Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the BC College of Nursing Professionals and all legislation relevant to nursing practice.
Nurses1 have a professional responsibility to delegate appropriately to other members of the health care team. Delegation means sharing authority with other care providers to provide a particular aspect of care. Delegation to unregulated care providers occurs when the required task is performed primarily by nurses and is outside the role description and training of an unregulated care provider. The delegated task is client-specific and may be either a restricted activity or a nursing activity that is not a restricted activity. The delegation is determined to be in the client's best interests. The delegating nurse is responsible for the decision to delegate and the process of delegation, including ongoing supervision to assess the unregulated care provider's ability to perform the delegated task. The unregulated care provider is accountable to the delegating nurse for the performance of the delegated task.
Unregulated care providers are paid providers who are neither registered nor licensed by a regulatory body. They have no legally defined scope of practice. Unregulated care providers do not have mandatory education or practice standards. Unregulated care providers include, but are not limited to, resident care attendants, home support workers, mental health workers, teaching assistants and community health representatives.
Delegation and assignment are different. Assignment to unregulated care providers occurs when the required task falls within the unregulated care provider's role description and training, as defined by the employer or supervisor. Delegation to unregulated care providers, on the other hand, occurs when the required task is performed primarily by nurses and is outside the role description and training of the unregulated care provider.
Nurses delegate tasks — not functions — to unregulated care providers. A function is a client care intervention that includes assessing and deciding to perform the function, planning and implementing the care and evaluating and managing the outcomes of care. A task is part of a client care function that has clearly defined limits and may be either a restricted activity or a nursing activity that is not a restricted activity.
Delegation can be very complicated. It is recommended that nurses review the BCCNP publication Assigning and Delegating to Unregulated Care Providers (pub. 98) and/or contact BCCNP Practice Support Services regarding this topic (see below).
When making a decision about delegating to an unregulated care provider, nurses consider factors related to the following:
Once the decision to delegate has been made, nurses delegate safely by:
Some aspects of the unregulated care provider's training may be done in a group setting and followed by client-specific instruction.
Supervision involves providing guidance or direction, support, evaluation and follow-up by the nurse for the purpose of achieving appropriate outcomes for the care which was delegated. Supervision may be either direct or indirect. The term direct supervision means being immediately present to guide or direct while indirect supervision means supervising from a distance but being available within a specified time frame. Nurses supervise activities by having the unregulated care provider report regularly to the nurse and by periodically observing the unregulated care provider's activities.
Delegation is more complex when the nurse and the unregulated care provider are employed by different organizations. In such cases, the unregulated care provider's organization must have policies for delegation and agree to accept the delegated task.
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