Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Division 47: Community-Based RN Delegation & Teaching
Division 47 Rules
Standards for RN Delegation of Nursing Care Tasks to Unlicensed Persons
Division 47 rules were approved 2/12/04.

Delegation Courses
 

Delegation Information
Delegation Definition:
 
One task taught and delegated to one unlicensed caregiver for one client.

Where Does Delegation of Nursing Tasks Occur?
  • Adult foster homes.
  • Assisted-living facilities.
  • 24-hour residential care facilities.
  • Child foster homes.
  • Private homes.
  • Public schools.
  • Local corrections facilities.
  • Lockups.
  • Juvenile detention.
  • Youth corrections facilities.
  • Detoxification facilities.
  • Other settings where a Registered Nurse is not regularly scheduled and is not available for direct supervision.


Elements of Delegation 
Only RNs can delegate tasks of nursing care.  Only the task is delegated; assessment and judgment cannot be delegated. 
 
A.  Assessment Components:
  1. Client’s condition is stable and predictable.
  2. Consider the setting and circumstances.
  3. Assess the task:
    a.  Complexity.
    b.  Risks involved.
    c.  Skills necessary to safely perform.
    d.  How often does the task need to be reassessed?
    e.  Can the task be safely performed without direct RN supervision?
  4. Assess the caregiver:
    a.  Determine whether an unlicensed person can perform the task safely without direct supervision of a RN.
    b.  Evaluate the skills, ability and willingness of the unlicensed person (caregiver).
    c.  How often do the caregiver’s skills need to be reassessed?
B.  Teaching Components:
  1. Explain why the task is important to the client’s wellbeing.
  2. Teach the proper procedure/technique.
  3. Observe the caregiver perform the task on the client until you are sure competency is achieved.
  4. What are the risks associated with the task?
  5. Observe the client's response to the task.
  6. What are the signs and symptoms that the client may be experiencing side effects?
  7. What are the appropriate responses to a side effect?
  8. How is the caregiver to document that he/she has done the task?
C.  Written Instructions:  Leave procedural guidance for the caregiver that includes:
  1. A specific, detailed outline of how the task of nursing is to be performed, step-by-step.
  2. Signs and symptoms to be observed
  3. Guidelines for what to do if negative signs and symptoms do occur.
  4. That the caregiver understands the risk involved in performing the task and knows the plan for dealing with the consequences.
  5. To whom the caregiver reports negative signs and symptoms or concerns.
D.  Documentation Components:  
  1. The stability of the client’s condition based on your nursing assessment.
  2. Skill, ability and willingness of unlicensed person.
  3. That the task was taught and the caregiver is competent. (How do you know? Was there a return demonstration?)
  4. The written instructions (procedural guidance).
  5. Evidence that the caregiver was instructed that the task is client specific and not transferable to other clients or caregivers.
  6. How frequently the client is to be assessed by the Registered Nurse.
  7. How frequently the caregiver is to be supervised and reevaluated.
  8. That the RN takes responsibility for delegating the task to the caregiver.
  9. Your rationale for delegating this task.
E.  Periodic Inspection, Supervision, and Re-evaluation: 
  1. You must periodically reassess the client to determine if their condition remains stable and predictable.
  2. Must periodically observe the competence of the caregiver to perform the task on the resident. Is the caregiver still capable and willing to safely perform the nursing task?
  3. Initial inspection must occur within 60-days of the delegation with frequency based on client's condition and caregivers' continued competence with the task.
  4. Subsequent inspections at your discretion, with frequency based on client's condition and caregivers' continued competence with the task, but no longer than 180 days between inspections.

Other Aspects of Delegation
  • RN may share supervision with another RN (OAR 851-047-0030(5)(a, b, c & d)).
  • RN may transfer delegation and supervision to another RN (OAR 851-047-0030(6)(a, b, c & d).
  • RN always has the authority to rescind delegation (OAR 851-047-0030(7) (a, b, c, d & e).

Subcutaneous Injections
May be considered for delegation by the RN through application of the delegation process.

IV Medications & Fluids (OAR 851-047-0030(8-12))
  • RN employed by home health, home infusion or hospice.
  • RN available 24-hours each day (on call).
  • Tasks limited to:
    • Flush the line with routine, pre-measured flushing solutions.
    • Add pre-measured medications.
    • Change bags of pre-measured fluids.
  • RN has the right to refuse to delegate administration of medications by IV route.

Teaching of Med Administration
Non-Injectable Medications
  • A RN (or a LPN at the direction of a RN) may teach an unlicensed caregiver to administer non-injectable medications.
  • The instructions taught should include:
    • Proper methods for administration.
    • What the medication is supposed to do for the client/resident (expected outcome).
    • Potential side effects & what to do if they occur.
    • Observe the resident’s response to the medication.
    • How to document administration.
    • How to verify the licensed independent providers' (LIP) order and transcribe the order on the medication administration record.
  • A RN (or a LPN at the direction of a RN) may write parameters to clarify the LIP's PRN orders.
 

Teaching for an Anticipated Emergency (OAR 851-047-0040)
An RN may teach tasks to unlicensed persons to prepare them to deal with anticipated client emergencies related to symptoms of severe hypoglycemia and symptoms of severe allergic reactions.