Delegation and Supervision

Who is responsible and accountable for delegation of nursing tasks?

Only a licensed nurse can delegate.

In accordance with KRS 314.021(2), nurses are held responsible and accountable for their decisions regarding the supervision and delegation of nursing acts to unlicensed personnel who provide nursing assistance, based upon the nurse's educational preparation and current clinical competence in nursing.

When aspects of nursing care need to be delegated beyond the traditional role, nurses may delegate some nursing acts to Unlicensed Assistive Personnel (UAP). UAP who provide assistance to nurses may contribute to the implementation of the plan of nursing care when the delegation of the task does not jeopardize the client welfare. Tasks may be delegated only after a nursing assessment is made and, in the nurse’s judgment, it is decided that delegation of the task is appropriate.

  • Delegation of Nursing Tasks is discussed in 201 KAR 20:400;
  • Advisory Opinion Statement (AOS) #15 Supervision and Delegation of Nursing Tasks to Unlicensed Personnel, found in the Document Library; and
  • The Decision Tree for Delegation to UAP (Unlicensed Assistive Personnel), found in the Document Library.

Supervision is defined as “the provision of guidance by a qualified nurse for the accomplishment of a nursing task with periodic observation and evaluation of the performance of the task including validation that the nursing task has been performed according to established standards of practice.” See 201 KAR 20:400.

Factors to be determined by the delegator include:

  • The stability and acuity of the patient;
  • The training and competency of the delegatee;
  • The complexity of the nursing task being delegated; and
  • The proximity and availability of the delegating nurse to the delegate when the nursing task is performed.

Degree of Supervision of the LPN:

  • Determined by the LPN’s supervisor; and
  • Is based on a patient’s condition, as determined by the LPN’s supervisor.

A supervisor may provide supervision without being physically present in the immediate vicinity of the LPN, when:

  • A patient’s condition is stable;
  • Predictable, and Rapid change is not anticipated; but
  • The supervisor must be readily available.

A supervisor must be physically present in the immediate vicinity of the LPN and immediately available to intervene in care, when:

  • A patient’s condition is or becomes unstable.
  • A patient is receiving blood, blood components, or plasma volume expanders.
  • A patient is receiving peritoneal dialysis or hemodialysis.
The Advisory Opinion Statement (AOS) #27 Components of Licensed Practical Nursing Practice may be found in the Document Library

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