The nurse staffing crisis requires nurses and administrators to think differently about how to get things done. Delegation is key to doing more work with fewer registered nurses (RNs) and retaining current RN staff. Responsibility for effective delegation does not rest solely with the RN but begins with the institution, and includes both the delegator and delegatee. While effective delegation has often been referred to as an art, knowing the science behind delegation can aid in honing a skill necessary for top of license practice.

As the demand on time and resources of licensed health care professionals increases and cost-containment measures challenge organizations, the use of unlicensed assistive personnel for patient care activities increases. Emphasis on safe and effective care delivery remains crucial when registered nurses (RNs) delegate certain tasks and aspects of patient care. The principles of delegation from the American Nurses Association and the National Council of State Boards of Nursing include the responsibility and accountability of the RN for patient care outcomes. Authority for delegation of clinical tasks in the chronic hemodialysis setting varies significantly by state. The responsibility remains with the RN to oversee complex tasks despite the staff skill mix. Knowing individual state Nurse Practice Acts remains the responsibility of the individual. This article discusses the results of a review of the available information on state positions on delegation of clinical tasks in hemodialysis.

BACKGROUND: Over the past hundred years, licensed practical nurses (LPN) have faced several challenges because of the changing situations in health care system. The current study addresses the role changing of LPNs in accordance with the context and new needs.
OBJECTIVE: This aim of situation analysis is to access what changes have occurred in the role of LPNs in the wake of changes in role of RNs over the past century and What factors and variables have influenced this process?
METHODS: This study used a Grounded Theory methodology called Situational Analysis. Data were collected through semistructured and in-depth interviews with 33 nurse.
RESULTS: Researchers identify six themes that focus on how the role of LPNs has been changing and variables have influenced this process.
CONCLUSIONS: In Iran, as in other countries of the world, the role of LPNs comes to fore when there are pressing needs and nursing shortage. Iranian policymakers have decided to eliminate LPNs, Although LPNs in other countries are working in community-based settings. Treatment-oriented and self-monitoring structure of the Iranian health care system, new nursing organizations and lack of clear role classification at the caring levels have made the nursing roles ambiguous.