Ohio Board of Nursing 77 South High Street
17th Floor Columbus, Ohio 43266- 0316
(614) 466- 3947 Nursing
Standards & Delegation: A Guide to Ohio Board of Nursing
Rules
This brochure is based on Ohio Board of Nursing rules in effect as of August, 1996
Dear Licensed Nurse: The Ohio Board of Nursing (Board) is pleased to provide this guide to the standards for safe nursing care, including standards for delegation. These standards became effective as Board rules December 1, 1995.
This brochure summarizes practice standards, especially as the standards relate to the delegation of nursing tasks or activities. Although few black and white answers can be provided, a series of commonly asked questions follows each topic area presented. The responses further explain or apply the content covered in a particular section. A decision tree (page 25) is also included to aid nurses in answering questions about whether a task is delegable.
Nursing standards require nurses to be knowledgeable about the laws and rules governing their practice. This brochure is one resource nurses can use to increase their understanding of the Board’s rules. Please read the brochure carefully in its entirety and retain it as a reference for use when issues relating to standards of nursing practice arise in the future.
Sincerely, Dorothy L. Fiorino, RN, MS Executive Director
INTRODUCTION BACKGROUND
The Ohio Board of Nursing has authority under the law to discipline any licensed nurse for “failure to practice in accordance with acceptable and prevailing standards of safe nursing care.” 1 Because Ohio law also authorizes registered nurses to delegate nursing practice, that delegation must be done in accordance with acceptable and prevailing standards of safe nursing care. 2
The Board adopted rules, effective December 1, 1995, that establish minimum regulatory standards governing Ohio’s registered nurses (RNs) and licensed practical nurses (LPNs) and that address delegation of nursing tasks and activities. 3 This brochure contains highlights of the standards for safe nursing care and highlights of the standards for delegation.
This brochure is intended to remind nurses of the acceptable and prevailing standards of safe nursing care and to serve as a guide for nurses to use when making decisions about delegation in any practice setting. It does not contain an in- depth presentation of the rules. To obtain a complete copy of the standards and delegation rules, send a request for those rules to the Ohio Board of Nursing, 77 South High Street, 17th Floor, Columbus, Ohio 43266- 0316, along with a self- addressed, business envelope with $. 55 postage affixed. A single copy of all rules of the Board, which includes the standards and delegation rules, is available for $3.00.
BOARD PROCEDURE WHEN A POSSIBLE RULE VIOLATION IS REPORTED
When the Board receives a complaint that a nurse may have failed to practice in accordance with acceptable and prevailing standards of safe nursing care, the Board will consider whether a
violation of the standards rules has occurred by first conducting a thorough investigation of the practice situation and its outcomes. Expert witnesses, nursing literature, and practice statements of nursing organizations will be used by the Board to determine prevailing and acceptable standards of nursing practice for particular specialties or settings.
A single nonadherence to a standard, which is done intentionally or irresponsibly, may be a violation; however, a violation more likely will result from a pattern or course of conduct or series of commissions or omissions related to the standards. Once a violation has been determined, the Board will consider mitigating circumstances, such as intent of the act and other factors that may have contributed to the nurse’s action or inaction. In accordance with due process as established by Ohio law, which includes notice to the nurse and an opportunity for a hearing, the Board may take one or more of the following actions: deny, revoke, suspend, or place restrictions on the license; reprimand, fine, or otherwise discipline the nurse; or take no action.
PREVAILING STANDARDS OF SAFE NURSING PRACTICE 4
Definitions for some of the terms used in this brochure may be found on page 26.
As members of the health care team, registered nurses and licensed practical nurses have a responsibility to: • Demonstrate knowledge and understanding
of the laws and rules governing nursing by functioning within the legal boundaries for the practice of nursing as an RN or LPN; • Maintain individual competence in nursing
practice; • Verify an order prescribed for a patient or
client by a licensed physician, dentist, optometrist, or podiatrist to ensure that the order is appropriate, properly authorized, and not contraindicated by other documented information; • Question an order, and if necessary to ensure
the safety of the patient or client, refuse to implement the order; • Implement the orders of physicians, dentists,
optometrists, or podiatrists that are within the scope of practice of the RN or LPN; • Implement the nursing regimen as appropriate;
• Communicate, collaborate, and consult with and make appropriate referrals to other members of the health care team; • Accept responsibility for individual nursing
actions and nursing judgments; • Maintain confidentiality of patient or client
information unless obligated by law or rule to disclose the information; • Display and identify (on a pin, identification
badge, or similar item) the licensure title of RN or LPN at all times while having direct client or patient contact as an RN or LPN;
• Delegate nursing tasks only in accordance with the rules of the Board that specifically address delegation; • Report and document in a complete, accurate, and timely manner, nursing assessments or observations, the care provided, and
the client or patient responses to the care; • Implement measures to promote a safe
environment for the patient or client; • When functioning as a nurse administrator,
assure that adequate procedures are in place to verify that nurse employees are currently and appropriately licensed and credentialed; and • Assure that supervision and evaluation of the
practice of nursing be performed by RNs only.
STANDARDS FOR IMPLEMENTING THE
NURSING PROCESS 5
The Board’s standards rules also address implementation of the nursing process by both RNs and LPNs.
• RNs are expected to utilize critical- thinking and decision- making skills based on their specialized knowledge, judgment, and ability when implementing each step of the nursing process. This process includes: • Conducting, documenting, and modifying, as needed, nursing assessments of
the health status of individuals and groups of individuals in an accurate and timely manner; • Analyzing assessment data and establishing, accepting, or modifying nursing
diagnoses to be used as a basis for nursing interventions; • Developing, maintaining, or modifying
and communicating in an accurate and timely manner, the nursing component of the plan of care, which is individualized and may vary depending upon the practice setting; • Implementing the nursing plan of care in
accordance with both the RN’s scope of practice and the knowledge, skills, and abilities of the RN. Additionally, performing specific functions or procedures which are beyond the basic preparation for an RN, provided the RN can demonstrate and has documentation of the knowledge, skills, and abilities required to perform the function or procedure. The function or procedure must not be prohibited by another law or rule; and • Evaluating and documenting in an
accurate and timely manner the responses of individuals and groups of individuals to nursing interventions.
• LPNs are expected to act in accordance with their knowledge, abilities, and skills when functioning at the direction of a registered nurse, licensed physician, dentist, optometrist, or podiatrist. This includes: • Contributing to the nursing assessment of
individuals and groups of individuals by collecting, reporting, and documenting objective and subjective data in an accurate and timely manner; • Participating in the development of the
nursing component of the plan of care at the direction of an RN; and • Implementing the nursing plan of care in
accordance with the LPN’s scope of practice. Additionally, at the direction of an RN, a licensed physician, dentist, optometrist, or podiatrist, the LPN may perform specific functions or procedures which are beyond the basic preparation for an LPN, provided the LPN can demonstrate and has documentation of the knowledge, skills, and abilities required to perform the function or procedure. The function or procedure also must not be prohibited by any law or rule. • Contributing to the evaluation of client
responses to nursing care and documenting in an accurate and timely manner.
STANDARDS FOR DELEGATION 6
INTRODUCTION
Delegation of certain aspects of nursing care is unavoidable because of the need to provide affordable, accessible, and quality health care to the public. In fact, the nurse practice act has long recognized the authority of a registered nurse to delegate nursing practice. While the Board acknowledges the inevitability of changes to the way nursing care is provided, certain principles or standards must form the basis for every delegation decision if safe care is to be assured. Board standards require a registered nurse to assess the situation or circumstances involved when delegation is being considered. Once a decision to delegate is made by a licensed nurse, the delegating nurse or another licensed nurse must teach the nursing task to the unlicensed person, in accordance with the rules of the Board, and must supervise the performance of the task, again in accordance with Board rules.
• Is bathing a patient a delegable nursing task? • Can a school nurse delegate the administration of medications to the school secretary? • The licensed nurse caring for Ms. Jones
delegated the nursing task of taking vital signs to an unlicensed nurse aide yesterday. Can that same task be delegated today?
While many nurses would like a “yes” or “no” answer to these questions, the delegation of nursing practice is not that simple. In reality, the answer to all these questions must be “it depends.” It depends upon the complexity of the task to be delegated. It depends upon the care needs of the patient or client, as assessed by a registered nurse. It depends upon the educational preparation, skills, and ability of the unlicensed person to whom the task will be delegated. And, it depends upon the availability and accessibility of essential resources, including supervision,
while the task is being performed. Nursing judgment is the essential element in every delegation decision.
In the most simplistic terms, five rights of delegation have been identified. 7 They are: • Right task (One that is delegable for a
specific patient); • Right circumstances (Appropriate patient
setting, available resources, and consideration of other relevant factors); • Right person (The right person is delegating
the right task to the right person to be performed on the right patient/ client); • Right direction/ communication (Clear,
concise description of the task including objectives, limits, and expectations); and • Right supervision (Appropriate monitoring,
evaluation, intervention, and as needed, feedback).
While the Board’s standards for safe delegation are more extensive than these “rights”, these five basic points will help a nurse determine whether a particular delegation is appropriate.
DELEGATION PRINCIPLES
• “Delegation” means the transfer of responsibility for the performance of a selected nursing activity or task from a licensed nurse authorized to perform the activity or task to someone who does not have the authority. • Delegation is unnecessary if the particular
activity or task is already within the legally recognized scope of practice of the individual who is to perform the activity or task. • If the activity or task is not within a nurse’s
scope of practice, it cannot be delegated by a nurse. You cannot delegate what you do not have! • Once the activity or task has been delegated,
only the individual given the authority to act may perform the activity or task. There can be no “subdelegation.”
• A particular activity or task may not be delegated if a specific law or rule says otherwise. For example, while initiating blood transfusions is within the scope of practice of a registered nurse, the activity may not be delegated to a licensed practical nurse as long as specific Board rules limit the role of the LPN in intravenous therapy.
Q I don’t want my license to be on the line. Am I liable for the acts of an unlicensed
person when I delegate a nursing task to that individual?
A Many nurses say, “I do not want my license on the line, and I do not want to be
‘liable’ for someone else.” This statement arises, in part, from confusion about the meanings of the terms “liability” and “accountability “or “responsibility”.
Liability is a term used in civil law meaning a person’s financial responsibility for civil wrongs such as medical malpractice or other negligence. Accountability or responsibility means the “obligation and duty to perform” which are required of every licensed nurse by the nurse practice act. In the context of delegation, that duty requires adherence to the delegation standards. When a nurse delegates in accordance with those standards, the nurse’s duty as it relates to delegation has been met.
Delegation standards require a licensed nurse, in keeping with that nurse’s scope of practice, to: • Assess the patient or client; • Determine the care needs of the patient or
client; • Determine whether the particular task is
delegable; • Determine whether the trained unlicensed
person has the skills needed to safely perform the task; and • Determine whether the appropriate supervision is available.
The trained unlicensed person is responsible for performing the task according to the directions of the licensed nurse.
Q What is the difference between “assignment” and “delegation”?
A Delegation is always downward. That is, delegation occurs when one individual has
authority to perform the task or activity while the other does not.
Assignment means that a nurse designates another nurse to be responsible for specific patients or selected nursing functions for specifically identified patients. Assignment occurs when the authority to do a task already exists. Both registered nurses and licensed practical nurses have a defined scope of practice established in law; therefore, RN to RN, and (when the activity is within the LPN’s scope of practice) RN to LPN, or LPN to LPN is an assignment.
An element of assignment exists in all delegation; however, assignment, which is horizontal in nature, does not require delegation. Both “assignment” and “delegation” decisions must be made by a licensed nurse on the basis of the skill levels of the care givers, patient or client care needs, and other considerations.
Nurses have always been accountable or responsible for their assignment decisions. Responsibility or answerability when delegating or assigning cannot be avoided. Liability may be avoided, if standards are followed.
Q I am a certified school nurse. What nursing activities can I delegate to a
registered nurse who is not a certified school nurse, but who is working in the student health clinic at one of my schools?
A No delegation is required with respect to nursing activities. Both nurses have the
same legally recognized scope of practice; therefore, both have identical authority to
provide nursing care. School districts and other employers may, however, establish policies that set limits on what tasks can be performed by unlicensed personnel. For example, an employer policy may state that no unlicensed personnel may perform any task which requires sterile technique. A school district policy might require that only certified school nurses perform nursing activities or tasks which would preclude delegation to anyone who does not meet the district’s criteria. An employer may adopt policies that are more restrictive but not less restrictive than Board standards. The Board rules do not require delegation. They merely establish the standards that must be met when delegation is to occur.
Q A trained unlicensed person has been asked by a licensed nurse to give a nonmedicated
enema to the patient in Room 209 A. The unlicensed person is busy, and the time for the enema is at hand. May the trained unlicensed person ask a co- worker to give the enema?
A No. While the co- worker may have sufficient training to be able to give the
enema, a licensed nurse must be involved in the decision to change the delegation. Unlicensed individuals must be directed to check with a licensed nurse to avoid “subdelegation”, which is prohibited. The actual process used to involve a licensed nurse when delegation must be changed will depend upon the policies and demands of the practice setting. Board rules do not require a complex process for redelegating.
Q Must a delegated nursing task be redelegated each day?
A Not necessarily. Board rules do not specify time frames for the assessment of patient
or client needs by a registered nurse and do not specify the length of time for delegation. When a nursing activity or task is delegated, the nurse
must determine when reassessment will be needed and specify whether and under what circumstances the activity or task may be performed repeatedly.
LIMITS ON DELEGATION
Delegation of nursing tasks is not without limits or restrictions. The Board rules state that: • A licensed nurse must not delegate to an
unlicensed person the use of the nursing process in its entirety or any steps of the nursing process, except for delegable nursing tasks as defined in the Board rules. • Any task requiring judgment based on
nursing knowledge or expertise may not be delegated. • An unlicensed person may not perform a
nursing task unless that task has been delegated in accordance with Board rules. • Employing or permitting an unlicensed
person to perform nursing tasks without delegation by a licensed nurse is prohibited. • Once the activity or task has been delegated,
only the individual given the authority to act may perform the activity or task. So- called “subdelegation” is prohibited. • Most significantly, the Board rules prohibit
the delegation of medication administration by a licensed nurse to an unlicensed person, unless a specific law exists authorizing an unlicensed person to do so. Trained unlicensed persons may administer medications in a Mental Retardation/ Developmental Disability (MR/ DD) county board facility, in an Intermediate Care Facility/ Mental Retardation (ICF/ MR) with fifteen or fewer resident beds, and in schools when certain requirements set forth in Ohio education law are met. 8
Assistance with self- administration of medications is not prohibited in certain circumstances.
Assistance with self- administration of medications is not the practice of nursing in a
setting where the substantial purpose of the setting is other than the provision of health care. Such settings may include schools, correctional facilities, the home, child care centers, adult day care facilities, and residential care facilities.
Assistance with self- administration of medications includes:
• Reminding an individual when to take the medication and ensuring that the individual follows the directions on the medication container; • Taking the medication in its container from
the area where it is stored; • Handing the medication in its container to
the individual; • Opening the container for an individual who
is physically unable to do so; • Upon the request or with the consent of a
physically impaired but mentally alert individual, assisting in removing oral or topical medications from the container and assisting in the taking or applying of the medication; and • If the individual is physically unable to place
a dose of medication in his/ her mouth without spilling or dropping it, placing the dose in another container and placing the container to the mouth of the individual.
Q A nine- year- old child attends school and must take an antibiotic q. i. d. for bronchitis
during the regular school day. School policies (written in accordance with Ohio education laws) are in place that designate the school secretary as the individual authorized to provide the medication. The child attends a latch key program conducted in the school gym after school is out. May an unlicensed person administer the scheduled antibiotic dose to the child in the latch key setting?
A No, unless the administration of the antibiotic in the latch key program could
be considered assistance with self- administration of medications which would not be the
practice of nursing in that setting.
Q Technicians in my workplace are administering medications. Am I violating the
law?
A A licensed nurse may not delegate medication administration to an unlicensed
person; however, a physician may do so. Policies of the workplace or unit must clearly indicate that the technician or unlicensed person is administering medications at the direction, supervision, and control of the physician.
Although principles of delegation require physician supervision of the medication administration activities he or she has delegated to a technician, the physician could delegate that supervisory responsibility to a licensed nurse. Provided the medication to be administered and the route of administration chosen is within the nurse’s scope of practice, the nurse could (but is not required to) accept the delegation. Nurses to whom physicians have delegated supervisory responsibilities must use nursing judgment to determine whether they wish to assume the responsibility. Again, workplace policies should clarify the nurse’s role and responsibility.
Nurses who undertake supervisory responsibility delegated by a physician should communicate any concerns they may have about the activities of the unlicensed person to the physician, and must withdraw the delegation if the unlicensed individual’s performance is not consistent with safe practice. Nurses should document their efforts to inform the physician and the steps taken to withdraw the delegation when necessary. This documentation should be done in accordance with workplace policies and procedures or in a manner that assures nurses will have records of their activities.
THE ROLE OF THE LPN IN DELEGATION
The legally recognized scope of practice for licensed practical nurses does not include the authority to delegate. However, Board rules allow LPNs to delegate nursing tasks within the LPN’s scope of practice, provided a registered nurse first delegates the authority to the LPN to do so. In addition, the RN may delegate to the LPN: • The authority to teach a nursing task to an
unlicensed person; • The authority to supervise the performance
of a nursing task by a trained unlicensed person; and • The authority to perform a nursing activity
beyond basic preparation for a licensed practical nurse, provided the LPN has the necessary knowledge, skill, and ability to perform the activity, and provided the task or activity is not specifically prohibited by another law or rule.
For the purposes of performing dialysis, a registered nurse may delegate to a licensed practical nurse certain nursing activities associated with intravenous therapy that may otherwise be prohibited. These activities include: • The routine administration and regulation of
saline solution for the purpose of maintaining the established fluid plan; • The administration of heparin either intravenously or peripherally via the fistula needle; • The loading and activation of the constant
infusion pump or the intermittent injection of the dose of medication prescribed by a physician; and • The administration of a subcutaneous local
anesthetic prior to insertion of the fistula needle.
Q May an LPN delegate a task to a trained unlicensed person?
A Yes, if the LPN has been authorized by the RN to delegate, the LPN may delegate a
task to a trained unlicensed person. The task must be one that is within the LPN’s scope of practice. The LPN may not, however, authorize a trained unlicensed person to delegate.
Q May an LPN supervise or direct the nursing practice of registered nurses?
A No. Because the nursing activities of RNs are outside the LPN’s scope of practice,
only an RN may supervise the nursing practice of another RN. An LPN may, however, supervise the employment activities of a registered nurse that do not constitute the practice of nursing such as attendance, appropriate dress, etc.
Q May an LPN supervise in a skilled facility on the 3- 11 or 11- 7 shifts when RN
coverage is not provided?
A Yes, provided an RN has delegated the supervisory authority to an LPN. The
authority extends only to tasks that are within the LPN’s scope of practice being performed by another LPN or by a trained unlicensed person.
DETERMINING WHAT TASKS ARE DELEGABLE
Not every nursing task is delegable nor is a particular task always delegable. Before delegating a nursing task to a trained unlicensed person, the licensed nurse should determine that: • The task requires no judgment based on
nursing knowledge or expertise; • The results of the task are reasonably
predictable; • The task can be performed safely, according
to exact, unchanging directions, with no need to alter the standard procedures for performing the task; • The performance of the task does not require
complex observations or critical decisions with respect to the task;
• No repeated nursing assessments are needed; and • The consequences of performing the nursing
task improperly are minimal and not life threatening.
When considering the appropriateness of delegating a particular task, the nurse should mentally review these criteria to determine whether the task is a delegable one. (A decision tree containing these criteria can be found on page 25.)
When a task is delegable, the nurse must then assess the nursing care needs of the patient or client, the skill level of the unlicensed person, and must consider any other factors that may or may not make delegation in a particular situation appropriate. Once again, there is no substitute for nursing judgment!
TRAINING THE UNLICENSED PERSON TO PERFORM DELEGABLE NURSING TASKS
When training an unlicensed person to perform a nursing task, a licensed nurse must present at least the following to the unlicensed person: • Information about infection control and
universal precautions related to the delegable task, unless the unlicensed person has already been given instruction on these topics; • Information and directions regarding the
concepts underlying each step of the task and how to perform the task in accordance with current standards of practice. Written stepby- step directions must be available to be used by the unlicensed person when performing the task; and • A demonstration of the task with a successful
return demonstration by the unlicensed person, which is documented on a written skills checklist by the nurse who provided the training.
A delegable task may be taught by a licensed
nurse one- on- one or may be taught to a group. The amount of time required to teach a task to an unlicensed person is determined on a caseby- case basis. Once learned, a task need not be retaught, provided the unlicensed person’s knowledge and skills are maintained and are current. Any variation in performing a task based on the patient’s or client’s particular needs must be taught by a licensed nurse and documented.
Documentation of the training and satisfactory return demonstration of the task are required and must be retained by the unlicensed person and the facility, person, or agency employing the unlicensed person. The form of the documentation and the method of retention will vary according to the practice setting.
The trained unlicensed person must always have step- by- step directions about how to perform the nursing task available whenever the task is to be performed. The person or agency employing the unlicensed person must also retain these directions, with the method of retention again varying according to the practice setting.
Q Must the delegating nurse provide all the training of the unlicensed person and
develop the printed information and skills checklist required by the Board rules?
A No. Some institutions provide in- service or orientation programs that include the
information and skills training needed to perform certain nursing tasks, and the program coordinator may then develop the skills checklists and the documentation tools needed to evaluate competency. Nurses are obliged to ask about the curriculum, course expectations, methods of evaluation, and continued competency expectations for the training programs sponsored by their own institutions or employers. Nurses must also be aware of the federal and state requirements that affect the content of
the training received by unlicensed individuals working in certain settings such as long- term care facilities and home health agencies.
Ideally, in order to alleviate any hesitancy nurses may have about the skills levels of trained unlicensed persons, an employer should accurately, routinely, and regularly describe the extent of any formal training provided to unlicensed persons.
Q Do nurse aides who complete a Training and Competency Evaluation (TCE)
program, or a training program developed by a health care institution or other facility such as Medicare Home Health Conditions of Participation Training and/ or Competency Evaluation or PASSPORT specifications have a scope of practice upon completion of the program that makes delegation unnecessary?
A No. The nurse aide does not have a legally recognized scope of practice. These
training programs provide some consistency and assurances to the licensed nurse that the aide received sufficient training in the performance of certain nursing tasks to make delegation possible. The nurse must still assess the patient or client and consider the circumstances under which the task will be performed before authorizing the aide to perform the task.
Q Why is so much documentation required?
A Only by having written documentation of the training received by an unlicensed
person can the delegating nurse be assured that a possible delegation is appropriate. In addition, according to some legal authorities, documentation also can be critical evidence in the event the delegation or delegated services are challenged legally. Appropriate documentation serves as additional protection for the delegating nurse, the trained unlicensed person,
and the patient or client receiving care. The Board rules are flexible enough to allow individual institutions and agencies to establish workable and simple delegation policies and documentation procedures that satisfy the rules while meeting the demands of the practice environment. Cumbersome and complex documentation systems which take up care giving time are not mandated by these rules.
Q How long must an agency, institution, or facility retain the documentation of the
training and skills of an unlicensed person once that individual leaves the agency where training occurred?
A The Board rules do not address the length of time this documentation must be
retained. Institutional policies will vary depending upon the needs and resources of the institution and the likelihood that former employees will return to the work place. Once an unlicensed person is trained, employers must regularly evaluate continuing competency. That requirement is especially important when an unlicensed person leaves employment even briefly. An entire training course may not need to be repeated if the employee adequately demonstrates competency.
SUPERVISION WHEN A NURSING TASK IS DELEGATED
The person who delegates the task must supervise the performance of the task or assure that appropriate and adequate supervision is available. Supervision is defined as initial and ongoing direction, procedural guidance, observation, and evaluation. When the substantial purpose of the setting, institution, or agency where the nursing task is to be performed is the provision of health care services, the supervision by a licensed nurse must be on- site, direct supervision. When the substantial purpose of the setting is other than health care, the supervision
may be provided by a licensed nurse who is always accessible through some form of telecommunication while the task is being performed.
On- site direct supervision does not necessarily mean that a delegated nursing task must be performed in the immediate presence of a licensed nurse. The actual extent of direct supervision will depend upon the care needs of the client or patient, the task being performed, and the skill level of the trained unlicensed person.
The adequacy of supervision is a factor to be considered when delegation is contemplated. If a licensed nurse is assuming responsibility for more than one practice setting, the distance between settings, the accessibility of each setting, any unusual traffic problems that may be encountered in reaching each setting, and the availability of emergency aid should be weighed. Regardless of the setting, decisions about the type and amount of supervision needed must be based on nursing judgment.
Q If I didn’t delegate a task to a trained unlicensed person what responsibilities do
I have if I see a task performed incorrectly?
A Regardless of who delegates a nursing task to a trained unlicensed person, any
licensed nurse who observes an unlicensed person performing a nursing task incorrectly must immediately withdraw the delegation and report the action taken in accordance with agency policies and procedures. There is no requirement in law that the Board be notified when delegation is done inappropriately or when a negative outcome occurs due to inappropriate delegation. An employer is, however, required to report when a licensed nurse is terminated voluntarily or involuntarily due to a violation of nursing standards, including standards for delegation.
CONCLUSION
Q What is the licensed nurse’s role when delegating a nursing task to a trained
unlicensed person?
A Based upon nursing judgment, state law, and agency policies, the nurse must
determine whether a task is delegable by relying on the criteria established in Board rules, and whether the current health status of the patient or client could be adversely affected by the contemplated delegation. Training, which includes the information specified in Board rules, must be provided to the unlicensed person. Following the training, the unlicensed person must demonstrate competency in performing the nursing task. Finally, adequate and appropriate supervision must be provided.
Delegation is an elementary act of managing. Effective delegation requires willingness or ability to apply the principles of delegation. Successful delegation requires receptiveness; willingness to let go; willingness to trust, within reason, the individual to whom a task is delegated; and willingness to establish and use broad controls. Delegation does not mean autonomy. Rather, it implies the establishment of guiding policies and requires careful sharing of authority by an individual who knows how and wants to delegate. Delegation is not an abdication of responsibility; therefore, it must be accompanied by controls designed to ensure that the delegated authority is used properly.
The practice of nursing remains the responsibility of the licensed professional, regardless of the setting in which the care is provided. Only a licensed nurse may decide whether delegation of nursing activities or tasks should occur. Based upon the criteria in the Board rules, if a particular delegation is determined by a licensed nurse to be risky, the delegation should not be authorized by the nurse. A licensed nurse must not be coerced by nursing and non- nursing managers or administrators into delegating outside of the standards established by the Board’s rules.
DELEGATION DECISION TREE
DEFINITIONS
For purposes of this brochure, the following definitions apply:
Activity— The term used for a nursing function delegated to an LPN.
Accountability/ responsibility— The state of being answerable for an obligation.
Authority— Having and/ or transferring the power to delegate the performance of a task/ activity to another person based upon the delegator’s scope of practice; applicable laws and rules of the Board; skill, knowledge, ability; and the policies of the institution/ agency that acts as the employer.
Documentation of training— Written information that must be available to show satisfactory completion of the required training regarding the delegable task/ activity. The form of documentation may vary depending on the practice setting and circumstances involved.
Licensed nurse— A registered nurse (RN) or a licensed practical nurse (LPN) licensed under Chapter 4723. Ohio Revised Code.
Scope of practice— As set forth at Section 4723.02 of the Ohio Revised Code the practice of nursing means:
As a registered nurse:
Providing to individuals and groups nursing care requiring specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences. Such nursing care includes: (1) Identifying patterns of human responses to
actual or potential health problems amenable to a nursing regimen; (2) Executing a nursing regimen through the
selection, performance, management, and evaluation of nursing actions; (3) Assessing health status for the purpose of
providing nursing care; (4) Providing health counseling and health
teaching; (5) Administering medications, treatments, and
executing regimens prescribed by licensed physicians, dentists, optometrists, and podiatrists; (6) Teaching, administering, supervising,
delegating, and evaluating nursing practice.
As a licensed practical nurse:
Providing to individuals and groups nursing care requiring the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences at the direction of a licensed physician, dentist, podiatrist, optometrist, or registered nurse. Such care includes: (1) Observation, patient teaching, and care in a
diversity of health care settings; (2) Contributions to the planning, implementation, and evaluation of nursing; and (3) Administration of medications and treatments, prescribed by a licensed physician,
dentist, optometrist, or podiatrist. Medications may be administered by a licensed practical nurse upon proof of completion of a course in medication administration approved by the Board.
Task— The term used for a nursing function delegated to a trained unlicensed person.
Trained unlicensed person— An individual not currently licensed by the Board who has been taught by a licensed nurse to perform a nursing task in accordance with rules of the Board under the supervision of a licensed nurse.
Unlicensed person— An individual not currently licensed by the Board as a registered nurse or a licensed practical nurse.
BIBLIOGRAPHY
1. Section 4723.28 (B)( 18) Ohio Revised Code.
2. See Chapter 4723. Ohio Revised Code for the law regulating nursing practice.
3. The rules of the Ohio Board of Nursing can be found in Chapters 4723- 1 through 4723- 22 Ohio Administrative Code.
4. Rule 4723- 4- 03 Ohio Administrative Code. 5. Rules 4723- 4- 04 and 4723- 4- 05 Ohio
Administrative Code. 6. Chapter 4723- 13 Ohio Administrative
Code. 7. Reprinted with the permission of the
National Council of State Boards of Nursing, Chicago, Illinois, which is a notfor- profit organization made up of boards of nursing in the United States and its territories.
8. Section 3313.713 Ohio Revised Code.