Patient Repositioning: RN Responsibility vs. Nursing Assistant Role

Accountability for Patient Positioning

The Registered Nurse (RN) holds ultimate accountability for ensuring safe, timely repositioning of patients at risk for pressure injuries.

Delegation Framework (NCSBN / ANA)

• RN responsibilities: Assessment (Braden scale, skin inspection), care planning (frequency, surfaces, offloading devices), delegation decision, supervision, evaluation of outcomes.
• NAP / CNA role: Executes turning/repositioning per schedule; uses proper technique (draw sheet, log roll); reports skin changes; documents completion.

Key Principles

• Repositioning is a **nursing intervention**, not just a task.
• Delegation requires: right task, right circumstance, right person, right direction/communication, right supervision/evaluation.
• RN must verify competency of NAP for specific patient (e.g., spinal precautions, lines, tubes).
• Documentation: RN documents assessment/plan; NAP documents execution; both sign.

Best Practice

1. Turn q2h (or individualized) with 30° lateral tilt (avoid direct trochanter pressure).
2. Use pressure-redistribution surfaces (foam, air, gel).
3. Heel offloading (boots, pillows under calves).
4. Micro-shifts q15–30 min for chair-bound.
5. Skin check every turn.

Culture of Safety

Repositioning is everyone's job, but the RN owns the plan and outcome. Team communication prevents "I thought you turned him."