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Delegation: The ProfessionalSchool Nurses Role
Julie Lindley, RN, BSNDirector of Health Services and PEGrapevine-Colleyville ISD
Delegation
Let’s Begin with the End in Mind!
Patient Safety
School Nurse Protection
Delegation
Know the:
Nurse Practice Act (NPA)
BON Rules and Regulations 225 224
Delegation
What is Delegation?
As defined by the ANA (2007) it is the ability of the nurse to transfer the responsibility of a nursing task to an unlicensed person while the nurse continues to be accountable for the outcomes.
Delegation
Accountable…
State Laws, Rules & Regulations
Employer Rules
Standards of Professional Nursing Practice
Delegation
What do the Rules require?
Collaboration
Accountability
Assessment
Supervision
Delegation
Collaboration
As defined by the BON is the process of working with the student and/or student’s parent to ensure that the highest possible degree of independence for the student is achieved in the school setting.
Delegation
Accountability
The RN is accountable for proper performance of the assessment and decisions made based on the assessment including the performance of a particular ADL or HMA for a student qualifies as not requiring delegation.
Delegation
Assessment – DelegationMust make an assessment to determine if the care:
Qualifies as an ADL or HMA not requiring delegation
Can be delegated
Should not be delegated
Delegation
Assessment – StudentMust make an assessment to determine if the: Adequacy and reliability of the
support system Degree of stability and predictability
of the student’s health status Frequency of reassessments
Delegation
Assessment – UAPMust make an assessment to determine if the:
Knowledge level of the UAP
Skill set of the UAP
Willingness of the UAP
Delegation
SupervisionMust periodically monitor and assess the capabilities and competencies of the UAP to safely perform delegated tasks. The RN determines the frequency of
reassessment & amount of supervision required.
Assignment by principal – RN still has a role!
Delegation
Supervision – DefinitionIs the process of directing, guiding and influencing the outcomes of individuals performance of delegated tasks.
Supervision may be: In person Telephonic Skype
The supervisor must be readably available in case of an emergency
Delegation
5 Rights of Delegation
1. Right Task
2. Right Person
3. Right Direction
4. Right Supervision
5. Right Circumstances
Delegation
Rule 225
Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments (ILE) for Clients with Stable and Predictable Conditions
Delegation
Definitions:
ADL’s not requiring delegation ADL’s that don’t fall within the practice of professional nursing may be performed by UAP in accordance to § 225 without being delegated. The following must be met:
Performed for a person with a functional disability & the client would perform the task if not for the disability
RN determines based on assessment that the task is such that it could be performed by any UAP without RN supervision
If these can’t be met, then the task may be delegated if they meet delegation requirements.
Delegation
Definitions:
ADL’s –
Limited to the following activities: Grooming
Feeding
Toileting
Transfer/ambulation.
Delegation
Definitions:
HMA’s not requiring delegation HMA’s that don’t fall within the practice of professional nursing may be performed by UAP in accordance to § 225 without being delegated. The following must be met:
Performed for a person with a functional disability & the client would perform the task if not for the disability
The task can be directed by the client or client’s responsible adult to be performed by any UAP without RN supervision.
Delegation
Definitions:HMA’s not requiring delegation cont.
Client’s responsible adult is able, and has agreed in
writing, to participate in directing the UAP’s actions in carrying out the HMA; and the client’s responsible adult is capable of:
Training the UAP in the proper performance of the task
Will be present when task is performed If not present, will observe the UAP
performing the task at least once and be immediately available
If these can’t be met, then the task may be delegated if they meet delegation requirements.
Delegation
Definitions:
HMA’s – Limited to tasks that enable the client to remain in an ILE & that go beyond ADL’s:
G-tubes – medication administration & feedings through permanently placed tubes
Elimination – stoma care, pouch changes & intermittent catheterizations
Delegation
RN Accountability Proper performance of the assessment
and decision made as a result of the assessment including the determination that performance of a particular ADL or HMA for a specific client qualifies as not requiring delegation
The RN is NOT accountable for an unlicensed person’s actual performance of ADL/HMA’s not requiring delegation
Delegation
Delegation Criteria Assess the client
Task does not require professional nursing judgment
Verify the experience & competency of the UAP to perform the task including the ability to recognize and inform the RN of changes related to the task through:
Instructed in performance of task Verified competency
Delegation
Delegation Criteria cont. Determined the level of supervision
required taking into account: The stability of the client Training & experience of the UAP Nature of the delegated task Proximity of the RN to the UAP
Can the 5 Rights of Delegation be met?
Delegation
Tasks that may be Delegated ADL/HMA’s that require delegation
Non-invasive or non-sterile treatments
Vital Signs, I & O
Reinforcement of teaching provided by the RN
Intermittent Catheterizations
Administration of Insulin
DelegationDelegation of Insulin RN must be available on call
Provide training on all aspects of insulin administration
Provide written instructions including physician orders for the performance of the insulin administration to be used as a reference
Limits the number of UAP’s who will administer insulin
DelegationDelegation of Insulin cont. Supervisory visits at least 3 times in first
60 days (1 within first 2 weeks) Make supervisory visits if there are
changes in the client’s status Provide written instructions including
physician orders for the performance of the insulin administration to be used as a reference
Written permission for delegation
Delegation
Tasks PROHIBITED from Delegation Assessment
Formulation of care plans
Health teaching/counseling
Calculation of medications
Administration of initial dose of a medication
Delegation
Case Studies
Delegation
Questions
DelegationReferences:
American Nurses Association & National Councils of Boards of Nursing (2007). Joint Statement on Delegation. Retrieved from: https://www.ncsbn.org/Joint_statement.pdf
Board of Nursing Practice Act (2009). Texas Board of Nursing for the State of Texas
Resha, C. (2010). Delegation in the school setting: Is it a safe practice? The Online Journal of Issues in Nursing, 15(2), Manuscript 5. Retrieved from: http:// www.nursingworld.org/ MainMenu Categories/ANAMarketplace/ANAPeriodicals/ OJIN/TableofContents/Vol152010/No2May2010/Delegation-in-School-Setting.aspx
National Association of School Nurses (2010). Delegation Position Statement. Retrieved from: http://www.nasn.org/Policy Advocacy/ PositionPapersandReports/NASNPositionStatements FullView/ tabid/462/smid/824/ArticleID/21/ Default.aspx
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