The Nevada Nurse Practice Act and Delegation

1. The Nevada Nurse Practice Act and Delegation Chris Sansom, MSN, RN Director of Operations Nevada State Board of Nursing

2. The Nevada Nurse Practice Act Nevada Revised Statutes – NRS 632 Bill passed by the Assembly and Senate and signed into law by the Governor Nevada Administrative Code – NAC 632 Adopted by the Board of Nursing to carry out the intent of the law Practice Decisions Scope of Practice

3. Roles and Responsibilities Registered Nurse  Independent, dependent and interdependent functions Licensed Practical Nurse (LPN)  At the direction of RN, APN, licensed physician, licensed physician assistant, or licensed podiatric physician

4. Roles and Responsibilities • Certified Nursing Assistant (CNA)  At the direction and under supervision of RN or LPN • Unlicensed Assistive Personnel (UAP) 

5. But in both [hospitals and private houses], let whoever is in charge keep this simple question in her head, (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? - Florence Nightingale

6. Delegation NAC 632.047 Delegation defined. “Delegation” means entrusting the performance of a delegable nursing duty to a person who is qualified and competent to perform the duty.”

7. What does it mean? Nurses possess the knowledge, skill and ability to coordinate and supervise the delivery of nursing care, which includes the assignment of nursing tasks to others. Nursing Process: assess, diagnose, outcomes, plan, implement, evaluate.

8. ANA’s Definition The transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome. Example: The nurse, in delegating an activity to an unlicensed individual, transfers the responsibility for the performance of the activity but retains professional accountability for the overall care. Responsibility – Allocated and accepted

9. The Nurse Practice Act (NPA) NAC 632.212 (2) An RN shall demonstrate competence in: (f) Delegating appropriate duties to other persons; (g) Supervising a person to whom the RN has delegated nursing duties; (h) Maintaining accountability in the delegation of care

10. NPA Continued NAC 632.222 (1) RN may delegate nursing care to other personnel and supervise other personnel in the provision of that care if those persons are qualified to provide that care. (2) RN shall perform or supervise any act necessary to ensure the quality and sufficiency of delegated care provided to a patient.

11. NPA Continued NAC 632.222 (3) Before delegating the RN shall determine: (a) Amount of direction (b) Complexity of care (c) Educational preparation and competency (d) Policy and procedures (4) The RN who delegates nursing care or duties is responsible for the care.

12. Still confused? Case study: Right task – is it safe, predictable outcome Right circumstance – client condition/setting, complexity Right person – within their scope of practice, education/competence Right direction/communication – clear, concise Right supervision – follow-up

13. Not Delegable Nursing judgment except to another RN Nursing assessment Evaluation of patient outcomes based on interventions Any act not within the persons scope of practice Any act that another reasonable and prudent nurse would not delegate

14. RN – Delegation Regulations NAC 632.212 RN duties NAC 632.220 Medications and treatment NAC 632.224 Supervision NAC 632.244 Unauthorized acts prohibited NAC 632.248 Assignment to UAPs NAC 632.340 Exemptions from required licensing or certification

15. LPN – Delegation Regulations NAC 632.230 Limitations; Supervision; Delegation NAC 632.450 Procedures delegable to LPNs NAC 632.455 Procedures not delegable to LPNs

16. Nurse Apprentices NAC 632.063 Nursing student NAC 632.252 Performance of tasks NAC 632.253 Prohibited acts

17. Unlicensed Assistive Personnel NAC 632.226 (2-4)(8) – Employment as school nurse; Qualified person

18. Medication Aides-Certified (MA-C) RN delegates medication administration to the MA-C Long term care facilities only May not give: enteral or parenteral, NG or G-tube, controlled substances May not take/transcribe orders, calculate dosages, destroy meds, perform treatments, assess, evaluate errors, conduct patient teaching

19. Responsibility of the nurse Patient advocacy Maintain accountability Choose to delegate (assign) or not to delegate (assign) Know the skill level of the healthcare team to provide safe and competent care to your patients Evaluate outcomes

20. Unprofessional Conduct The following acts related to delegation are considered unprofessional conduct by the Board and are grounds for disciplinary action. NAC 632.890 (6-8), (15), (19), (24) (27-28), (30), (31), (33), (34), (39)

21. Handouts Delegation Decision-making Tree, National Council of State Boards of Nursing Scope of Practice Decision Tree Nevada State Board of Nursing

22. References American Nurses Association www.nursingworld.org Draft Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP), 2012 National Council of State Boards of Nursing www.ncsbn.org Working with Others: A Position Paper, 2005 Delegating Effectively Video (on their website and on YouTube.com) Nevada State Board of Nursing www.nevadanursingboard.org

23. QUESTIONS?