Welcome to the Manitoba Nurses' Union - Worksite 97!

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The College of Registered Nurses of Manitoba recognizes that there are many circumstances where it is necessary and desirable to delegate registered nursing tasks to unregulated health care providers. The College would like to remind members that delegation is a three part process:
1. Assessment: of the client and their situation as well as assessment of competence of the care provider;
2. Delegation of the task; and
3. Supervision.

Unregulated care providers are paid health care workers who are not registered with a regulatory body. They have no legally defined scope of practice, do not have a mandatory education requirement and do not have established standards of practice. They provide health care services under the direction of an RN or other regulated health care professional. Unregulated care providers include but are not limited to; resident aides, health care aides, service workers in the community, psychiatric assistants, home support workers, and in some settings, office assistants.

Delegation is the transfer of a task normally performed by a registered nurse or other regulated care provider to an unregulated care provider. The task is normally outside the role description and training of the care provider.

PRINCIPLES
Assessment

1. The registered nurse is responsible for the appropriate delegation of tasks to unregulated care providers. The RN must assess the client within the particular context of care (home, clinic or facility setting) as well as the competence of the care provider.
2. The registered nurse may only delegate tasks when the client's health status is stable and the client's response to the task/intervention is predictable.
3. The registered nurse must assess the risk involved in delegating a task. Tasks which require knowledge or judgment from the unregulated care provider cannot be delegated.
4. The registered nurse must initially assess the competence of the care provider receiving the delegation and is responsible for the ongoing assessment of competence.
5. The registered nurse involved in the direct care of the client determines when and if delegation is appropriate given the client status, the setting and context of care and determines when to discontinue the delegation based on the assessment of the client, the situation and the competence of the care provider.
6. The registered nurse is responsible for the ongoing assessment of the appropriateness of the delegation as well as for the ongoing assessment of the client's health status and plan of care.

Delegation

1. The registered nurse assumes responsibility for the delegation. The RN provides initial instruction for the task including a demonstration with the actual client.
2. The unregulated care provider must have opportunity to perform the task on the actual client under direct supervision of the registered nurse. The care provider is not allowed to perform the task independently until competency has been established.
3. The task is client specific- that is, not transferable to other clients or settings and the unregulated care provider cannot in turn delegate the task to other care providers or train them in the task.

Supervision

1. The registered nurse is responsible for the ongoing supervision of the delegation.
2. The registered nurse is responsible for periodic inspection and evaluation of the competence of the care provider and the provision of corrective action when needed.
3. Changes to client status or the competence of the care provider may result in a reassessment of the delegation and may result in a discontinuation of the delegated task(s).

CRNM RESOURCES
The Registered Nurses Act and Regulation
The Standards of Practice for Registered Nurses in Manitoba
Registered Nurse Responsibilities Regarding Unregulated Care Providers - Interpretive Document

For more information, please contact a CRNM Nursing Practice Consultant at (204) 774-3477 or (800) 665-2027 (Manitoba toll-free)

This publication is provided for general information. For more specific information, see the CRNM Standards of Practice for Registered Nurses, the Canadian Nurses Association Code of Ethics for Registered Nurses and the Registered Nurses Act and Regulations. CRNM publications are available on our website at www.crnm.mb.ca

PUBLISHED: 08/2010

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