Nurse Delegation to LNAs &Unlicensed Personnel in the Ambulatory Care Settings

1. Nurse Delegation to LNAs &Unlicensed Personnel in the Ambulatory Care Settings Margaret Walker, Ed.D., RN NH Board of Nursing

2. What are we seeing as trends in the ambulatory settings • Increased responsibility questions have been coming to the board. • Unlicensed and nursing assistant staff are providing a scope of practice that is more intense which, challenges the educational experience of personnel.

3. What do we need to keep in mind? • The delegation rules in Nur 400 • These rules allow nurse delegation of nursing tasks to individuals for care to individuals who are stable.

4. Where do I find Nur 400? • www.state.nh.us/nursing • Go to “Nurse Practice Act” • Open Administrative Rules Chapters 100-800. • Note: The NH Legislature gives approval for these rules that govern our practice through legislative process.

5. What does the Delegation rule say? • The licensed nurse can delegate tasks to LNAs and unlicensed persons provided the patient does not have an acute problem rendering them unstable. • The nurse must make sure the delegatee has the competencies to perform the task. • The nurse is ultimately responsible and accountable for delegated tasks.

6. What if the nurse is simply teaching a task and delegating? • The nurse can teach and must make it clear that she/he is not delegating but simply teaching the skills.

7. Where can I find board clinical practice answers already processes? • The quick link section on the board’s home page connects you to the nursing practice page. This page contains board opinions for the last several years. Older decisions are located in archived newsletters located in the Applications, Forms, and Publications section of the website.

8. Recent board advisories related to the expanding roles of licensee • Go to the website and click on “Nursing Practice”. • There is a section where the board has provided practice opinions at its board meeting. The questions are posted for 30 days or longer for public comments.

9. What is the process for board advisories? • Individuals with questions go to the Nursing Practice section of the website and use the “Decision Tree” to determine if the task is part of their practice. • If, after completing the decision tree and researching the question it is still not clear…the person can ask the board.

10. Completing a Clinical Practice Inquiry Form • The form is located on the Nursing Practice page of the website. • Please complete all sections and make sure you provide as much information as possible to allow full board understanding of your question. • Also provide information regarding your research of the question.

11. What next? • There are several avenues/options you can take; • Attend the OPEN FORUM of the board meeting to present your question ; and/or • Mail or email (boardquestions@nursing.state.nh.us) your form and watch for the board minutes and Nursing Practice page for the final results.

12. Board action on advisory questions…how does it work? • The board receives the board packet in advance of the meeting for review and research; • The board may answer the question at the meeting; or • Refer the question to the Practice and Education Committee for additional research.

13. Practice and Education Committee • This committee is an important part of the board process. • After careful study and deliberation of the question, the committee develops and presents a recommendation to the next board meeting. • The questions are becoming numerous!!

14. What is the definition of “stable patient” • The concept of predictable outcomes is important. • Stability is defined as the expectation of the individual patient’s level of predictable outcomes. • Delegation can occur with individuals who are “stable” and have predictable outcomes of care.

15. What if my patient has serious health issues but we know about their condition? • If the condition of the patient is known and consistently occurs, it is considered a predictable outcome for that patient. • If the patient suddenly has a condition they have never experienced and is not part of the care plan, we have an unpredictable outcome.

16. The constantly changing health care delivery system • This is a work environment that is impacted by new technologies; • Health care systems are continually changing to improve patient outcomes; • Financial/economic issues have created an environment that changes to adapt to reimbursement, costs, and effective care.

17. Prediction for the Future • The board is aware that we need to adapt to the changing healthcare needs and at the same time--- • Maintain optimal patient care. • Maintain patient safety. • Assure quality care systems.

18. So, how do I keep up on all of these changes? • Review the board’s website on a regular basis. • Continue to learn new skills. • Continue to maintain a good knowledge base and keep up with changes in the healthcare options for patients. • Ask questions to make sure you are working within your scope of practice.

19. Thank you • Margaret’s email Mwalker@nursing.state.nh.us • Norma Blake norma.blake@nursing.state.nh.us • Board staff member for LNAs is Mary Lou Moreen RN at marylou.moreen@nursing.state.nh.us