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 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.
- 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:
B. Teaching Components:
- Client’s condition is stable and predictable.
- Consider the setting and circumstances.
- Assess the task:
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?
- 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?
C. Written Instructions: Leave procedural guidance for the caregiver that includes:
- Explain why the task is important to the client’s wellbeing.
- Teach the proper procedure/technique.
- Observe the caregiver perform the task on the client until you are sure competency is achieved.
- What are the risks associated with the task?
- Observe the client's response to the task.
- What are the signs and symptoms that the client may be experiencing side effects?
- What are the appropriate responses to a side effect?
- How is the caregiver to document that he/she has done the task?
D. Documentation Components:
- A specific, detailed outline of how the task of nursing is to be performed, step-by-step.
- Signs and symptoms to be observed
- Guidelines for what to do if negative signs and symptoms do occur.
- That the caregiver understands the risk involved in performing the task and knows the plan for dealing with the consequences.
- To whom the caregiver reports negative signs and symptoms or concerns.
E. Periodic Inspection, Supervision, and Re-evaluation:
- The stability of the client’s condition based on your nursing assessment.
- Skill, ability and willingness of unlicensed person.
- That the task was taught and the caregiver is competent. (How do you know? Was there a return demonstration?)
- The written instructions (procedural guidance).
- Evidence that the caregiver was instructed that the task is client specific and not transferable to other clients or caregivers.
- How frequently the client is to be assessed by the Registered Nurse.
- How frequently the caregiver is to be supervised and reevaluated.
- That the RN takes responsibility for delegating the task to the caregiver.
- Your rationale for delegating this task.
- You must periodically reassess the client to determine if their condition remains stable and predictable.
- 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?
- Initial inspection must occur within 60-days of the delegation with frequency based on client's condition and caregivers' continued competence with the task.
- 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).
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.