPNs) but now the hospital has announced there will be a health-care aide (HCA) on our unit. She will be replacing one of the LPNs. As the charge nurse, I will have to supervise the HCA and ensure she has an appropriate patient assignment. The HCA is not a regulated health professional. It makes me wonder what the difference is between delegation and assignment.
Delegation is the formal transfer of authority to perform an act from the person who has legal authority to a person who would not have the legal authority unless delegation took place. An example of this would be an RN who delegates their authority to perform a urinary catheterization to a HCA who may not have the legal authority to perform that specific clinical act (depending on provincial or territorial legislation and regulation).
Assignment is allocating specific staff to specific patients or specific patient care needs for a period of time, usually a shift. It is a division of labour based on an assessment of care needs, care plans, goals of treatment or care, scopes of practice, and the skill mix of staff.
Assignment will always take place, according to applicable health institution policy, but delegation will only occur if the right conditions exist between the delegator and delegate.
The legislation and regulations that govern a health profession are the primary source of legal authority for professional scope of practice and may also contain provisions about delegation of controlled acts or restricted activities. Prior to delegation, nurses must ensure they are empowered to transfer authority for that specific clinical act to another care provider, who in turn can accept delegation if permitted by their scope of practice, scope of employment and training. The health institution has hired the HCA and knows the level of training and skill they have, therefore, management or clinical educators can be invaluable in introducing the new team to each other and helping staff understand what they can expect of each other now and as the HCA becomes accustomed to the unit.
As a charge nurse, you will be responsible for reasonable supervision of other staff and to facilitate communications amongst care team members. It may not be possible for a charge nurse to personally supervise and monitor nursing staff at all times. Other options exist, such as enlisting experienced staff to be a resource person for certain staff members or procedures. Good communication is the responsibility of all staff members. It can be enhanced by conveying patient information in a structured way: briefly outlining the current situation; providing background information about the patient; detailing the staff member’s assessment of the situation; and stating what is being sought from the other team member.
CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
Published May 2016
THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.