Washington State Nurse Delegation

There are five conditions for nurse delegation:

1. A licensed Registered Nurse transfers performance of a task.

2. There are four specific tasks that may not be delegated.

3. A delegation covers a specific task for one client.

4. Only qualified Nursing Assistants/Home Care Aides can accept a delegation. 5. Delegation can only happen in four community settings.

The following four tasks may NOT be delegated to you.

1. Injections, other than insulin.

2. Sterile procedures.

3. Maintenance of central lines.

4. Tasks that require nursing judgment.

There are five requirements to be qualified to receive a delegation. You must:

1. Be an HCA, NA-R or a NA-C current and in good standing in Washington State.

2. Have completed the educational requirements for delegation.

3. Be willing to perform the specific task to be delegated.

4. Demonstrate your competence to perform the specific tasks to be delegated correctly and without direct supervision to the delegating RN.

There are four settings in which delegation can occur:

1. Certified community residential programs for the developmentally disabled.

2. Licensed adult family homes.

3. Licensed assisted living facilities.

4. In clients' homes.

Five conditions for nurse delegation

Tasks that may NOT be delegated

Qualified NA

Community settings

In the delegation process, there are five key roles that you should understand. The role of the:

1. Client

2. Delegating RN

3. Nursing Assistant/Home Care Aide

4. Case Manager

5. Home care agency supervisor or facility Administrator

The client or his/her representative must give consent for nurse delegation.

True

The RN has five main areas of responsibility in delegation:

1. Assessing the client and evaluating the appropriateness of the delegation.

2. Obtaining written informed consent from the client or authorized representative for the delegation process.

3. Delegating the task.

4. Supervising the delegation.

5. Rescinding (canceling) the delegation.

There are four primary actions you are responsible for in a delegation:

Performing the delegated task according to the specific instructions of the RN.

Observing the client for:

- Potential side effects from medications.

- Negative reactions to procedures.

- Complications from diseases.

Reporting changes in your client's condition promptly to the delegating RN.

Reporting new or changed medications or treatments.

Renewing your registration or certification on time so you can legally perform a delegated task.

You are not required to accept delegated tasks. You can refuse if you feel the client's safety is at risk or that you are not competent to perform the task.

True

There are three people involved in the delegation who must agree to it: the RN, the client or authorized representative, and you.

True

Injections, other than insulin, sterile procedures, and central line maintenance cannot be delegated to you.

True

The RN must evaluate the delegation periodically.

True

Nurse Delegation tasks are only for one client. You cannot perform a delegated task for another client unless you are specifically delegated to do that task for that client.

Case manager

Supervisor agency

Employer administrator

Key points

True

It is the employer/administrator's responsibility to:

Ensure all legal requirements are met.

Set the policies and procedures for the facility.

Cardiovascular

Move blood in order to deliver oxygen and remove carbon dioxide from the different parts of the body.

Disorders of the Cardiovascular System

Hypertension

Hypotension

Congestive Heart Failure (CHF)

Heart attack

Stroke or CVA

Heart arrhythmia

Respiratory

Manage the transfer of oxygen from the air to the blood, and remove carbon dioxide from the blood for transfer to the air.

Disorders of the Respiratory System

Upper Respiratory Infections (URI)

Pneumonia

Chronic Obstructive Pulmonary Disease (COPD)

Asthma

Integumentary (Skin)

Epidermis - barrier against bacteria and moisture. Holds in moisture to keep body tissues from drying out

Dermis - contains hair follicles, oil glands, sweat glands that regulate body temperature, and sense receptors that identify pain, pressure, heat, cold, etc.

Subcutaneous tissue - fibrous tissue connectsthe upper skin layers to the skeletal muscles. Fatty tissue holds in body heat, provides insulation, and provides an energy source

Disorders of the Integumentary System

Pressure injuries (bed sores)

Stasis/venous ulcers

Arterial ulcers (Diabetic)

Rashes and infections

Burns

Skin cancer/lesions

Dehisced wounds

Fistulas

Genito-Urinary

organs of reproductive and urinary systems

Gastrointestinal

Changes food into substances that can be used by all the cells in the body

Gets rid of waste products through feces

Disorders of the Gastrointestinal System

Constipation

Fecal Impaction

Hemorrhoids

Gastro-intestinal ulcer

Colitis (Irritable Bowel)

Dehydration

GERD

Disorders of the Genito-Urinary

Urinary Tract Infection (UTI)

Incontinence

(Urge, Stress and Overflow)

Enlarged prostate

Endocrine

Produces chemicals called hormones which regulate and control body activities and growth

Disorders of Endocrine

Diabetes Mellitus - Type I and II

Hypothyroidism

Nervous

Coordinates body functions and monitors changes in the body and the environment

Disorders of the Nervous

Seizures and Epilepsy

Parkinson's Disease and other tremors

Alzheimer's and other Dementias

Traumatic Brain Injury (TBI)

Musculo-Skeletal

Protects the internal body organs, provides a framework for the body, maintains posture, and makes body movement possible

Disorders of Musculo-Skeletal

Osteoporosis Arthritis

Fractures

Sensory

Gives the body information about the world around it through sight, smell, hearing, touch, and taste.

Sensory Disorders

Eyes:

• Cataracts• Glaucoma• Macular Degeneration • Diabetic Retinopathy • Dry Eyes

Ears:

• Hearing loss• Tinnitis• Vertigo or dizziness

All labels should contain the following information:

• Client name

•Medication name •Dose

•Route

•Schedule

•Expiration date

In medication assistance, you are helping the client to self-administer their medication only as much as they need to complete the task for themselves. The client is aware that they are taking medication.

True

In medication administration under Nurse Delegation, you are administering the medication as delegated by the RN. Only HCAs, NACs and NARs under delegation can perform medication administration.

True

Medications are given using the Five Rights of Medication Administration.

• Right client

• Right medication

• Right dose

• Right route

• Right time

There are five steps in the medication administration process:

Evaluate the client.

Set up the medication.

Administer the medication.

Document the medication administration. Observe the client for side effects.

A medication is any compound that changes the chemical activity within the human body.

Legend Drugs

can only be dispensed with a prescription

Non-Legend Drugs

Can be purchased without a prescription, OTC.

A prescription is an order for medication or treatment given by an authorized health care professional with specific instructions for use. Health care professionals whocan give prescriptions include doctors, nurse practitioners, physician's assistants, or dentists.

Medications have two names you need to know:

- Generic name

- Brand name

Scheduled Medication

Scheduled medications are called controlled substances. These medications could be dangerous or have a high potential for abuse and addiction. Examples are narcotics, depressants, stimulants, and psychedelic medications.

Medications do three main things:

1. Treat, cure, or control an illness.

2. Relieve symptoms like pain.

3. Prevent disease.

Six personal characteristics can affect a medication's action:

1. Age

2. Size

3. Sex

4. Genetic Inheritance

5. Physical Condition 6. Emotional Condition

Other factors that might affect response to a medication are:

• Route of administration

• Time of day the medication is given

• Number of medications a person takes and size of dose

• Environmental conditions

The most common packaging types for medications are:

• Vials or bottles

• Bubble packs

• Medication organizers

• Unit dose packaging

Oral Administration

Taken by mouth and swallowed

Sublingual Administration

Placed under the tongue

Topical Administration

Applied directly to the skin or mucous membrane

Rectal Administration

Inserted directly into the rectum

Vaginal Administration

Inserted directly into the vagina

Inhalation Administration

Sprayed or inhaled into the nose, throat, and lungs

Injection Administration

Piercing the skin with a needle and putting medication into a muscle, under the skin, or into a vein

All labels should contain the following information:

• Client name

• Medication name

• Dose

• Route

• Schedule

• Expiration date

Intellectual Disability

is defined by score on IQ tests (usually a score of 69 or less). The person has difficulty with learning. A licensed psychologist can determine if a person has an intellectual disability.

Cerebral Palsy

affects a person's ability to control their movements because of muscle rigidity, spasticity, or tremors. Cerebral palsy is caused by an injury to the brain. A doctor makes the diagnosis of cerebral palsy.

Epilepsy

is the misfiring of neurons in the brain causing seizures. These can often be controlled by medication. A doctor makes the diagnosis of epilepsy.

Autism

includes difficulty with communication, difficulty with social situations, and restrictions in activities of daily living. A psychiatrist or clinical psychologist makes the diagnosis of autism.

Down Syndrome

is a condition that a person is born with caused by a defect in one of the chromosomes. Down Syndrome causes a distinct facial appearance, intellectual disability, developmental delays, and may be associated with thyroid or heart disease