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Delegation

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					                      Delegation
             How do I delegate so I can

                            SLEEP
                            at night?
Isa Chase, RN, CPNP
Franklin School District

Sally Roepe, RN, BSN
Wauwatosa School District
“I   can’t do THAT….it might
         be my license!”
                     Pre-test
               Is this delegation?
   The principal tells the school secretary to give the
    noon time medications today. Is this delegate?
   The school nurse trains the physical education
    coach to give nebulized Albuteral. The nurse
    work 3 hours a week in the school district. Is this
    delegation?
   The school nurse trains and monitors the special
    education assistant to give a gastrostomy tube
    feeding. The nurse works 20 hours a week in the
    school district. Is this delegation?
                Objectives
   What is delegation?
   What does the law state regarding
    delegation?
   What can you delegate and to whom?
   What is consultation?
   What should not be delegated?
           What is delegation?
   To commit powers to act as a representative
    for another (Webster Dictionary).
   The transfer of responsibility for the
    performance of a task from one person to
    another with the former retaining
    accountability for the outcome. (ANA, 1994)
   Transfer to a competent individual the
    authority to perform a selected nursing task
    in a selected situation. (NCSBN, 1995)
    What does the Wisconsin Law state
         regarding delegation?
   N 6.03(5) – “Delegated nursing act”: means acts
    delegated to an L.P.N. or less skilled assistant by
    an R.N.”
   Nursing acts – Not defined in Wisconsin
    Administrative Code
   N 6.03(3) Delegate commensurate with education
    preparation and demonstrated abilities, provide
    direction and assistance, observe and monitor
    activities and evaluate effectiveness.
   Medical provider delegate/authorize the
    institution not the nurse to perform the task.
    What are consultative services?

   Nurse does not have the day-to-day
    availability in the school.
   The nurse does not own the nursing task
   Authority goes from the physician to the
    parent to the delegate in the school.
   Nurse owns the evaluation of staff for
    “competency to perform the duty”.
      Delegation vs. consultation
   The school nurse’s job description or
    contract should identify if the nurse is
    delegating or consulting.

   School district remains responsible for
    providing the necessary nursing services to
    provide safe care to students.
               More terms
 General Supervision – regularly to
  coordinate, direct and inspect the practice of
  another

 Direct Supervision – immediate availability to
  continually coordinate, direct and inspect at
  first hand the practice of another.
                                  5 Rights
   The Right Task
   The Right Person
   The Right Direction
   The Right Supervision
   The Right
    Circumstances
( National Council of State Boards of
    Nursing, 1995)
      What nursing tasks can nurses
              delegated?
   No list of nursing task - delegate
   Within area of responsibility
   Within the knowledge, skills and ability of
    the nurse
   Task that another reasonable and prudent
    nurse would find to be within generally
    accepted nursing practice
   Act consistent with health and safety of
    student
            How do I decide if I can
              delegate the task?
   The nurse needs to assess the following:
       Capacity to own the task
       Student’s health care needs – complexity and
        predictability of the care, frequency of the care,
        stability of the student’s health, degree of risk if
        the task is not carried out
       Delegate skills - training, experience and
        education (also learning style)
       Nature of task – potential for harm,
        predictability of outcome, complexity of task
    What are the responsibility of the
           nurse delegating?
   Assessment of the willingness of the delegate
   Appropriate training of the delegate
   Assessment of the competency of the
    delegate
   Ongoing supervision and evaluation
   Instruction on how to intervene in any of
    the foreseeable risks that may associated
    with the delegated task
What are the responsibilities of
       the delegatee?
 The delegatee can not transfer
  responsibility to another Unlicensed
  Assistive Personnel or train others.
 Must notify the nurse if they are
  unable to perform the task
 Notify the nurse of any changes noted
  in the health of the student or the task
         What can’t I delegate?
   Assessment , Planning and Evaluation
    (Board of Nursing Position Paper)

   Independent IV Therapy
     What do I need to document
         when delegating?
   Assessment of the student’s health status
    and self care skill level
   Date and time of training sessions
   Performance by the Delegatee of the
    delegated task
   Need for further instruction and monitoring
   Continuation or withdraw of delegation.
   Individual Health Care Plan
    Decision NOT to Delegate to
               UAP
 School district continues to be
  responsible for providing for the
  nursing care
 Notify and Problem Solve with
  Administrator and Medical Provider
 Special Health Care Nurse vs. Private
  Duty Nursing
What are the differences between
 assignment and delegation?

   Principals may assign a staff member
    to administer medication

   Nurses delegate
         Board of Nursing
   Only delegate that which you “own”
  (based on the BON white position paper
                  of 6/04)

http://drl.wi.gov/boards/nur/pap/pap05.pdf
                 Is this delegation?
                      Post-Test
   The principal tells the school secretary to give the noon
    time medications today. Is this delegate?
    No
   The school nurse trains the physical education coach to
    give nebulized Albuteral. The nurse work 3 hours a week
    in the school district. Is this delegation?
    Maybe not, supervision and consultation may not be
    available.
   The school nurse trains and monitors the special education
    assistant to give a gastrostomy tube feeding. The nurse
    works 20 hours a week in the school district. Is this
    delegation?
    Yes
        Delegation Decision???
1.   8 year old student with cardiomypathy who
     has an order for oxygen. Oxygen is used
     PRN based on color, respiratory rate, effort
     and fatigue level. When O2 saturation fall
     below 85, call 911. Would you delegate O2
     administration?
         Delegation Decision???
2. 6 year old student with type 1
    diabetes, who has a continuous
    glucose monitoring pump. Student
    was diagnosed at age 4 and received
    the pump two months ago. Student’s
    self-care skills are limited to
    appropriate snack selection. Has
    limited awareness of his own signs
    and symptoms of hypoglycemia.
    Unable to carb count. Would you
    delegate insulin boluses to UAP?
         Delegation Decision???
3. 9 year old female with Acardi Syndrome with tonic clonic
  seizure disorder. Student has history of 20 minute seizure
  with and without respiratory distress. You receive a
  medical provider order for administration of Diastat after
  5 minutes of tonic clonic seizure activity. Student has
  received Diastat on a frequent basis and tolerated the
  medication without respiratory distress. Do you delegate
  the Diastat?
Questions!!!

				
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posted:12/21/2011
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