Arkansas Administrative Code › Agency 067 - Board of Nursing › Rule 067.00.22-002 - ASBN Rules, Chapter Five- Delegation

Current through Register Vol. 49, No. 6, June, 2024
CHAPTER
		  FIVE
DELEGATION
A.
PURPOSE
Registered nurses, licensed practical nurses, and licensed
			 psychiatric technician nurses, within the parameters of their education and
			 experience, are responsible for all nursing care that a client receives under
			 their direction. Assessment of the nursing needs of a client, the plan of
			 nursing actions, implementation of the plan, and evaluation of the plan, under
			 the direction of a registered professional nurse, are essential components of
			 nursing practice. Unlicensed personnel may be used to complement the licensed
			 nurse in the performance of nursing functions; but such personnel cannot be
			 used as a substitute for the licensed nurse.
Delegation by registered nurses, licensed practical nurses, and
			 licensed psychiatric technician nurses must fall within the definitions of
			 Arkansas Code Annotated []
			 17-87-102.
			 Delegation must occur within the framework of the job description of the
			 delegatee and organizational policies and procedures, and must be in compliance
			 with the Arkansas
Nurse Practice Act
. The following sections
			 govern the licensed nurse in delegating and supervising nursing tasks to
			 unlicensed personnel in all settings.
B.
CRITERIA FOR DELEGATION
1. Delegation of nursing tasks to unlicensed
		  persons shall comply with the following requirements:
a. A licensed nurse delegating the task is
		  responsible for the nursing care given to the client and for the final decision
		  regarding which nursing tasks can be safely delegated.
b. A licensed nurse must make an assessment
		  of the client's nursing care needs prior to delegating the nursing task. (Ref.
		  Section C. for exceptions.)
c. The
		  nursing task must be one that a reasonable and prudent licensed nurse would
		  assess to be appropriately delegated; would not require the unlicensed person
		  to exercise nursing assessment, judgment, evaluation or teaching skill; and
		  that can be properly and safely performed by the unlicensed person involved
		  without jeopardizing the client's welfare.
d. A licensed nurse shall have written
		  procedures available for the proper performance of each task and shall have
		  documentation of the competency of the unlicensed person to whom the task is to
		  be delegated.
e. The delegating
		  licensed nurse shall be readily available either in person or by
		  telecommunication.
f. The licensed
		  nurse shall be responsible for documentation of delegated tasks.
g. Unlicensed nursing students may work only
		  as unlicensed nursing personnel. They may not represent themselves, or
		  practice, as nursing students except as part of a scheduled clinical learning
		  activity in the curriculum of a Board approved nursing program.
h. The licensed nurse shall adequately
		  supervise the performance of delegated nursing tasks in accordance with the
		  requirements of supervision which follow.
2. Supervision: The degree of supervision
		  required shall be determined by the licensed nurse after an evaluation of
		  appropriate factors involved, including, but not limited to, the following:
a. The stability of the condition of the
		  client;
b. The training and
		  capability of the unlicensed person to whom the nursing task is
		  delegated;
c. The nature of the
		  nursing task being delegated; and
d. The proximity and availability of a
		  licensed nurse to the unlicensed person when performing the nursing
		  task.
C.
SPECIFIC NURSING TASKS WHICH MAY BE DELEGATED WITHOUT PRIOR NURSING
		  ASSESSMENT
By way of example, and not in limitation, the following nursing
			 tasks are ones that are within the scope of sound nursing practice to be
			 delegated, provided the delegation is in compliance with ACA []
			 17-87-102
			 and the level of supervision required is determined by the nurse.
1. Noninvasive and non-sterile treatments
		  unless otherwise prohibited by Section D. of this Chapter (relating to nursing
		  tasks that may not be routinely delegated);
2. The collecting, reporting, and
		  documentation of data including, but not limited to:
a. Vital signs, height, weight, intake and
		  output, urine test, and hematest results;
b. Changes from baseline data established by
		  the nurse;
c. Environmental and
		  safety situations;
d. Client or
		  family comments relating to the client's care; and
e. Behaviors related to the plan of
		  care;
3. Ambulation,
		  positioning, and turning;
4.
		  Transportation of the client within a facility;
5. Personal hygiene;
6. Feeding, cutting up of food, or placing of
		  meal trays;
7. Socialization
		  activities;
8. Activities of daily
		  living; and
9. Reinforcement of
		  health teaching planned and/or provided by the registered nurse.
D.
NURSING TASKS THAT MAY
		  NOT BE ROUTINELY DELEGATED
1. Nursing
		  tasks not included in Section C. are not usually within the scope of sound
		  nursing judgment to delegate and may be delegated only in accordance with
		  subsection 2. of this section.
2.
		  The nursing tasks of this section may be delegated to an unlicensed person
		  only:
a. Under circumstances where a
		  reasonable and prudent licensed nurse would find that the delegation does not
		  jeopardize the client's safety and/or welfare;
b. If, in the judgment of the licensed nurse,
		  the unlicensed person has the appropriate knowledge and skills to perform the
		  nursing task(s) in a safe and effective manner;
c. If the licensed nurse delegating the task
		  is directly responsible for the nursing care given to the client;
d. If the agency, facility, or institution,
		  employing unlicensed personnel, follows a current protocol for the instruction
		  and training of unlicensed personnel performing nursing tasks under this
		  subsection; and that said protocol is developed by and taught under the
		  supervision of registered nurses currently employed in the facility, and
		  includes:
(1) The manner in which the
		  instruction addresses the complexity of the delegated task;
(2) The manner in which the unlicensed person
		  demonstrates competency of the delegated task;
(3) The mechanism for reevaluation of the
		  competency; and
(4) An established
		  mechanism for identifying those individuals to whom nursing tasks under this
		  subsection may be delegated; and
e. If the protocol recognizes that the final
		  decision as to what nursing tasks can be safely delegated in any specific
		  situation is within the specific scope of the nurse's professional
		  judgment.
E.
NURSING TASKS THAT SHALL NOT BE DELEGATED
By way of example, and not in limitation, the following are
			 nursing tasks that are not within the scope of sound nursing judgment to
			 delegate:
1. Physical, psychological,
		  and social assessment which requires nursing judgment, intervention, referral,
		  or follow-up;
2. Formulation of the
		  plan of nursing care and evaluation of the client's response to the care
		  rendered;
3. Specific tasks
		  involved in the implementation of the plan of care which require nursing
		  judgment or intervention;
4. The
		  responsibility and accountability for client health teaching and health
		  counseling which promotes client education and involves the client's
		  significant others in accomplishing health goals; and
5. Administration of any medications or
		  intravenous therapy, including blood or blood products except as allowed by
		  ASBN Rules Chapter 8 for Medication Assistant-Certified and by ASBN School
		  Nurse Roles and Responsibilities Practice Guidelines.
6. Receiving or transmitting verbal or
		  telephone orders;
7. Registered
		  nurse practitioners and advanced practice nurses shall not delegate to
		  unlicensed ancillary staff the calling in of prescriptions to the
		  pharmacy.
F.
TRANSFERENCE OF DELEGATED NURSING TASKS
It is the responsibility of the licensed nurse to assess each
			 client prior to delegation of a nursing task and determine that the unlicensed
			 person has the competence to perform the nursing task in that client's
			 situation.
1. The licensed nurse shall
		  not transfer delegated tasks to other clients under the care of the unlicensed
		  person.
2. In delegating personal
		  care, a licensed nurse is not required to assess each client; but must
		  periodically assess the competence of the caregiver in those
		  activities.
G.
EXCLUSIONS
These sections shall not be construed to apply to:
1. The gratuitous nursing care of the sick by
		  family or friends;
2. The
		  furnishing of nursing care where treatment is by prayer or spiritual means
		  alone;
3. Acts done by persons
		  licensed by any board or agency of the State of Arkansas if such acts are
		  authorized by such licensing statutes;
4. Nursing tasks performed by nursing
		  students enrolled in Board approved nursing programs while practicing under the
		  direct supervision of qualified faculty or preceptors;
5. The instruction and/or supervision of
		  licensed nurses by registered professional nurses in the proper performance of
		  tasks as a part of a state approved training/education course designed to
		  prepare persons to obtain certification;
6. Nursing tasks performed by
		  paramedic/emergency medical technician students enrolled in State approved
		  programs while practicing under the direct supervision of qualified faculty or
		  preceptors;
7. The performance in
		  the school setting of nursing procedures necessary for students to achieve
		  activities of daily living as cited in the Education of the Handicapped Act, 20
		  United States Code 1400-1485, and which are routinely performed by the student
		  or the student's family in the home setting.
8. The acts of unlicensed persons responding
		  to an emergency. This exclusion shall not be construed as permitting licensed
		  nurses to delegate routinely to unlicensed persons.
9. Health maintenance activities performed by
		  a designated care aide in the home as defined in the Consumer Directed Care Act
		  of 2005, ACA §
									17-87-103(11).
10. The drawing and measuring of glucagon or
		  insulin by a trained employee of a city or county detention center as defined
		  in ACA
		  17-87-103(14).
11. The administration of an emergency dose
		  of medication to a public school student who is diagnosed with an adrenal
		  insufficiency by trained volunteer public school personnel.
H.
CONSUMER DIRECTED
		  CARE
1. Health maintenance activities
		  may be provided by a designated care aide for a competent adult at the
		  direction of the adult or for a minor child or incompetent adult at the
		  direction of a caretaker.
2.
		  Caretaker means a person who is directly and personally involved in providing
		  care for a minor child or incompetent adult, and the parent, foster parent,
		  family member, friend, or legal guardian of the minor child or incompetent
		  adult receiving care.
3. Designated
		  care aide means the person hired by the competent adult or caretaker to provide
		  care for the competent adult, minor child, or incompetent adult.
4. Health maintenance activities mean
		  activities that the minor child or adult is unable to perform for himself or
		  herself.
5. The attending
		  physician, advanced practice nurse, or registered nurse must determine a
		  designated care aide under the direction of a competent adult or caretaker can
		  safely perform the activity in the minor child's or adult's home.
6. Home shall not include nursing home,
		  assisted living facility, residential care facility, an intermediate care
		  facility, or hospice care facility.
7. Health maintenance activities that are not
		  exempted by the Consumer Directed Care Act of 2005 include:
a. Physical, psychological, and social
		  assessment which requires nursing judgment, intervention, referral, or
		  follow-up;
b. Formulation of the
		  plan of nursing care and evaluation of the client's response to the care
		  rendered;
c. Tasks that require
		  nursing judgment or intervention;
d. Teaching and health counseling;
e. Administration of any injectable
		  medications (intradermal, subcutaneous, intramuscular, intravenous,
		  intraosseous, or any other form of injection) or intravenous therapy.
f. Receiving or transmitting verbal or
		  telephone orders.
8. The
		  designated care aide must demonstrate the ability to safely perform the health
		  maintenance activity.