New delegating rules, Whats a RN to do?

[vfahnholz]

Some Feedback Please

1) In my employment setting, RNs are receiving increasing pressure to delegate tasks to unskilled unlicensed assistive personnel who have minimal competency. The employer has written policy about delegation and delegation duties are included in the RNs job descriptions. When RNs choose not to delegate, they are asked to justify why they do not want to delegate tasks to the unlicensed assistive personnel. Can employers force RNs to delegate?

2) What is the RN's responsibility when s/he supervises unlicensed assistive personnel, and the physician is delegating to the unlicensed assistive personnel? May a RN delegate to and from another agency with which you do not have supervisory authority?

[VivaLasViejas, ASN, RN]

Some Feedback Please

1) In my employment setting, RNs are receiving increasing pressure to delegate tasks to unskilled unlicensed assistive personnel who have minimal competency. The employer has written policy about delegation and delegation duties are included in the RNs job descriptions. When RNs choose not to delegate, they are asked to justify why they do not want to delegate tasks to the unlicensed assistive personnel. Can employers force RNs to delegate?

2) What is the RN’s responsibility when s/he supervises unlicensed assistive personnel, and the physician is delegating to the unlicensed assistive personnel? May a RN delegate to and from another agency with which you do not have supervisory authority?

I live in Oregon, where the delegation rules may be different, but I think your first question can be answered the same way in all states: NO, your employer cannot force an RN to delegate. Ever. They may put pressure on you to do so, and some will no doubt even threaten you, but they cannot make you delegate anything. That is YOUR license on the line, and if you don't feel comfortable delegating a certain task, or delegating to a certain person, it's not only your right, but your responsibility not to.

Now, here in Oregon, our responsibility for a delegated task begins with our decision to delegate it, goes through teaching of the task, supervision of the person performing it, and periodic reevaluation of both the caregiver and the resident.........but it ends with the caregiver her/himself. If you have taught a task, are assured of the caregiver's competence, and have documented evidence of continuing competence---and the caregiver does something wrong ---it is on THEIR head, not yours. You cannot be held liable for something that you taught in good faith and can prove that the caregiver can perform competently. (Some caregivers don't know this, and think they can mess up with impunity.........WRONG!!)

As to your other questions: A physician does not 'delegate' to an unlicensed assistive person. They may, of course, show a caregiver or family member how to do something, but for assisted living purposes, an RN must take responsibility for teaching the task, supervising the facility employees, and assuring their continued competence.

As for agency delegation: An example might be a home health agency which has been treating a resident with a stasis ulcer, and it's time to discharge the patient from that agency's care. The RN who has been working with that resident will usually transfer the delegation of that task to the facility nurse, who may then delegate it to an unlicensed person or do the care herself. Sometimes, but not often, the agency will delegate directly to the facility staff, but it remains their responsibility to supervise and re-delegate the task at the mandated intervals (in Oregon, it's 60 days for the first re-delegation), and I would imagine most wouldn't want to do that once they've D/C'd the resident from their care.

Hope I've given you some help..........in the meantime, please check with your state board of nursing and get a copy of your state's Nurse Practice Act, which will contain all of the information you need. Good luck to you!