172 Neb. Admin. Code, ch. 99, § 004

Current through September 17, 2024

Section 172-99-004 - STANDARDS FOR DELEGATION

Registered nurses may delegate nursing interventions or tasks to be performed by unlicensed persons. A registered nurse retains accountability for the application of the nursing process and outcomes of care in making a delegation decision.

004.01DELEGATION PROCESS. Registered nurses must use a systematic delegation decision making process based upon nursing education, a body of nursing knowledge, and nursing judgment to delegate in a manner that allows for safe, accountable, and responsible provision for nursing care.

004.01(A)REGISTERED NURSE RESPONSIBLITIES.A registered nurse must:

(i) Determine the consumer's needs and when to delegate;

(ii) Determine the competency of unlicensed person or delegatee selected to complete the task;

(iii) Determine the method of supervision;

(iv) Communicate the plan to the delegatee;

(v) Retain accountability for the individual delegation decision, the delegation plan, and evaluation of the delegation outcomes.

004.01(B)UNLICENSED PERSON RESPONSIBLITIES. An unlicensed person must:

(i) Accept activities based on his or her own competence level;

(ii) Maintain competence for the delegated responsibility;

(iii) Maintain accountability for the delegated activity or task;

(iv) Communicate with a registered nurse regarding competence, variations in care, and data gathered from the task.

004.01(C)NURSING SERVICE ADMINISTRATOR RESPONSIBLITIES.A nursing services administrator must

(i) Determine nursing responsibilities that can be delegated, including to whom and under what circumstances;

(ii) Develop delegation guidelines such as employer guidelines; and

(iii) Provide adequate resources for delegation to occur.

004.02DELEGATION PLAN. A registered nurse develops, implements and retains accountability for evaluation of delegation plan outcomes. The delegation plan includes

004.02(A) ASSESSMENT. A registered nurse must assess the consumer's health status, analyze the data, and identify the consumer's specific goals, nursing care needs, and necessary interventions. This must include assessment of:

(i) Stability of the consumer's condition;

(ii) Experience and competency of the unlicensed persons providing nursing interventions;

(iii) Level of nursing judgment required for the delegated nursing interventions; and

(iv) Willingness and ability of the consumer to be involved in the management of his or her own care.

004.02(B)PLANNING. A registered nurse must develop and communicate a plan that includes delegation of the right task, the right circumstance, right person, right directions and communication, and the right supervision and evaluation.

004.02(C)INTERVENTIONS. A registered nurse must select and identify nursing interventions or tasks which may be delegated. Selected interventions must:

(i) Frequently occur or reoccur in the daily care of a consumer or group of consumers;

(ii) Not require the unlicensed person to exercise independent nursing judgment;

(iii) Not require complex or multi-dimensional application of the nursing process;

(iv) Be those for which the results of the intervention are predictable and the potential risk is minimal; and

(v) Utilize a standard and unchanging procedure.

004.02(D)EVALUATION. A registered nurse is responsible and accountable to evaluate consumer's responses as well as outcomes of the delegated nursing interventions. Evaluation methods include:

(i) Obtaining feedback from unlicensed persons;

(ii) Providing feedback to unlicensed persons;

(iii) Measuring consumer response and goal attainment related to the delegated interventions; and

(iv) Altering the delegation plan as indicated by consumer responses.

004.03COMMUNICATION. Implementing the delegation plan must include communication regarding competency and comfort of the unlicensed person regarding performing the task, exact directions, conditions for feedback and reporting, as well as the method of supervision. This may include:

004.03(A)INSTRUCTION OR VERIFICATION. A registered nurse must instruct and assess, verify, and identify the unlicensed person's:

(i) Competency for the task on an individual and consumer specific needs basis;

(ii) Understanding of the delegation plan, including specific parameters, signs and symptoms of problems or issues to report, and method of supervision; and

(iii) Feedback on if the task was completed with consumer response.

004.04SUPERVISION OF THE DELEGATEE. A registered nurse must determine the method of supervision on an individual basis and identify any other licensed nurses who have been assigned the responsibility of supervision. Registered nurses may utilize both direct and indirect methods of supervision. Registered nurses may assign the responsibility of supervision within the delegation plan to other licensed nurses only if the conditions of the supervision have been defined and communicated within the plan.

172 Neb. Admin. Code, ch. 99, § 004

Amended effective 10/5/2020