1. The NH Nurse Practice Act and RN Delegation Denise M. Nies, MSN, RN, BC

2. Revised Statute Annotated (RSA) THE LAW 326-B:28  “A nurse holding a currently valid license as an RN or LPN may delegate specific nursing activities and tasks under the circumstances, and in accordance with the constraints, set forth in rules of the board adopted under RSA 541-A

3. RSA-B:29 Delegation; Circumstances Not Subject to Disciplinary Action by the Board of Nursing-  “I. A licensee who delegates or has delegated a specific nursing activity or task in compliance with this chapter shall not be subject to disciplinary action because of the performance of the person to whom the nursing activity or task is or was delegated.”

4. RSA 326-B: 29 II  “II. No person may coerce an RN or LPN into compromising client safety by requiring the nurse to delegate a nursing activity or task when the nurse determines that it is inappropriate to do so. A licensee shall not be subject to disciplinary action for refusing to delegate or refusing to provide training related to such delegation when the licensee has determined that such delegation may compromise client safety.”

5. The Administrative Rules that accompany the Law (RSA 326-B)  Nur Chapters 100-800 are the administrative rules the board follows. The board does not have the right to waive any rule that is legislated by the NH Legislature  To obtain a copy of the law and rules go to www.state.nh.us/nursing and then go to “Nurse Practice Act.” www.state.nh.us/nursing

6. Nur 404.01-Nur 404.07  Scenario #1:  You have worked as a licensed nursing assistant for many years and your employer has offered to have you educated as a Medication Nursing Assistant.  Who would be your supervisor in the Nursing Assistant role?  What is the responsibility of your supervisor?

7. What is the scope of practice for the Medication Nursing Assistant?  Scenario #2: You are administering medications as delegated by your supervising nurse when another LNA asks you to medicate a resident for pain.  Nur 404.02 (and Nur Chapter 800) does not allow independent action by the LNA.  Nur 404.03 B prohibits the LNA from delegation authority,

8. Who has the authority to delegate to the Nursing Assistant?  Nur 404.03  The APRN, RN or LPN  Note: The LPN cannot practice independently and must work under direct or indirect supervision of the APRN, RN, Physician, or Dentist

9. As a licensed nurse, can I delegate to the Medical Assistant?  The NH Nurses Assn. and the NH Board of Nursing have provided a collaborative statement related to delegation of non-nursing personnel. Please review this material on the NHHA and NH Board of Nursing website carefully if you have a position that requires oversight of Medical Assistants.

10. Why do we need guidelines on delegation to the Medical Assistant?  The Medical Assistant is not licensed in the State of NH.  The role of the Medical Assistant varies in healthcare settings  Many settings do not have clear delineation of the role of the nurse when delegating tasks to the Medical Assistant role  The licensed nurse is responsible and accountable for safe delegation.

11. What if the activity I am delegating is not within my scope of practice?  DO NOT DELEGATE!  You may delegate those tasks that you have authority and competency to perform.  You are responsible and accountable for what you delegate  You need to rescind a delegation if you have concerns for client safety

12. Can the LNA administer medications to residents in the Assisted Living setting?  State administrative rules allow a level of assistance to residents in Assisted and Residential settings. This assistance does not include administration of medications.  Educated and approved facility personnel may remind, obtain, facilitate, and document observations of medication administration but, it is the resident who administers their own medication.

13. Can my employer tell me to delegate?  Nur 404.06 requires that you delegate only those procedures within your scope of practice and:  1. only to a competent delegatee  2. only when the client is stable  3. only when you can monitor the situation  4. and, you must have a comfort level that the client will receive proper care

14. But, what if my employer forces me to delegate and I don’t agree?  Revised Statute Annotated (RSA) 326-B:28 Delegation of Nursing Activities and Tasks reads:  “A nurse holding a current valid license as an RN or LPN may delegate specific nursing activities and tasks under the circumstances, and in accordance with the constraints, set forth in rules of the board adopted under RSA 541-A.

15. RSA 326-B:29  1. “A licensee who delegates or has delegated a specific nursing activity or task in compliance with this chapter shall not be subject to disciplinary action because of the performance of the person to whom the nursing activity or task is or was delegated.  2. No person may coerce an RN or LPN into compromising client safety by requiring the nurse to delegate…”

16. So, what do I want to remember?  Read the Nurse Practice Act in the state where you are working as a nurse;  Review the websites of your professional organization;  Go to the National Council of State Boards of Nursing and watch the on-line video on Delegation at www.ncsbn.com; andwww.ncsbn.com  Always consider the safety of your client when delegating nursing activities.

17. Thank you  Congratulations on your nursing education accomplishments and Welcome to the Nursing Community.