PCTs scope of practice in Texas . . . - Page 2

Our floor techs help with baths/ADLs, etc. The ER techs start IVs, draw blood, put in Foleys. I think maybe there were EMTs before being techs in ER? Not sure

Any task performed by a PCT or CNA must be delegated to them by a nurse. The rules for delegation in the state of Texas are determined by the Nurse Practice Act. Below is the delegation rule from the NPA in Texas. You can go to bon.state.tx.us and read the entire NPA. Many hospitals have specific policies regarding delegation to unlicensed assistive staff in addition to following the NPA. Unfortunately, many nurses are unaware of the delegation rules and they delegate things that should NEVER be delegated. Many nurses don't know the NPA. If they have a BSN, they had a course going over the NPA. However, many nurses don't have a BSN and never took the time to learn the laws that govern their license. Critical care areas and Emergency Departments do not staff unlicensed assistive staff in the DFW area because as you can see from the delegation rules, only tasks for stable, non critical patients can be delegated. Our ERs have medics (EMTs, ACTs, etc). They are licensed staff, which is different than an unlicensed person.

RULE §224.8Delegation of Tasks(a) Tasks Which are Most Commonly Delegated. By way of example, and not in limitation, the following nursing tasks are ones that are most commonly the type of tasks within the scope of sound professional nursing practice to be considered for delegation, regardless of the setting, provided the delegation is in compliance with §224.6 of this title (relating to General Criteria for Delegation) and the level of supervision required is determined by the RN in accordance with §224.7 of this title (relating to Supervision):
(1) non-invasive and non-sterile treatments;
(2) the collecting, reporting, and documentation of data including, but not limited to:
(A) vital signs, height, weight, intake and output, capillary blood and urine test for sugar and hematest results,
(B) environmental situations;
(C) client or family comments relating to the client's care; and
(D) behaviors related to the plan of care;
(3) ambulation, positioning, and turning;
(4) transportation of the client within a facility;
(5) personal hygiene and elimination, including vaginal irrigations and cleansing enemas;
(6) feeding, cutting up of food, or placing of meal trays;
(7) socialization activities;
(8) activities of daily living; and
(9) reinforcement of health teaching planned and/or provided by the registered nurse.
(b) Discretionary Delegation Tasks.
(1) In addition to General Criteria for Delegation outlined in §224.6 of this title, the nursing tasks which follow in paragraph (2) of this subsection may be delegated to an unlicensed person only:
(A) if the RN delegating the task is directly responsible for the nursing care given to the client;
(B) if the agency, facility, or institution employing unlicensed personnel follows a current protocol for the instruction and training of unlicensed personnel performing nursing tasks under this subsection and that the protocol is developed with input by registered nurses currently employed in the facility and includes:
(i) the manner in which the instruction addresses the complexity of the delegated task;
(ii) the manner in which the unlicensed person demonstrates competency of the delegated task;
(iii) the mechanism for reevaluation of the competency; and
(iv) an established mechanism for identifying those individuals to whom nursing tasks under this subsection may be delegated; and
(C) if the protocol recognizes that the final decision as to what nursing tasks can be safely delegated in any specific situation is within the specific scope of the RN's professional judgment.
(2) the following are nursing tasks that are not usually within the scope of sound professional nursing judgment to delegate and may be delegated only in accordance with, §224.6 of this title and paragraph (1) of this subsection. These types of tasks include:
(A) sterile procedures--those procedures involving a wound or an anatomical site which could potentially become infected;
(B) non-sterile procedures, such as dressing or cleansing penetrating wounds and deep burns;
(C) invasive procedures--inserting tubes in a body cavity or instilling or inserting substances into an indwelling tube; and
(D) care of broken skin other than minor abrasions or cuts generally classified as requiring only first aid treatment.
(c) Nursing Tasks Prohibited from Delegation By way of example, and not in limitation, the following are nursing tasks that are not within the scope of sound professional nursing judgment to delegate:
(1) physical, psychological, and social assessment which requires professional nursing judgment, intervention, referral, or follow-up;
(2) formulation of the nursing care plan and evaluation of the client's response to the care rendered;
(3) specific tasks involved in the implementation of the care plan which require professional nursing judgment or intervention;
(4) the responsibility and accountability for client health teaching and health counseling which promotes client education and involves the client's significant others in accomplishing health goals; and
(5) administration of medications, including intravenous fluids, except by medication aides as permitted under §224.9 of this title (relating to The Medication Aide Permit Holder).
Source Note: The provisions of this §224.8 adopted to be effective February 19, 2003, 28 TexReg 1384

Me too - we took a special 12 week class offered by the hospital for nursing students, and we were able to do foleys, assist with sterile dressing changes, phelbotomy, set up equipment like a chest tube unit or infusion wamer etc, pretty much everything on the list. This was back in the early 90's when they were pushing the PCT concept pretty hard.

EKGs probably just mean hooking up patients to the monitors (putting those sticker pads on the patient and connecting the wires correctly, etc). I have worked in two hospitals, one as a PCNA and one as a tech and although I can do a lot more a tech, I hooked patients up to monitors in both positions.

i am a tech in a trauma facility in the er and this is what i am allowed to do based on what you asked..

clinical job duties of the patient care assistant may include: discontinuation of iv’s yes. we d/c and we start. but we are not allowed to flush, as ns is considered a medication, so the rn/lvn in charge of that particular patient would have to come behind and flush.

clean and irrigate lacerations no, requires nursing assessment and skills

set up rapid infusor, heptafiler setup. no

answer phones locate equipment and transport non critical patients and assist with critical patients yes

foley catheters dressing changes yes i am able to do this. i can start and discontinue. this involves a regular cath and straight caths.
and feed patients assist with comfort measures / safety measures. yes

attend to the psyche patients and escort patients to treatment areas, clean rooms, yes

collect specimens, chest tube setups relieve mr’s, i can collect certain specimens, like ua, and cbcs etc. we can set up for different procedures, chest tube setup, pelvic exam etc, if this is what you mean by setup.

clinitech documentation and collection change sharp boxes and o2. yes

decontamination procedures yes

ekg’s, we can do ekgs

assist with o2 delivery i don't see where there would be need for assistance. however, you can, in theory 'assist', however you cannot administer it yourself. (same with my facility)

clean instruments yes

and post-mortem care. we do not participate in the care of the actual body, but we do help the rns with stuff that is going on in the room after somebody has passed such as cleaning up what we might have used, or covering the body etc, stuff like that.
copy charts for admissions yes

splint assistance, yes

suction, no!

crutch walking instructions no! teaching is a nursing responsibility. you can reinforce teaching, but you cannot do the initial teaching. (same at my facility)

and adjustments take vital signs and assist with pelvic exams yes

perform phlebotomy. yes we perform phlebotomy.