Delegation of Care & Specialized Health Services for Health Assistants

Janie Lee Hall, School Health Advocate, NW RegionOffice of School & Adolescent Health

Public Health Division, NMDOH

What Does Delegation Mean to You?

(Let’s delegate a task…)

New Mexico Nurse Practice Act Rules

Delegation is “the transferringto a competent individual theauthority to perform a selectednursing task in a selected

situation”

Alphabet Soup

◦UAP: Unlicensed Assistive Personnel◦NAP: Nursing Assistive Personnel

◦ Individuals who are trained to function in an assistive role to the registered nurse in the provision of student care activities as delegated by and under the supervision of the registered professional nurse (NASNC, 200)

In schools, this may be the health assistant, educational assistant, teacher, secretary, or anyone who accepts delegation from the school nurse and is not licensed by the State Board of Nursing (NASN, 2004)

Legal Guidelines

New Mexico Nurse Practice Act

Local, State and National Standards of Practice

District Policy and Procedures

New Mexico Nurse Practice Rules

The Delegating Nurse:

Shall assign/delegate to unlicensed persons only those nursing actions which that person is prepared, qualified, or licensed, or certified to perform

Is accountable for assessing the situation and responsible for the decision to delegate or make the assignment

New Mexico Nurse Practice Act Rules

The Delegating Nurse:

Is accountable for each activity delegated, for supervising the delegated activity, and for assessing the outcome of the delegated activity

May not delegate the specific functions of nursing assessment, evaluation and nursing judgment to non-licensed persons

Key Points The New Mexico Nurse Practice Act governs the

practice of all nursing, including delegation

Delegation is the process of assigning a nursing task to a competent person who is not a nurse

Only a registered nurse can legally delegate

Only a registered nurse can decide when, what and to whom to delegate

Key Points Delegation is a process that requires ongoing

training, supervision, and documentation

A delegated task may not be further delegated to another person except by a the nurse

The nurse must supervise the health outcome of the student

The health, safety, and welfare of the student must be the primary consideration in any decision to delegate...

Specialized Nursing Procedures

The parent notifies the school nurse of a specialized nursing procedure that needs to be performed at school

Written orders from the student’s primary care provider must verify the need for specialized health services, and indicate time, frequency, condition(s), and management of side effects

The School Nurse transcribes the orders, and determines if elements of care can be delegated

Specialized Nursing Procedures

The School Nurse writes the Individualized Healthcare Plan (IHP) and is responsible for all changes and revisions

The School Nurse provides training and supervision of delegated tasks/care activities

What are some specialized nursing tasks that can be delegated?

Criteria for Delegation to UAP (NCSBN, 2005)

The task is within the UAP range of functions

Frequently recurs in the daily care of client(s)

Performed according to an established sequence of steps

Involves little or no modification from one situation to another

May be performed with a predictable outcome

Does not inherently involve ongoing assessment, interpretation, or decision-making, which cannot be logically separated from the procedure itself

Does not endanger the client’s life or well-being

Criteria for Delegation to UAP (continued)

Your Role in Delegated Care of Students

Accept the responsibility for delegated tasks

Affirm understanding of expectations

Ask questions regarding delegation and seek clarification of expectations as needed

Inform nurse if you have not or infrequently performed a delegated task/function/activity

Your Role in Delegated Care of Students

Demonstrate competence to perform specific task

Ask for additional training/supervision as needed

Safely perform tasks as trained

Follow protocols and guidelines

Your Role in Delegated Care of Students

Determine communication & documentation methods with the nurse

Understand plan of action in emergency situations

Acknowledge liability for actions outside scope (eg: practicing nursing without a license)

Agency/Employer Delegation Responsibilities

Provide adequate staffing

Follow-up on every report of concern

Provide education and orientation to all employees, including training on delegation

Nursing Assessment & EvaluationRemember: The RN may not delegate the

specificfunctions of nursing assessment, evaluation and nursingjudgment to non-licensed persons

However, under the direction & supervision of theSchool Nurse, the Health Assistant may:

Collect, report and record basic objective & subjective data

Observe and report signs & symptoms or deviations from normal health status

You are the eyes, ears and hands of the school nurses

What Would You Do?

Your nurse is at her other school today. She calls you 15 minutes before a tubefeeding is scheduled. She says she won’tbe able to get back in time and for youto perform the tube feeding. You haveseen it performed once, 2 months ago.

What Would You Do?

You just finished assisting a student with hismedication. Another student runs in vomitingand you are helping that student. The nurse (who happens to be in the office that day)

tells you that she will document the medicationfor you, since you are busy.

Thank you for all you do to keep our students to keep healthy and safe!