Skip to content
Andrew Pollack-Gray

Nursing Notes

Chain of Command and Delegation

2 min read

Quick Reference

Chain of Command: The established reporting structure used to communicate concerns, receive instructions, and escalate problems.
Typical Structure:

  1. Certified Nursing Assistant (CNA)
  2. Supervising Nurse (RN or LVN/LPN)
  3. Director of Nursing (DON)
  4. Facility Administrator
    Actual reporting structures vary by facility.

Delegation

Delegation occurs when an authorized healthcare professional assigns an appropriate task to another worker.
Before Accepting:

  • Is the task within my authorized scope?
  • Am I trained and competent to perform it?
  • Is the task appropriate for this resident and situation?
  • Do I understand the instructions and expected outcome?
  • Do I know when and what to report?
    After Accepting:
  • Complete the task safely and promptly.
  • Report unexpected findings or inability to complete it.
  • Document according to facility policy.

Refusing or Clarifying Tasks

  • Do not perform tasks outside your authorized scope or competence.
  • Explain concerns professionally.
  • Ask for clarification or additional training.
  • Follow the chain of command when concerns remain unresolved.

Teaching vs. Reinforcing

  • Teaching: Introducing new clinical information or patient education requiring licensed professional judgment.
  • Reinforcing: Reminding or helping a resident practice previously taught instructions.
    Example: “Let’s practice the technique your nurse showed you.”

Important Considerations

  • Delegation does not automatically expand CNA scope of practice.
  • Do not accept a task you cannot perform safely.
  • Never silently abandon an accepted task.
  • Report urgent safety concerns immediately rather than delaying for routine reporting channels.
  • Follow facility procedures when an unresolved concern requires escalation.

Sources

  • CNA Module 1 — Chain of Command and Delegation
  • Facility delegation and reporting policies

Flashcards

What must a CNA do if delegated a task beyond training or permitted scope?03-application / reference-guidelines
Answer

Seek clarification and decline unsafe or unauthorized performance.

Graph View

Backlinks