6 Nursing made Incredibly Easy! May/June 2017 www.NursingMadeIncrediblyEasy.com
According to the U.S Bureau of Labor
Statistics, over 1 million individuals
are employed as patient care assistants
(PCAs). The role of the PCA is to assist
the RN in keeping the healthcare unit
safe and delivering care to patients by
performing tasks, such as maintaining a
hygienic environment, transferring patients to other departments, documenting vital signs, and satisfying patients
needs. PCAs may possess different competencies based on their various work
experience, and many PCAs dont have
previous professional healthcare training. Although healthcare facilities provide training programs for PCAs during
their orientation, additional clinical and
critical-thinking skills can be acquired
through interaction with other healthcare team members.
Nursing students often interact with
PCAs during their clinical experience, so
learning to collaborate will foster successful patient outcomes. In addition,
nursing students need to acquire the
competency to delegate appropriate
tasks to PCAs over the course of their
training. In this article, we discuss strategies to boost nursing students delegation skills.
Challenges that interfere with students
practicing delegation include fear of
causing tension or being viewed negatively and lack of preparation. Students
may worry about burdening already
busy PCAs. They may be uncomfortable delegating a task to a PCA because
they feel that they dont have the authority. Students may be more comfortable delegating to PCAs when the clinical nurses on the unit specifically ask
Nursing students and delegation
By Kathryn Puskar, DrPH, MPH, MSN, RN, FAAN; Danielle Berju, BSN; Xiaojun Shi; and Tricia McFadden, MA, BS
STURTI / ISTOCK
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.
www.NursingMadeIncrediblyEasy.com May/June 2017 Nursing made Incredibly Easy! 7
When nursing students do delegate assignments to PCAs, they may face the following
lack of understanding of the PCAs skill sets
lack of standardization in PCA education,
training, and experience
lack of organizational guidelines for
lack of the communication skills needed
lack of time to evaluate the PCAs
Seventy-eight percent of nursing students in a U.K. study didnt believe that
their training prepared them to work with
PCAs. Although all nursing students surveyed reported that they were taught the
difference between various healthcare
providers, they indicated that necessary
information on the supervisory and
accountability issues regarding delegation
to PCAs was lacking. Most nursing students surveyed noted that nursing schools
should provide education about how to
work with PCAs before they go into clinical practice areas.
Not only do nursing students sometimes struggle with delegating, but new
RNs can also fi nd it diffi cult. In one
study, researchers observed and interviewed new RNs, PCAs, and managers
from three hospitals to examine new
nurses abilities to manage time, delegate,
and cooperate with PCAs. Factors that
continued to limit effective delegation
included role confusion, inadequate communication, different working styles, and
inadequate delegation skills.
To increase nursing students delegation
abilities, researchers developed a learning
program that included simulation, case
study analysis, and a debriefi ng session,
which was offered to 97 participants.
During the simulation and case study
analysis, students were asked to listen to
an audiotaped report about the simulated
patient and then provide care using their
own knowledge about delegation. During
the group debriefi ng, teachers and RNs
instructed students on delegation. After
the program, 52 students believed that
they were more confi dent with delegation skills and 67 students reported that
their understanding of delegation was
To prepare nursing students for delegation, another research team established a
course with three approaches: didactic
learning, case studies, and clinical placements. The didactic content focused on
basic theories and principles of delegation, and included weekly exams to check
students understanding of these theories.
Students were also required to complete
fi ve delegation case studies and practice
delegation skills during their clinical rotation under the direction and supervision of
As a clinical nurse, you can help nursing
students on your unit delegate effectively.
assembling the team of student, PCA, and
other clinical nurses
Case study 1
Junior nursing student Samantha is assigned to the pediatric oncology
unit for her pediatric rotation. During one shift, her patient needs a blood
transfusion due to severe anemia. The blood is ordered to be transfused
over 4 hours. The protocol for giving blood products is to take vital signs
before the transfusion, 15 minutes after the transfusion begins, every
hour, and after the transfusion is complete. The clinical nurse delegates
this task to Samantha and tells her to work with the PCA. Samantha
can only be present for the first four checks due to other obligations.
Samantha discusses her availability with the PCA and delegates the final
two checks to her.
Case study 2
Natalie is a sophomore nursing student on a medical-surgical unit. Her
patient has limited mobility and requires assistance with her activities of
daily living. Natalies patient alerts her that she needs assistance using the
bathroom. When Natalies instructor calls her to another room for a learning experience, Natalie asks the PCA to help her patient use the bathroom
so that she doesnt miss the educational opportunity.
Case study 3
Nursing student Adam is taking care of a 70-year-old patient with incontinence. When the patient leaks urine onto the bed, Adam first delegates
the task of gathering the bed linens to the PCA while he gets the bath
materials. While assisting the patient, he also asks the PCA to help turn
the patient and roll the sheets on the opposite side.
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.
8 Nursing made Incredibly Easy! May/June 2017 www.NursingMadeIncrediblyEasy.com
identifying the role of each team
explaining how to safely delegate
tasks to provide patient care, including
clear communication of team member
assigning patients and specifi c tasks based
on team member skills.
Practice makes perfect
Nursing students must learn how to effectively delegate to maintain patient
safety. Ineffective delegation can lead to
missed care and negative patient outcomes. In addition to delegation being
incorporated into both didactic and clinical components of nursing education,
you can serve as a role model for nursing students on your unit. Because delegation of tasks to PCAs must be communicated to the primary nurse assigned to
The five rights
1. The right task
2. Under the right circumstances
3. To the right person
4. With the right directions and
5. Under the right supervision and evaluation
Source: American Nurses Association, National Council of State
Boards of Nursing. Joint statement on delegation. https://www.
the patient, the nursing student can gain
a wealth of clinical, critical thinking, and
decision-making insight when he or she
discusses with you what tasks can be
American Nurses Association, National Council of
State Boards of Nursing. Joint statement on delegation.
Aued GK, Bernardino E, Peres AM, Lacerda MR, Dallaire
C, Ribas Edo N. Clinical competences of nursing assistants: a strategy for people management. Rev Bras Enferm.
Gravlin G, Phoenix Bittner N. Nurses and nursing assistants reports of missed care and delegation. J Nurs Adm.
Hasson F, McKenna HP, Keeney S. Delegating and supervising unregistered professionals: the student nurse experience. Nurse Educ Today. 2013;33(3):229-235.
Hawthorne-Spears N, Whitlock A. Behind our eyes: the
voice of the patient care assistant. J Nurs Educ Pract.
Johnson M, Magnusson C, Allan H, et al. Doing the
writing and working in parallel: how distal nursing
affects delegation and supervision in the emerging role of
the newly qualifi ed nurse. Nurse Educ Today. 2015;35(2):
Kaplan B, Ura D. Use of multiple patient simulators to
enhance prioritizing and delegating skills for senior nursing students. J Nurs Educ. 2010;49(7):371-377.
McKenna HP, Hasson F, Keeney S. Patient safety and
quality of care: the role of the health care assistant. J Nurs
Powell RM. Improving students delegation skills. Nurse
Tompkins F. Delegation in correctional nursing practice.
J Correct Health Care. 2016;22(3):218-224.
U.S. Bureau of Labor Statistics. Nursing assistants
and orderlies. www.bls.gov/ooh/healthcare/nursingassistants.htm.
At the University of Pittsburgh (Pa.) School of Nursing, Kathryn
Puskar is a Professor and the Associate Dean of Undergraduate
Education; Danielle Berju was a BSN student; and Xiaojun Shi
is a BSN student. Tricia McFadden is an Assistant Professor at
St. Francis University in Loretto, Pa.
The authors have disclosed no financial relationships related to
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.
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