NURSE DELEGATION NORTH DAKOTA

FEBRUARY 17, 2010

ND BOARD OF NURSINGConstance B. Kalanek PhD, RN

Executive Director www.ndbon.org

ckalanek@ndbon.org

1ND Board of Nursing

NDBON Overview NDCC Nurse Practice Act NDAC Rules Unlicensed Assistive Persons &

Medication AssistantsCollaboration with stakeholders

2ND Board of Nursing

ELEMENTS REQUIRED BEFORE DELEGATION CAN OCCUR1. Authority (legal)2. Role or job description3. Knowledge of responsibility4. Recognize accountability5. Trust

3ND Board of Nursing

CAN YOU DEFINE THE TERM “DELEGATION”?“Delegation" means: The authorization for the

performance of selected nursing interventions from a licensed nurse to an unlicensed assistive person NDAC 54-01-03(16).

4ND Board of Nursing

DEFINITIONS UNLICENSED ASSISTIVE PERSON

(UAP) – means an assistant to the nurse who regardless of title is authorized by the board to perform nursing interventions delegated and supervised by a licensed nurse. (NDCC 43-12.1-02(9).

5ND Board of Nursing

WHO ARE UAPs IN ND?-CNA in nursing home-HH & Hospice aide -Medical Assistant -Surgical Technician -NA in acute care-Workers in correctional facility, DD settings & home settings

6ND Board of Nursing

NURSE ACCOUNTABILITY

SelfClientsEmployerNDBONProfession

7ND Board of Nursing

LIMITS ON DELEGATONAssessmentNursing DiagnosisPlan of CareTeachingCounselingTriageReceiving/transmitting orders

NDAC 54-05-04-05

8ND Board of Nursing

DESIRED DELEGATION OUTCOMES

Protection of client safetyAchievement of desired client

outcomesReduction of health care costsAccess to appropriate levels of

health careDecreased nursing liability

9ND Board of Nursing

KEYS TO DELEGATING EFFECTIVELY

Communicate continuouslyValue all team member

contributionsDevelop trust between co-

workersLearn from experience

10ND Board of Nursing

MEDICATION ASSISTANTS

Three levels – I, II, IIIVariation in depth of programNDAC RulesDelegation process – not meant to

replace the nurse

11ND Board of Nursing

COLLABORATIVE EFFORTS - WORK GROUPS

Between state agenciesUnderstand the specifics of the

law & rulesAssist in the provision of care in

all settings.

12ND Board of Nursing

FAQI’m an RN who works with Quality

Service providers in a home setting. Can I delegate to the QSPs to assist the client in assistance with medication administration?

13ND Board of Nursing

APPROPRIATE/INAPPROPRIATE DELEGATION

Susan, a nurse works for a county social service , has delegated to Jane, the assistant, the task of assisting Mr. Jones with taking his medications. He is very shaky & can not open the bottle easily without spilling the contents. Did Susan do the right thing?

14ND Board of Nursing

APPROPRIATE/INAPPROPRIATE DELEGATION

Linda, a nurse working for the County Social Services has delegated to Bob, the assistant, the task of suctioning Mr. Clark. Mr. Clark has been on ventilator support for 15 years. Did Linda do the right thing?

15ND Board of Nursing

FAQI’m an RN who works in a self

directed cares program and I do not oversee the caregivers directly. What is my role in delegation?

16ND Board of Nursing

Questions

. Can I be sued if I make a mistake?

. If a UAP makes a mistake is my nursing license on the line?

17ND Board of Nursing