delegation of care & specialized health services for health assistants janie lee hall, school...
TRANSCRIPT
Delegation of Care & Specialized Health Services for Health Assistants
Janie Lee Hall, School Health Advocate, NW RegionOffice of School & Adolescent Health
Public Health Division, NMDOH
What Does Delegation Mean to You?
(Let’s delegate a task…)
New Mexico Nurse Practice Act Rules
Delegation is “the transferringto a competent individual theauthority to perform a selectednursing task in a selected
situation”
Alphabet Soup
◦UAP: Unlicensed Assistive Personnel◦NAP: Nursing Assistive Personnel
◦ Individuals who are trained to function in an assistive role to the registered nurse in the provision of student care activities as delegated by and under the supervision of the registered professional nurse (NASNC, 200)
In schools, this may be the health assistant, educational assistant, teacher, secretary, or anyone who accepts delegation from the school nurse and is not licensed by the State Board of Nursing (NASN, 2004)
Legal Guidelines
New Mexico Nurse Practice Act
Local, State and National Standards of Practice
District Policy and Procedures
New Mexico Nurse Practice Rules
The Delegating Nurse:
Shall assign/delegate to unlicensed persons only those nursing actions which that person is prepared, qualified, or licensed, or certified to perform
Is accountable for assessing the situation and responsible for the decision to delegate or make the assignment
New Mexico Nurse Practice Act Rules
The Delegating Nurse:
Is accountable for each activity delegated, for supervising the delegated activity, and for assessing the outcome of the delegated activity
May not delegate the specific functions of nursing assessment, evaluation and nursing judgment to non-licensed persons
Key Points The New Mexico Nurse Practice Act governs the
practice of all nursing, including delegation
Delegation is the process of assigning a nursing task to a competent person who is not a nurse
Only a registered nurse can legally delegate
Only a registered nurse can decide when, what and to whom to delegate
Key Points Delegation is a process that requires ongoing
training, supervision, and documentation
A delegated task may not be further delegated to another person except by a the nurse
The nurse must supervise the health outcome of the student
The health, safety, and welfare of the student must be the primary consideration in any decision to delegate...
Specialized Nursing Procedures
The parent notifies the school nurse of a specialized nursing procedure that needs to be performed at school
Written orders from the student’s primary care provider must verify the need for specialized health services, and indicate time, frequency, condition(s), and management of side effects
The School Nurse transcribes the orders, and determines if elements of care can be delegated
Specialized Nursing Procedures
The School Nurse writes the Individualized Healthcare Plan (IHP) and is responsible for all changes and revisions
The School Nurse provides training and supervision of delegated tasks/care activities
What are some specialized nursing tasks that can be delegated?
Criteria for Delegation to UAP (NCSBN, 2005)
The task is within the UAP range of functions
Frequently recurs in the daily care of client(s)
Performed according to an established sequence of steps
Involves little or no modification from one situation to another
May be performed with a predictable outcome
Does not inherently involve ongoing assessment, interpretation, or decision-making, which cannot be logically separated from the procedure itself
Does not endanger the client’s life or well-being
Criteria for Delegation to UAP (continued)
Your Role in Delegated Care of Students
Accept the responsibility for delegated tasks
Affirm understanding of expectations
Ask questions regarding delegation and seek clarification of expectations as needed
Inform nurse if you have not or infrequently performed a delegated task/function/activity
Your Role in Delegated Care of Students
Demonstrate competence to perform specific task
Ask for additional training/supervision as needed
Safely perform tasks as trained
Follow protocols and guidelines
Your Role in Delegated Care of Students
Determine communication & documentation methods with the nurse
Understand plan of action in emergency situations
Acknowledge liability for actions outside scope (eg: practicing nursing without a license)
Agency/Employer Delegation Responsibilities
Provide adequate staffing
Follow-up on every report of concern
Provide education and orientation to all employees, including training on delegation
Nursing Assessment & EvaluationRemember: The RN may not delegate the
specificfunctions of nursing assessment, evaluation and nursingjudgment to non-licensed persons
However, under the direction & supervision of theSchool Nurse, the Health Assistant may:
Collect, report and record basic objective & subjective data
Observe and report signs & symptoms or deviations from normal health status
You are the eyes, ears and hands of the school nurses
What Would You Do?
Your nurse is at her other school today. She calls you 15 minutes before a tubefeeding is scheduled. She says she won’tbe able to get back in time and for youto perform the tube feeding. You haveseen it performed once, 2 months ago.
What Would You Do?
You just finished assisting a student with hismedication. Another student runs in vomitingand you are helping that student. The nurse (who happens to be in the office that day)
tells you that she will document the medicationfor you, since you are busy.
Thank you for all you do to keep our students to keep healthy and safe!