Delegation to unlicensed assistive personnel

1. Delegation to unlicensed assistive personnel

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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?

11. 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?

12. 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?