what type of license is required to utilize the two bon rules on delegation

Topics
Board Rule 224 - Delegation of Nursing Tasks by RNs to Unlicensed Personnel for Clients with Agile Conditions or in Acute Care Environments	Board Rule 225 - RN Delegation to Unlicensed Personnel & Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable & Anticipated Conditions.
Overview of Delegation	Applicability
Delegation/Assignment	Customer's Responsible Adult
Advanced Practice Registered Nurses	Health Maintenance Activities
Licensed Vocational Nurses	Medication Administration
Unlicensed Assistive Personnel	Medication or Procedures in an Emergency Situation
Emergency Medical Technicians/Paramedics	Hospice
Family unit Members	Delegation for the School Nurse
Nurse Externs	References
Documentation
Supervision
Doc Orders
Procedures/Treatments
Medication Administration

Board Rule 224 - Overview of Delegation

Delegation is an essential nursing skill that RNs use to maximize the nursing intendance that clients receive.

Delegation is based upon:

1. The needs of the patient and the stability of the patient'south condition;
2. The RN assessment of the potential for patient harm;
3. The complexity of the task;
4. The predictability of the outcomes;
5. The abilities of the unlicensed assistive personnel (UAP) staff to whom the task is delegated;
6. The context of other patient needs to achieve the almost benefit from nursing care since the RN is responsible and answerable for safe and advisable delegation (§224.5, RN Accountability for Delegated Tasks), delegation is utilized at the RN's discretion.

The delegation process is multifaceted. It begins with decisions made at the authoritative level of the system and extends to the staff responsible for delegating, overseeing the process, and performing the responsibilities (NCSBN, 2016). Employers have a responsibility to ensure that practices specified in chore descriptions comply with applicable state and federal laws, regulations and credentialing requirements (e.g., Texas Department of State Wellness Services; Centers for Medicare & Medicaid Services).

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Delegation/Assignment

Delegation & Assignment Defined

The utilise of terms delegate and assign tin be disruptive and atomic number 82 to questions regarding the licensure responsibilities associated with the terms. Delegation is defined as "authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs the task. Information technology does not include situations in which an unlicensed person is directly assisting a RN by carrying out nursing tasks in the presence of a RN." [§224.four(3)]...

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Advanced Practice Registered Nurses

May an Advanced Practice Registered Nurse (APRN) consul tasks to other nurses or unlicensed assistive personnel?

Under the RN licensure and role, APRNs may only delegate tasks to unlicensed staff or assistive personnel utilizing the applicative RN Delegation Rules 224 or 225 as advisable and in compliance with Rule 217.11(3)(B). APRNs are not authorized to exceed the delegation criteria in Rules 224 and 225. While APRNs accept collaborative working agreements with physicians, APRNs practise not accept the same delegatory authority as physicians and therefore are limited to delegation of nursing tasks within the RN licensure and role. The BON's delegation rules (§224 & §225) apply to both RNs and APRNs...

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Licensed Vocational Nurses

What is the LVN's scope of practice and office in delegation?

The LVN telescopic of practice is both directed and supervised [NPA §301.002(2); NPA §301.353; §217.11(2)]. The LVN performs a focused assessment [§217.xi(2)]. The delegation decision is based on the comprehensive assessment that is performed by the RN [§217.11(three)]. Since the LVN practice is non autonomous, and the LVN is non educated or licensed to perform a comprehensive cess, it is beyond the LVN scope of practice to delegate tasks. However, the LVN may assign tasks not requiring delegation and provide supervision to the UAP for assigned tasks...

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Unlicensed Assistive Personnel

RNs may be asked to delegate tasks to UAPs with minimal skill levels or skill sets. Organizations may have policies regarding delegation and delegation duties may exist included in RN job descriptions. If an RN refuses to consul based on the cess, tin the RN be required to delegate?

Delegation is widely viewed as an essential nursing skill the RN uses at their discretion based upon the RN assessment. Since the RN is accountable for the delegation process, the decision to delegate belongs to the RN (Rules §224.five & §225.5 apropos accountability). However, others (e.g., the client, client's family/significant others, the RN'due south supervisor, the UAP) may have input that the RN needs to consider in the conclusion making process. The decision to delegate is based on a thorough working knowledge of BON Rules (§224, §225, and §217 .11) and other relevant regulations. When delegating a task, RNs have a duty to maintain patient prophylactic [Rule 217.11(1)(B)] which supersedes other mandates such as facility policy or medico orders (Position Statement 15.14, Duty of A Nurse in any Do Setting)...

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Emergency Medical Technicians/Paramedics

Tin can an RN delegate nursing tasks to an emergency medical technician (EMT) or paramedic?

The BON's rules in Chapter 224 describe the requirements for RN delegation to unlicensed personnel in an acute intendance environment such equally the emergency department. The BON does not regulate practice settings or facility policies, nor does the Board regulate emergency medical technicians or paramedics. Whether certified or licensed, the BON views the EMT or paramedic role inside the astute care, inpatient setting or emergency department setting to exist equivalent with the UAP for the purposes of RN delegation. While EMTs and paramedics practise have out-of-hospital preparation and licensure/certification applicable to the out-of-hospital setting, within the acute care environment the telescopic of practise of the EMT or paramedic is limited to the role of the UAP...

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Family Members

Patients' families may help in patient care. When instructing family members in providing care, is this considered delegation?

RNs may be involved in patient/family teaching and this is not delegation. The RN is responsible for providing complete and authentic instructions and oversight, in improver to customer cess (§ 224.vi(i) and 225.5(a)). Nonetheless, the requirements of the rules in Chapters 224 & 225 typically do not apply in this context. Further, the BON defines UAPs equally individuals who are "monetarily compensated" to provide health care services. Since families and significant others are not normally compensated for providing care to their loved i, this is not a delegation situation.

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Nursing Students

Many organizations use nursing students (i.due east., individuals who are employed in the organization and are currently students in an accredited school of nursing).

• Is it an acceptable practice for nursing students who provide documented didactic education and demonstration of competence from their nursing program, to perform such duties equally urinary catheter placement, sterile dressing changes, and venipuncture in acute care settings?
  
• May they perform patient assessments and independently document these assessments in acute care settings?

Employers may hire nursing students to work equally UAPs in positions such every bit aides or nursing administration. This is a different situation than nursing students who are completing their clinical class work requirements in a facility and are monitored by nursing schoolhouse faculty. In that scenario, students are authorized to perform nursing tasks as a office of their bookish program; therefore, RN delegation is not required. However, nursing students who are employed by a facility as UAPs must function nether the delegated potency of a RN to perform nursing tasks [see Rule 224.four(4)(C)...

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Documentation

When a RN delegates a task to a UAP, is that UAP responsible for documenting the care provided or is the RN responsible? Does the RN have to co-sign this documentation?

Responsibilities regarding documentation and co-signature are non specified in the delegation rule but may be addressed in facility policies and procedures. The RN's responsibility for complete and accurate documentation is delineated in the Standards of Nursing Practice [BON Rule §217.11 (ane)(D)]. As determined past the employing bureau/facility with nursing collaboration, UAPs might play a function in the documentation of care they provide. Co-signature indicates that the RN was present or observed all the activities that the UAP is reporting in the record. Without this presence or observation, the BON does non recommend that a RN co-sign others' documentation.

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Supervision

What is the RN'southward/APRN's responsibility when s/he supervises an unlicensed assistive person who has been delegated tasks by a doc or other non-RN practitioners?

Board rules §224.10 and §225.fourteen address situations where the RN is supervising a UAP, yet that RN is non the delegating practitioner considering another licensed practitioner is delegating to this UAP. The Documentation Supervision delegation rules permit this practice since delegation, as addressed by BON dominion, is not restricted past employment relationships. That is, information technology is permissible by BON rule for a treating physician or a RN from i employing agency (e.g., a home wellness bureau) to consul to a UAP from a unlike agency (due east.g., an assisted living facility)...

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Physician Orders

In what circumstances is a physician order required for nursing delegation?

Since RN delegation is defined equally authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs the job, the BON does not require RNs to obtain physician orders for RN delegation nor can a physician forcefulness an RN to delegate. The RN is answerable for the delegation process, therefore the decision to delegate belongs to the RN (Rules §224.5 & §225.five pertaining to accountability). However, others (i.e., the physician, the client, client's family/significant others, the RN'south supervisor, the UAP) may have input into the decision making procedure. The decision to delegate is based on a thorough working cognition of BON Rules (§224, §225, and §217.eleven) and other relevant regulations.

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Procedures/Treatments

Can a RN delegate finger sticks to collect capillary blood for claret glucose testing?

Aye, a RN may delegate finger sticks for claret glucose monitoring [§224.8(a)(2)(A) and §225.10(4)(A)]. In Board Rule §225.12, Delegation of Insulin or Other Injectable Medications Prescribed in the Handling of Diabetes Mellitus, blood glucose monitoring [§225.12(ii)] is an important component of this delegated task...

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Medication Assistants

Can UAPs administer immunizations?

The laws regarding immunizations are non within the BON'south authority. With regard to vaccines of any kind, an Chaser General opinion in 1981 (MW-318) determined immunizations are preventative, thus no medical diagnosis is required or made when a person receives an immunization.

Nevertheless, RN/APRNs may not delegate the administration of immunizations under the delegation rules. Where immune past state police, appropriate non-doctor personnel may provide vaccinations under a physician-canonical standing lodge without the need for physician test and a client-specific order. An boosted document that may provide guidance is the FAQ: Seasonal Influenza, and Vaccinations available on the Board's website also as the Board's Position Argument fifteen.5 Nurses with Responsibleness for Initiating Standing Orders.

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Lath Rule 225 - Applicability

In relation to delegation, what types of clients and settings should a RN refer to Chapter 225? In relation to delegation, what types of clients and settings should a RN refer to Affiliate 225?

There are three criteria that must be met in order for a Registered Nurse to apply the delegation rules from Chapter 225. The criteria is 1) the client is in an independent living environment such equally a home a group dwelling house, foster home, assisted living facility or school; (2) the customer, if xvi or older, or client's responsible adult is willing and able to participate in decisions most the overall management of the client's wellness intendance; and (3) the chore is for a stable, anticipated status every bit defined by §225.4. [Lath Dominion 225.1(a)]

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Client'south Responsible Adult

Who is eligible to serve as the "customer's responsible adult" (CRA)? Is it possible for the CRA and the unlicensed assistive person (UAP) to be the same person? Can the CRA exist an employee of the facility/agency providing the services?

BON Dominion 225.four(5) defines CRA as "an individual, xviii or older, normally chosen by the customer, who is willing and able to participate in decisions about the overall management of the client's health care and to fulfill any other responsibilities required nether this chapter for care of the client. The term includes simply is not limited to parent, foster parent, family unit member, pregnant other, or legal guardian."...

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Health Maintenance Activities

RNs in independent living environments such as, home and community-based settings or school health while caring for clients with stable and predictable weather condition must utilise the rules in Chapter 225, RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Contained Living Environments for Clients with Stable and Predictable Atmospheric condition when making decisions that pertain to delegation...

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Medication Administration

Is drawing up a required dose of insulin a delegated job?

According to Rule §225.12, the RN may consul assistants of insulin or other injectable medications prescribed in the treatment of diabetes mellitus subcutaneously, nasally or via an insulin pump. Every bit part of the medication administration procedure, the UAP may be required to depict upwards the insulin or other injectable medications utilizing a sliding scale to determine the required dose of insulin or medication. These are generally permissible tasks and should exist specified in the RN'south instructions and doc's social club. The RN may not delegate these activities if s/he will have to make decisions that require professional nursing or medical judgment. The calculation of insulin doses may not be delegated. The BON does not consider the application of a sliding scale to be of the aforementioned complexity of calculating a dose based on carbohydrate-to-insulin ratios.

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Medication or Procedures in an Emergency Situation

Are there whatever medications or procedures that may be delegated in an emergency situation in independent living environments such as in home health or school health?

Planning for emergencies in independent living environments requires the RN to employ both Chapter 224 , Delegation of Nursing Tasks past Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Weather or in Acute Intendance Environments and Chapter 225, RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions...

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Hospice

Is a client receiving hospice care considered stable & predictable?

Yep, according to Rule §225.iv(11). Stable and anticipated is defined as "a situation where the customer's clinical and behavioral condition is determined to exist non-fluctuating and consistent. A stable/predictable condition involves long term health care needs which are non recuperative in nature and do not crave the regularly scheduled presence of a registered nurse or licensed vocational nurse. Excluded by this definition are situations where the client'south clinical and behavioral status is expected to change speedily or in need of the continuous/continual cess and evaluation of a registered nurse or licensed vocational nurse. The condition of clients receiving hospice care in an independent living environs where deterioration is predictable shall exist deemed to exist stable and anticipated."

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Delegation for the Schoolhouse Nurse

Can RNs consul medication administration via envelopes or sealed plastic numberless and give it to the teacher or another UAP when south/he accompanies students on field trips?

Co-ordinate to Board Rule 225.11(ane), a RN may delegate the administration of medications from a daily reminder pill container. This dominion section also applies to RNs who consul medication assistants to UAPs in the schoolhouse setting when in that location is from a properly labeled unit dosage container filled by a registered nurse or another qualified district employee...

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References

• Nursing Practice Act (http://www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp)
• Board Rules & Regulations(http://world wide web.bon.texas.gov/laws_and_rules_rules_and_regulations.asp)
• Position Statements (http://www.bon.texas.gov/practice_bon_position_statements.asp)
• Delegation Resources Packet (http://www.bon.texas.gov/practice_delegation_resource_packet.asp)
• National Quango of State Board of Nursing (NCSBN) and the American Nurses Clan (ANA) (2006). Joint statement on delegation. Retrieved from: https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf
• National Council of State boards of Nursing (NCSBN) National Guidelines for Delegation 2016. Retrieved from: https://www.ncsbn.org/NCSBN_Delegation_Guidelines.pdf

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For more information on these and other topics, utilise the sear ch field at the elevation right corner of the folio. Should you take farther questions or are in need of description, please experience free to contact the Board.

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Source: https://www.bon.texas.gov/faq_delegation.asp

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