Transcript Diapositiva 1 - Texas School Nurses Organization

Julie Lindley, RN, BSN
Director of Health Services and PE
Grapevine-Colleyville ISD
Delegation: The Professional
School Nurses Role
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 – Delegation
Must 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 – Student
Must 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 – UAP
Must make an assessment to
determine if the:
 Knowledge level of the UAP
 Skill set of the UAP
 Willingness of the UAP
Delegation
Supervision
Must 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 – Definition
Is 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
Delegation
Delegation 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
Delegation
Delegation 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
Delegation
References:
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