How do I delegate so I can
Isa Chase, RN, CPNP
Franklin School District
Sally Roepe, RN, BSN
Wauwatosa School District
“I can’t do THAT….it might
be my license!”
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
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?
What is delegation?
What does the law state regarding
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
N 6.03(5) – “Delegated nursing act”: means acts
delegated to an L.P.N. or less skilled assistant by
Nursing acts – Not defined in Wisconsin
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.
General Supervision – regularly to
coordinate, direct and inspect the practice of
Direct Supervision – immediate availability to
continually coordinate, direct and inspect at
first hand the practice of another.
The Right Task
The Right Person
The Right Direction
The Right Supervision
( National Council of State Boards of
What nursing tasks can nurses
No list of nursing task - delegate
Within area of responsibility
Within the knowledge, skills and ability of
Task that another reasonable and prudent
nurse would find to be within generally
accepted nursing practice
Act consistent with health and safety of
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
Assessment of the willingness of the delegate
Appropriate training of the delegate
Assessment of the competency of the
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 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
Assessment of the student’s health status
and self care skill level
Date and time of training sessions
Performance by the Delegatee of the
Need for further instruction and monitoring
Continuation or withdraw of delegation.
Individual Health Care Plan
Decision NOT to Delegate to
School district continues to be
responsible for providing for the
Notify and Problem Solve with
Administrator and Medical Provider
Special Health Care Nurse vs. Private
What are the differences between
assignment and delegation?
Principals may assign a staff member
to administer medication
Board of Nursing
Only delegate that which you “own”
(based on the BON white position paper
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?
Maybe not, supervision and consultation may not be
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
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
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?
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