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