Code of Massachusetts Regulations › 244 CMR - BOARD OF REGISTRATION IN NURSING › Title 244 CMR 3.00 - Registered Nurse And Licensed Practical Nurse › Section 3.05 - Delegation and Supervision of Selected Nursing Activities by Licensed Nurses to Unlicensed Persons

Current through Register 1525, July 5, 2024
The licensed nurse is responsible for engaging in the practice
				of nursing in accordance with the nurse's scope of practice as defined at
				M.G.L. c. 112 § 80B, and 244 CMR:
Board of Registration in
				Nursing
within the limits of the nurse's educational preparation,
				subsequent acquired education, experience and demonstrated competence. Nursing
				assessment and analysis of the nursing needs of a patient, development of the
				nursing plan of care, implementation of the plan, and evaluation of the plan
				are essential components of nursing practice and are the functions of the
				licensed nurse. The full utilization of the services of a licensed nurse may
				permit him or her to delegate selected nursing activities to unlicensed
				persons. Although unlicensed persons may be used to complement the licensed
				nurse in the performance of nursing functions, such persons cannot be used as a
				substitute for the licensed nurse. The following sections govern the licensed
				nurse in delegating and supervising nursing activities to unlicensed
				persons.
(1)
Definitions
. Definitions for terms used in 244 CMR
			 3.05 and throughout 244 CMR are set forth in 244 CMR 10.00:
Definitions
			 and Severability
.
Delegation
- The authorization by a
				qualified licensed nurse to an unlicensed person as defined in 244 CMR 3.05(1)
				to provide selected nursing services.
Supervision
- Provision of guidance by
				a qualified licensed nurse for the accomplishment of a nursing task or activity
				with initial direction of the task or activity and periodic inspection of the
				actual act of accomplishing the task or activity.
Unlicensed Person
- A trained,
				responsible individual other than the qualified licensed nurse who functions in
				a complementary or assistive role to the qualified licensed nurse in providing
				direct patient/client care or carrying out common nursing functions. The term
				includes, but is not limited to, nurses' aides, orderlies, assistants,
				attendants, technicians, home health aides, and other health
				aides.
(2)
General Criteria for Delegation
. Regardless of
			 setting, the licensed nurse who delegates nursing activities to unlicensed
			 persons must comply with the following requirements:
(a) The delegating nurse is directly
			 responsible for the nature and quality of nursing care rendered under his or
			 her direction. However, in the event the qualified unlicensed person deviates
			 from the instruction, nursing plan of care or other delegating nurse directive,
			 the delegating nurse does not bear responsibility and accountability for the
			 outcome of the delegated activity performed by the unlicensed person.
(b) The final decision as to what can be
			 safely delegated in any specific situation is within the scope of the
			 delegating nurse's judgment.
(c)
			 Prior to delegating the nursing activity, the delegating nurse must make an
			 assessment of the patient's nursing care needs and care delivery setting to
			 ensure it can be safely delegated to the unlicensed person.
(d) The nursing activity to be delegated must
			 be one that a reasonable and prudent nurse would determine to be delegable
			 within the scope of nursing judgment; would not require the unlicensed person
			 to systematically assess, analyze, interpret, plan and/or evaluate patient
			 data. The delegated activity must be one that can be properly performed by the
			 unlicensed person without jeopardizing the patient's safety and
			 welfare.
(e) Said delegation must
			 occur within the job description of the unlicensed person, and the employing
			 agency's policies and procedures in compliance with 244 CMR 3.05(4) and (5).
			 Such employer policies and procedures must include acknowledgement that the
			 final decision to delegate is made by the delegating nurse only. Employer
			 policy or contractual language can not mandate the licensed nurse to delegate,
			 nor mandate any components of the delegation process.
(f) The unlicensed person must have on file
			 within the employing agency current documentation of the unlicensed person's
			 competencies for the proper performance of each of the nursing activities
			 identified within the unlicensed person's job description. Such documentation
			 must demonstrate that the unlicensed person's competence for each nursing
			 activity has been periodically validated; and that an administratively
			 designated nurse has communicated the unlicensed person's job functions and
			 competencies to the licensed nurse(s) who will be delegating activities to the
			 unlicensed person. Uniform training and certification may be used as a basis to
			 presume the baseline competencies of an unlicensed person.
(g) In addition to the unlicensed person's
			 competence to perform selected nursing activities, other competencies to be
			 considered include, but are not limited to, the unlicensed person's ability to
			 effectively collaborate, communicate and cooperate, as appropriate, with other
			 health care providers and with the patient.
(h) The delegating nurse must provide the
			 unlicensed person with a nursing plan of care that includes, but is not limited
			 to, the desired effect of the activity, the sequence of steps to perform the
			 activity, adverse side effects to be reported to the appropriate licensed
			 nurse, and the need to report to the licensed nurse those activities that do
			 not produce the desired effect.
(i) The delegating nurse must adequately
			 supervise the performance of the delegated nursing activity in accordance with
			 the requirements of supervision as found in 244 CMR 3.05(3).
(j) The delegating nurse can determine at any
			 time that the nursing activity can no longer be delegated based on a change in
			 the health status of the patient, in the unlicensed person's performance of the
			 activity, or other reason the delegating nurse determines may jeopardize
			 patient health or safety.