Delegation to unlicensed assistive personnel

Delegation Guidelines The Nurse Practice Act establishes the standard that each licensed nurse is accountable for the safety of nursing care s/he delivers The Board’s regulations hold that the nurse is also responsible for all the nursing care that a patient receives under his/her direction

Delegation Guidelines RN retains ultimate responsibility, accountability and legal liability for delegation Supervision- directing, guiding or influencing the outcome of another’s performance

Appropriate activities for Delegation Delegated tasks must be performed according to established guidelines/protocols Have little to no modification from one situation to another Never involve assessment, interpretation or decision-making which can’t be separated from the task

Never Delegate Nursing assessment or formulation of nursing care plans Evaluation of patients response to care Health teaching and counseling Administration of medications (micostatin or albuterol) O2 therapy

Questions to consider before delegating Have I assessed this patient Would a reasonable and prudent nurse delegate this activity Documentation of competency of PCT/NA Ability of RN to provide supervision

Questions to consider before delegating What information do I need to give the PCT/NA to insure they understand what they are being asked to do How will I document the hand-off to PCT/ NA Should the PCT/NA use a ‘scut sheet’ to document the task request Does the PCT/NA understand their responsibility in documenting when the task is completed

Questions to consider before delegating Patient condition Complexity of assignment/Intricacy of task Custodial nature of task Infection control/safety issues Potential for harm Amount of technology used

Vignette #1 Mrs. D. is recovering from a total abdominal hysterectomy. The MD ordered removal of the urethral catheter. The PCT has documented competencies in removing indwelling catheters.

Vignette #1 Is this a reasonable activity to delegate? What factors would go into your decision to delegate or not delegate? If this were Mr. D. who is due to have the urinary catheter removed after successful cholecystectomy what factors would go into your decision to delegate or not?

Vignette # 2 Mrs. W. has been identified as an aspiration risk. She has orders to begin oral feeding. Should this task be delegated? What factors would go into your decision to delegate or not? Are there safety precautions you would put at the bedside?

Vignette # 3 Mr. P. is in the cardiac unit and has been on oxygen therapy for 3 days. He has a new order to increase his O2. Is this a task that can be delegated to a PCT/NA? What factors go into your decision to delegate or not?