Practice Guideline:
Nursing Delegation to Unlicensed Assistive
Personnel in Day and Resident Camps
U.S. Version. Adopted 2 Dec 2013
These statements assume that a registered nurse (RN) licensed by the State in which the camp is located, oversees and
reviews the activities of the unlicensed assistive personnel (UAP). In addition, the overseeing RN must be familiar with
pertinent State requirements, American Camp Association (ACA) Standards, and Association of Camp Nurses (ACN) Standards
of Camp Nursing germane to delegation.
1.
That UAPs are informed in writing about the scope of practice for delegated activities and potential exceptions to these
practices. Clear boundaries of activities the UAP may perform are outlined and the RN has verified the UAP understands
those conditions of their role.
2.
The UAP is recognized as a paraprofessional whose role is to assist the RN in providing health care in the camp setting.
For example, while a UAP may take vital signs (temperature, blood pressure), the RN must interpret the data and plan
appropriate nursing interventions.
3.
Delegation shall be based on the American Nurses Association (ANA) and National Council of State Boards of Nursing
(NCSBN) Joint Statement on Delegation (2013) considerations. “The RN assigns or delegates tasks based on the needs
and condition of the patient, potential for harm, stability of the patient’s condition, complexity of the task, predictability
of the outcomes, abilities of the staff to whom the task is delegated and the context of other patient needs”(pg. 2).
4.
Principles of Delegation (adapted from ANA & NCSBN, 2013):
a. The RN takes accountability and responsibility for all nursing care performed by the RN or an UAP. Nurses are often
fearful of delegating because they feel responsible for someone else’s work. However, the UAP also has a part of
the responsibility when they agree to perform an activity delegated to them. The responsibility is actually shared
(Weydt, 2010).
b. The RN may delegate components of care but may NOT delegate the nursing process itself.
c. The RN delegates only those tasks for which she or he believes the UAP has knowledge, skills, experience, and
training to perform in a culturally sensitive manner according to camp protocols.
d. The RN provides clear, concise, and accurate communication regarding delegated tasks.
e. The RN verifies UAP comprehension of delegated task instructions.
f. RN follows the Five Rights of Delegation:
Right
The right task
The right circumstances
The right person
The right directions and
communication
The right supervision and
evaluation
Questions to Ponder
Is the task within the scope of the delegating nurse?
Is the task within the UAP’s range of function?
Is the task performed according to an established protocol and similarly on all patients?
Examples of possible delegated tasks include: measuring vital signs, mobility measures, bathing,
collecting specimens, collecting data on patient’s condition, housekeeping, clerical duties,
transportation, and dietary functions.
Has the nurse assessed the patient’s needs prior to delegation?
Does the UAP have the appropriate knowledge, skills, and abilities to accept the delegated task?
Does the ability of the UAP match the care needs of the patient?
Have camp protocols for performing the task been communicated to the UAP?
Is there an established two-way communication process between the RN and UAP?
Has the RN communicated his/her willingness and availability to support the UAP?
Is appropriate and timely supervision available for the UAP?
Was the delegation successful?
ACN Delegation Practice Guideline, page 1
5.
Delegation to Licensed Practical Nurses or Licensed Vocational Nurses may require direct on-site supervision by a
RN, depending on specific state regulations. Consult state nurse practice acts for most current information.
References
American Nurses Association and National Council of State Boards of Nursing (2013). Joint Statement on
Delegation. Retrieved June 1, 2013, from http://www.nursingworld.org/MainMenuCategories/PolicyAdvocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/
Joint-Statements-on-Delegation-American-Nurses-Association-ANA-and-National-Council-of-StateBoards.html
Kaernested, B. & Bradadottir, H. (2012). Delegation of Registered Nurses Revisited: Attitudes towards
delegation and preparedness to delegate effectively. Nursing Science, 32(103), 10-15.
Kleinman, C. S. & Saccomano, S.J. (2006). Registered Nurses and Unlicensed Assistive Personnel: An
uneasy alliance. The Journal of Continuing Education in Nursing, 37(4), 162-170.
Plawecki, L.H. & Amrhein, D. W. (2010). A Question of Delegation: Unlicensed assistive personnel and
the professional nurse. Journal of Gerontological Nursing, 36(8), 18-21.
Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation Practices between Registered Nurses and
Nursing Assistive Personnel. Journal of Nursing Management, 18, 157-165.
Sikma, S.K. & Young, H.M. (2001). Balancing Freedom with Risks: The experience of nursing task
delegation in community-based residential care settings. Nursing Outlook, 49 (4), 193-201.
Weydt, A. (2010). Developing delegation skills. Online Journal of Issues in Nursing, 15(2), Manuscript 1. Retrieved
from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No
2May2010/Delegation-Skills.html.
ACN Delegation Practice Guideline, page 2