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Communtity-Based RN Delegation and Teaching

Definition of Delegation:

One task taught and delegated to one unlicensed caregiver for one client.
 

Delegation occurs in a variety of settings:​

  • 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.

​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:
    • Complexity.
    • Risks involved.
    • Skills necessary to safely perform.
    • How often does the task need to be reassessed?
    • Can the task be safely performed without direct RN supervision?
  4. Assess the caregiver:
    • Determine whether an unlicensed person can perform the task safely without direct supervision of a RN.
    • Evaluate the skills, ability and willingness of the unlicensed person (caregiver).
    • 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.

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