Delegation Rule 224 Board Rules, regulation Legislative Statutes

Delegation Rule 224 Acute care environment Acute conditions Stricter Delegation Rule 225 Non-acute care Stable and predictable i.e. assisted living/hospice

Definition: Delegation: authorizing an UAP to provide nursing services while RN retains accountability for the outcome Decisions to delegate belongs to RN Cannot delegate to LVN because they are licensed RN can make assignments for LVN RN comprehensive assessment, LVN focused assessment RN license is safe if criteria and accountability is met but does not apply to civil liability of malpractice

Criteria 224.6 Applies to all situations 1) 2) 3) 4) Assess clients nursing care needs Within scope of sound professional nursing judgment UAP can safely perform without jeopardizing Task does not require nursing judgment or intervention

UAP identified, competency verified or personally instructed, adequate supervision, periodically evaluate delegation,

Supervision 224.7 Level of supervision depends on condition of client, competency of UAP, nature of task and availability of RN to UAP Delegation RN or equally qualified RN must be available to UAP directly or by telecommunication RN must be readily available with clients with changing conditions Assisting Rule 224.4(3) It does not include situations in which an UAP is directly assisting a RN by carrying out nursing tasks in the presence of a RN. This is not a form of delegation. 3 Categories of Tasks Tasks most commonly delegated 224.8 (a) A reasonable and prudent nurse would find delegation of these tasks within scope of professional judgement Assistance w/ ambulation, positioning, collecting, reporting, documenting data ADLs: reinforcement of health teaching Discretionary Tasks 224.8(b) More invasive/complicated tasks Not usually within scope of sound judgement RN directly responsible for clients care and facility follows protocol for training UAPs. Examples: Sterile procedures, invasive procedures, care of broken skin; Non invasive procedure, i.e. dressing/cleansing, penetrating wounds and deep burns Tasks Prohibited from Delegation 224.8(c)1 Assessments requiring nursing judgement, formulating plan of care/evaluation Responsibility for client teaching Medication administration, except in special circumstances (e.g. Medication Aide with valid permit issued by DSHS in home or long term care facilities) DSHS (Department of social and health services)

Nursing Students Working as UAPs 224.4(c)

Student must be enrolled in accredited RN program or on semester break Student must demonstrate competency RN must delegate in accordance with Rule 224

Additional Points BON recommends RN document in clients record: assessment of client, clients ability to participate, other significant issues BON recommends RN document in UAPs personnel record: UAP training, competency, evluation by the RN, required RN supervision Know the 5 Rights of Delegation [224.6(2)] 1) 2) 3) 4) 5) right task right person right circumstance right direction and comm. Right supervision