NURSE DELEGATION NORTH DAKOTA FEBRUARY 17, 2010

1. NURSE DELEGATION NORTH DAKOTAFEBRUARY 17, 2010 • ND BOARD OF NURSING • Constance B. Kalanek PhD, RN • Executive Director • www.ndbon.org • ckalanek@ndbon.org ND Board of Nursing

2. NDBON Overview • NDCC Nurse Practice Act • NDAC Rules • Unlicensed Assistive Persons & Medication Assistants • Collaboration with stakeholders ND Board of Nursing

3. ELEMENTS REQUIRED BEFORE DELEGATION CAN OCCUR • 1. Authority (legal) • 2. Role or job description • 3. Knowledge of responsibility • 4. Recognize accountability • 5. Trust ND Board of Nursing

4. CAN YOU DEFINE THE TERM “DELEGATION”? • “Delegation" means: The authorization for the performance of selected nursing interventions from a licensed nurse to an unlicensed assistive person NDAC 54-01-03(16). ND Board of Nursing

5. DEFINITIONS • UNLICENSED ASSISTIVE PERSON (UAP) – means an assistant to the nurse who regardless of title is authorized by the board to perform nursing interventions delegated and supervised by a licensed nurse. (NDCC 43-12.1-02(9). ND Board of Nursing

6. WHO ARE UAPs IN ND? • -CNA in nursing home • -HH & Hospice aide • -Medical Assistant • -Surgical Technician • -NA in acute care • -Workers in correctional facility, DD settings & home settings ND Board of Nursing

7. NURSE ACCOUNTABILITY • Self • Clients • Employer • NDBON • Profession ND Board of Nursing

8. LIMITS ON DELEGATON • Assessment • Nursing Diagnosis • Plan of Care • Teaching • Counseling • Triage • Receiving/transmitting orders NDAC 54-05-04-05 ND Board of Nursing

9. DESIRED DELEGATION OUTCOMES • Protection of client safety • Achievement of desired client outcomes • Reduction of health care costs • Access to appropriate levels of health care • Decreased nursing liability ND Board of Nursing

10. KEYS TO DELEGATING EFFECTIVELY • Communicate continuously • Value all team member contributions • Develop trust between co-workers • Learn from experience ND Board of Nursing

11. MEDICATION ASSISTANTS • Three levels – I, II, III • Variation in depth of program • NDAC Rules • Delegation process – not meant to replace the nurse ND Board of Nursing

12. COLLABORATIVE EFFORTS - WORK GROUPS • Between state agencies • Understand the specifics of the law & rules • Assist in the provision of care in all settings. ND Board of Nursing

13. FAQ • I’m an RN who works with Quality Service providers in a home setting. Can I delegate to the QSPs to assist the client in assistance with medication administration? ND Board of Nursing

14. APPROPRIATE/INAPPROPRIATE DELEGATION • Susan, a nurse works for a county social service , has delegated to Jane, the assistant, the task of assisting Mr. Jones with taking his medications. He is very shaky & can not open the bottle easily without spilling the contents. Did Susan do the right thing? ND Board of Nursing

15. APPROPRIATE/INAPPROPRIATE DELEGATION • Linda, a nurse working for the County Social Services has delegated to Bob, the assistant, the task of suctioning Mr. Clark. Mr. Clark has been on ventilator support for 15 years. Did Linda do the right thing? ND Board of Nursing

16. FAQ • I’m an RN who works in a self directed cares program and I do not oversee the caregivers directly. What is my role in delegation? ND Board of Nursing

17. Questions . Can I be sued if I make a mistake? . If a UAP makes a mistake is my nursing license on the line? ND Board of Nursing