Delegation of Care & Specialized Health Services for Health Assistants

1. Delegation of Care & Specialized Health Services for Health Assistants Janie Lee Hall, School Health Advocate, NW Region Office of School & Adolescent Health Public Health Division, NMDOH

2. What Does Delegation Mean to You?(Let’s delegate a task…)

3. New Mexico Nurse Practice Act Rules Delegation is “the transferring to a competent individual the authority to perform a selected nursing task in a selected situation”

4. 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)

5. Legal Guidelines New Mexico Nurse Practice Act Local, State and National Standards of Practice District Policy and Procedures

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. What are some specialized nursing tasks that can be delegated?

14. 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

15. Criteria for Delegation to UAP (continued) • 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

16. 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

17. 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

18. 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)

19. 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

20. Nursing Assessment & Evaluation Remember: The RN may not delegate the specific functions of nursing assessment, evaluation and nursingjudgmentto non-licensed persons However, under the direction & supervision of the SchoolNurse, the Health Assistant may: Collect, report and record basic objective & subjective data Observe and report signs & symptoms or deviations from normal health status

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

22. What Would You Do? Your nurse is at her other school today. She calls you 15 minutes before a tube feeding is scheduled. She says she won’t be able to get back in time and for you to perform the tube feeding. You have seen it performed once, 2 months ago.

23. What Would You Do? You just finished assisting a student with his medication. Another student runs in vomiting and you are helping that student. The nurse (who happens to be in the office that day) tells you that she will document the medication for you, since you are busy.

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