Health Care Team Roles, Scope of Practice and Delegation

The Interdisciplinary Health Care Team

The resident is the central focus of the interdisciplinary health care team. Family members are also involved in care planning according to the resident's wishes. To ensure comprehensive care, team members work collaboratively to meet the physical, psychological, and social needs of each resident. Every professional on the team contributes specialized skills toward the resident's well-being.

Licensed medical and nursing professionals direct and coordinate clinical treatments. The physician examines residents, diagnoses medical conditions, prescribes medications, and directs medical treatment. The Registered Nurse (RN) coordinates total resident care, conducts assessments, and formulates the nursing care plan. The RN also assigns daily duties to nurse aides and supervises their work. The Licensed Practical Nurse (LPN) provides bedside care, administers medications, and performs treatments under the direction of an RN or physician.

Rehabilitation and dietary specialists focus on restoring functional abilities and maintaining health. The physical therapist designs and implements exercise and mobility programs to restore gross motor function and ambulation. The occupational therapist assists residents in regaining or adapting motor skills needed to perform daily activities. The speech-language pathologist assesses and treats residents with communication, language, and swallowing disorders. The registered dietitian assesses nutritional needs and recommends or plans diets in coordination with the resident's healthcare provider.

Supportive and specialized therapy services address overall health, social well-being, and recreation. The respiratory therapist evaluates respiratory function and manages specialized airway and breathing equipment. The pharmacist dispenses medications, monitors drug interactions, and advises the team on pharmaceutical safety. The medical social worker provides support for emotional and financial needs and assists with discharge planning. The activities director plans recreational programs that meet the social, physical, and emotional needs of residents. When concerns arise regarding any aspect of care, the nurse aide promptly reports resident concerns to the nurse and follows the facility's chain of command when further help or escalation is needed.

Nurse Aide Scope of Practice and Daily Responsibilities

The nurse aide provides basic personal care to help residents with activities of daily living. Activities of daily living include bathing, dressing, grooming, eating, toileting, and mobility. While providing this care, the nurse aide keeps the resident's living environment clean, safe, and comfortable. Nurse aides promote resident independence by encouraging residents to do as much for themselves as possible safely. During every care interaction, the aide practices infection prevention measures, such as hand hygiene and standard precautions, protects resident privacy, and maintains confidentiality of all personal health information.

The nurse aide's role has strict legal boundaries. A nurse aide does not perform clinical assessments, make medical diagnoses, or develop or modify the nursing care plan independently. Nurse aides do not administer medications to residents or adjust prescribed oxygen flow rates. In addition, the aide does not insert or remove intravenous lines or urinary catheters, nor do they perform sterile dressing changes or sterile procedures. A nurse aide does not interpret laboratory results, diagnostic tests, or vital sign patterns, and cannot take verbal or telephone orders from physicians.

When a task or resident need falls outside the nurse aide's scope of practice, the aide must report it to the nurse. For example, if a resident asks for pain medication or asks to have their oxygen flow rate adjusted, the nurse aide must not attempt these tasks. The aide explains their role courteously and immediately brings the resident's request directly to the nurse.

The Nursing Care Plan, Observation, and Documentation

The nursing care plan contains specific instructions detailing the individualized care each resident requires. The nurse aide must review the nursing care plan before providing care to ensure safe and individualized assistance. Reviewing the care plan informs the aide of the resident's specific transfer techniques, dietary preferences, or personal routines, ensuring consistent care across the entire health care team.

Observation is an ongoing duty during routine personal care. The nurse aide observes the resident's physical and emotional status while assisting with daily tasks. The aide measures and records objective data such as vital signs, height, and weight, as well as resident fluid intake and output. The nurse aide does not interpret findings, but must promptly report any observed changes in a resident's condition to the supervising nurse so the nurse can evaluate the resident and update the care plan.

Proper record-keeping provides a clear account of the resident's daily care. The nurse aide must document care only after the care has actually been completed. Recording tasks before they are performed is unsafe and inaccurate. By documenting care after completion and promptly reporting resident progress and concerns to the nurse, the aide ensures the nursing care plan remains accurate and effective.

Principles of Delegation and Accountability

Delegation is the transfer of responsibility for performing a nursing task to another individual while retaining accountability. An RN may delegate appropriate tasks to a nurse aide. Whether an LPN/LVN may delegate or assign tasks depends on state law and facility policy. The delegating nurse remains legally accountable for the overall care of the resident and the delegation decision. At the same time, the nurse aide is accountable for their own actions and for performing delegated tasks correctly and safely. A nurse aide cannot delegate tasks to other nurse aides or health team members.

Safe delegation relies on structured guidelines known as the Five Rights of Delegation. These include the right task, the right circumstance, the right person, the right direction and communication, and the right supervision and evaluation. Licensed nurses apply these five rights to ensure that the task is safe to delegate for that particular resident at that specific time.

Communication between the nurse and the aide is critical before any delegated task begins. The nurse aide must receive clear and complete instructions before accepting a delegated task. If any part of the direction is unclear, the nurse aide must ask the nurse for clarification or assistance. The aide must never guess or proceed without complete information.

A nurse aide has a professional duty to protect the resident by recognizing when to refuse a task. The nurse aide must refuse a delegated task if the task falls outside the nurse aide's legal scope of practice, or if the aide has not been trained to perform it safely. When refusing a task that is unsafe or outside scope, the nurse aide must immediately and professionally explain the reason to the nurse.