Delegation

1. Delegation How do I delegate so I can SLEEP at night? Isa Chase, RN, CPNP Franklin School District Sally Roepe, RN, BSN Wauwatosa School District

2. “I can’t do THAT….it might be my license!”

3. Pre-testIs this delegation? • The principal tells the school secretary to give the noon time medications today. Is this delegate? • The school nurse trains the physical education coach to give nebulizedAlbuteral. The nurse work 3 hours a week in the school district. Is this delegation? • The school nurse trains and monitors the special education assistant to give a gastrostomy tube feeding. The nurse works 20 hours a week in the school district. Is this delegation?

5. Objectives • What is delegation? • What does the law state regarding delegation? • What can you delegate and to whom? • What is consultation? • What should not be delegated?

6. What is delegation? • To commit powers to act as a representative for another (Webster Dictionary). • The transfer of responsibility for the performance of a task from one person to another with the former retaining accountability for the outcome. (ANA, 1994) • Transfer to a competent individual the authority to perform a selected nursing task in a selected situation. (NCSBN, 1995)

7. What does the Wisconsin Law state regarding delegation? • N 6.03(5) – “Delegated nursing act”: means acts delegated to an L.P.N. or less skilled assistant by an R.N.” • Nursing acts – Not defined in Wisconsin Administrative Code • N 6.03(3) Delegate commensurate with education preparation and demonstrated abilities, provide direction and assistance, observe and monitor activities and evaluate effectiveness. • Medical provider delegate/authorize the institution not the nurse to perform the task.

8. What are consultative services? • Nurse does not have the day-to-day availability in the school. • The nurse does not own the nursing task • Authority goes from the physician to the parent to the delegate in the school. • Nurse owns the evaluation of staff for “competency to perform the duty”.

9. Delegation vs. consultation • The school nurse’s job description or contract should identify if the nurse is delegating or consulting. • School district remains responsible for providing the necessary nursing services to provide safe care to students.

10. More terms • General Supervision – regularly to coordinate, direct and inspect the practice of another • Direct Supervision – immediate availability to continually coordinate, direct and inspect at first hand the practice of another.

11. 5 Rights • The Right Task • The Right Person • The Right Direction • The Right Supervision • The Right Circumstances ( National Council of State Boards of Nursing, 1995)

12. What nursing tasks can nurses delegated? • No list of nursing task - delegate • Within area of responsibility • Within the knowledge, skills and ability of the nurse • Task that another reasonable and prudent nurse would find to be within generally accepted nursing practice • Act consistent with health and safety of student

13. How do I decide if I can delegate the task? • The nurse needs to assess the following: • Capacity to own the task • Student’s health care needs – complexity and predictability of the care, frequency of the care, stability of the student’s health, degree of risk if the task is not carried out • Delegate skills - training, experience and education (also learning style) • Nature of task – potential for harm, predictability of outcome, complexity of task

14. What are the responsibility of the nurse delegating? • Assessment of the willingness of the delegate • Appropriate training of the delegate • Assessment of the competency of the delegate • Ongoing supervision and evaluation • Instruction on how to intervene in any of the foreseeable risks that may associated with the delegated task

15. What are the responsibilities of the delegatee? • The delegatee can not transfer responsibility to another Unlicensed Assistive Personnel or train others. • Must notify the nurse if they are unable to perform the task • Notify the nurse of any changes noted in the health of the student or the task

16. What can’t I delegate? • Assessment , Planning and Evaluation (Board of Nursing Position Paper) • Independent IV Therapy

17. What do I need to document when delegating? • Assessment of the student’s health status and self care skill level • Date and time of training sessions • Performance by the Delegatee of the delegated task • Need for further instruction and monitoring • Continuation or withdraw of delegation. • Individual Health Care Plan

18. Decision NOT to Delegate to UAP • School district continues to be responsible for providing for the nursing care • Notify and Problem Solve with Administrator and Medical Provider • Special Health Care Nurse vs. Private Duty Nursing

19. What are the differences between assignment and delegation? • Principals may assign a staff member to administer medication • Nurses delegate

20. Board of Nursing Only delegate that which you “own” (based on the BON white position paper of 6/04) http://drl.wi.gov/boards/nur/pap/pap05.pdf

22. Is this delegation?Post-Test • The principal tells the school secretary to give the noon time medications today. Is this delegate? No • The school nurse trains the physical education coach to give nebulizedAlbuteral. The nurse work 3 hours a week in the school district. Is this delegation? Maybe not, supervision and consultation may not be available. • The school nurse trains and monitors the special education assistant to give a gastrostomy tube feeding. The nurse works 20 hours a week in the school district. Is this delegation? Yes

23. Delegation Decision??? • 8 year old student with cardiomypathy who has an order for oxygen. Oxygen is used PRN based on color, respiratory rate, effort and fatigue level. When O2 saturation fall below 85, call 911. Would you delegate O2 administration?

24. Delegation Decision??? 2. 6 year old student with type 1 diabetes, who has a continuous glucose monitoring pump. Student was diagnosed at age 4 and received the pump two months ago. Student’s self-care skills are limited to appropriate snack selection. Has limited awareness of his own signs and symptoms of hypoglycemia. Unable to carb count. Would you delegate insulin boluses to UAP?

25. Delegation Decision??? 3. 9 year old female with Acardi Syndrome with tonic clonic seizure disorder. Student has history of 20 minute seizure with and without respiratory distress. You receive a medical provider order for administration of Diastat after 5 minutes of tonic clonic seizure activity. Student has received Diastat on a frequent basis and tolerated the medication without respiratory distress. Do you delegate the Diastat?

26. Questions!!!