1. Puskar, Kathryn DrPH, MPH, MSN, RN, FAAN
  2. Berju, Danielle BSN
  3. Shi, Xiaojun
  4. McFadden, Tricia MA, BS

Article Content

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 don't 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.

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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 don't have the authority. Students may be more comfortable delegating to PCAs when the clinical nurses on the unit specifically ask them to.


When nursing students do delegate assignments to PCAs, they may face the following challenges:


* lack of understanding of the PCAs' skill sets


* lack of standardization in PCA education, training, and experience


* lack of organizational guidelines for delegation


* lack of the communication skills needed for delegation


* lack of time to evaluate the PCA's work.



Seventy-eight percent of nursing students in a U.K. study didn't 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 find it difficult. 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 debriefing 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 debriefing, teachers and RNs instructed students on delegation. After the program, 52 students believed that they were more confident with delegation skills and 67 students reported that their understanding of delegation was improved.


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 five delegation case studies and practice delegation skills during their clinical rotation under the direction and supervision of their preceptors.


Your role

As a clinical nurse, you can help nursing students on your unit delegate effectively. Steps include:


* assembling the team of student, PCA, and other clinical nurses


* identifying the role of each team member


* explaining how to safely delegate tasks to provide patient care, including clear communication of team member responsibilities


* assigning patients and specific 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 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 safely delegated.


consider this

Case study 1

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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. Natalie's patient alerts her that she needs assistance using the bathroom. When Natalie's instructor calls her to another room for a learning experience, Natalie asks the PCA to help her patient use the bathroom so that she doesn't 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.


cheat sheet

The five rights of delegation


1. The right task


2. Under the right circumstances


3. To the right person


4. With the right directions and communication


5. Under the right supervision and evaluation


Source: American Nurses Association, National Council of State Boards of Nursing. Joint statement on delegation.




American Nurses Association, National Council of State Boards of Nursing. Joint statement on delegation. https://


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