The Nevada The Nevada Nurse Practice Act Nurse Practice Act

and and Delegation Delegation

Chris Sansom, MSN, RNDirector of Operations

Nevada State Board of Nursing

The Nevada Nurse Practice ActThe Nevada Nurse Practice Act

• Nevada Revised Statutes – NRS 632 Bill passed by the Assembly and Senate and signed

into law by the Governor

• Nevada Administrative Code – NAC 632 Adopted by the Board of Nursing to carry out the

intent of the law

• Practice Decisions• Scope of Practice

Roles and ResponsibilitiesRoles and Responsibilities

• Registered Nurse Independent, dependent and interdependent

functions

• Licensed Practical Nurse (LPN) At the direction of RN, APN, licensed

physician, licensed physician assistant, or licensed podiatric physician

Roles and ResponsibilitiesRoles and Responsibilities• Certified Nursing Assistant (CNA)

At the direction and under supervision of RN or LPN

• Unlicensed Assistive Personnel (UAP)

But in both [hospitals and private houses], let whoever is in charge keep this simple question in her head, (not, how can I always do this right thing

myself, but) how can I provide for this right thing to be always done?

- Florence Nightingale

DelegationDelegation

• NAC 632.047 Delegation defined. “Delegation” means entrusting the

performance of a delegable nursing duty to a person who is qualified and competent to perform the duty.”

What does it mean? What does it mean?

Nurses possess the knowledge, skill and ability to coordinate and supervise the delivery of nursing care, which includes the assignment of nursing tasks to others.

Nursing Process: assess, diagnose, outcomes, plan, implement, evaluate.

ANA’s DefinitionANA’s Definition• The transfer of responsibility for the performance

of an activity from one individual to another while retaining accountability for the outcome.

Example: The nurse, in delegating an activity to an unlicensed individual, transfers the responsibility for the performance of the activity but retains professional accountability for the overall care.

Responsibility – Allocated and accepted

The Nurse Practice Act (NPA)The Nurse Practice Act (NPA)NAC 632.212 (2) An RN shall demonstrate competence in:(f) Delegating appropriate duties to other persons;(g) Supervising a person to whom the

RN has delegated nursing duties;(h) Maintaining accountability in the

delegation of care

NPA ContinuedNPA ContinuedNAC 632.222 (1) RN may delegate nursing care to otherpersonnel and supervise other personnel in theprovision of that care if those persons arequalified to provide that care.

(2) RN shall perform or supervise any act necessary to ensure the quality and sufficiency of delegated care provided to a patient.

NPA ContinuedNPA ContinuedNAC 632.222 (3) Before delegating the RN shall determine:

(a) Amount of direction(b) Complexity of care(c) Educational preparation and competency (d) Policy and procedures

(4) The RN who delegates nursing care or duties is responsible for the care.

Still confused?Still confused?• Case study:

Right task – is it safe, predictable outcomeRight circumstance – client condition/setting,complexityRight person – within their scope of practice,education/competence Right direction/communication – clear,concise

Right supervision – follow-up

Not DelegableNot Delegable

• Nursing judgment except to another RN• Nursing assessment• Evaluation of patient outcomes based on interventions• Any act not within the persons scope of practice• Any act that another reasonable and

prudent nurse would not delegate

RN – Delegation RegulationsRN – Delegation Regulations• NAC 632.212 RN duties

• NAC 632.220 Medications and treatment

• NAC 632.224 Supervision

• NAC 632.244 Unauthorized acts prohibited

• NAC 632.248 Assignment to UAPs • NAC 632.340 Exemptions from required

licensing or certification

LPN – Delegation RegulationsLPN – Delegation Regulations• NAC 632.230 Limitations; Supervision;

Delegation

• NAC 632.450 Procedures delegable to LPNs

• NAC 632.455 Procedures not delegable to LPNs

Nurse Apprentices Nurse Apprentices

• NAC 632.063 Nursing student• NAC 632.252 Performance of tasks• NAC 632.253 Prohibited acts

Unlicensed Assistive PersonnelUnlicensed Assistive Personnel

• NAC 632.226 (2-4)(8) – Employment as school nurse; Qualified person

Medication Aides-Certified (MA-C)Medication Aides-Certified (MA-C)• RN delegates medication administration to the MA-C• Long term care facilities only• May not give: enteral or parenteral, NG or

G-tube, controlled substances • May not take/transcribe orders, calculate dosages, destroy meds, perform treatments, assess, evaluate errors, conduct patient teaching

Responsibility of the nurseResponsibility of the nurse

• Patient advocacy• Maintain accountability• Choose to delegate (assign) or not to

delegate (assign)• Know the skill level of the healthcare

team to provide safe and competent care to your patients

• Evaluate outcomes

Unprofessional ConductUnprofessional Conduct

• The following acts related to delegation are considered unprofessional conduct by the Board and are grounds for disciplinary action.

• NAC 632.890 (6-8), (15), (19), (24) (27-28), (30), (31), (33), (34), (39)

HandoutsHandouts

• Delegation Decision-making Tree, National Council of State Boards

of Nursing

• Scope of Practice Decision Tree Nevada State Board of Nursing

ReferencesReferencesAmerican Nurses Associationwww.nursingworld.org

Draft Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP), 2012

National Council of State Boards of Nursingwww.ncsbn.org

Working with Others: A Position Paper, 2005Delegating Effectively Video (on their website and

on YouTube.com)

Nevada State Board of Nursingwww.nevadanursingboard.org

QUESTIONS?QUESTIONS?