RN & LPN Delegation to the Nursing Care Partner (NCP)

System Nursing Professional Practice Advisory Council Q4 2020

Purpose

To define appropriate use of the UAP NCP role within Sentara Healthcare as functioning under the direction and delegation from the RN and/or LPN.  This document summarizes information into succinct guidelines to guide scope of nursing practice, supervision and delegation. Patient safety always is the priority; when questions remain lift the situation in question to nurse leaders for resolution and guidance.  All nurses are responsible for adherence to Board of Nursing regulations and laws of the state in which they practice.

Definitions

Unlicensed assistive personnel (UAP): An umbrella term to describe a job class of paraprofessionals who assist individuals with their activities of daily living and provide care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse, or other healthcare professionals. UAP by definition do not hold a license or other mandatory professional requirements for practice, though many hold various certifications.

Accountability: To be answerable to oneself and others for one’s own choices, decisions and actions as measured against a standard (ANA, 2015).

Assignment: The routine care, activities and procedures that are within the authorized scope of practice of the RN or LPN or part of the routine functions of the assigned person.

Delegated Responsibility: A nursing activity, skill or procedure that is transferred from a licensed nurse to a delegatee.

Delegation: Transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome (ANA, 2015).

Supervision: Guidance or direction of a delegated nursing task or procedure by a qualified, registered nurse who provides periodic observation and evaluation of the performance of the task and who is accessible to the unlicensed person.

 


Delegation

Delegation is a complex process involving the licensed nurses responsibilities for understanding what can be delegated, to whom, when, in what circumstances, and with what supervision or evaluation. Delegation is determined by accepted professional nursing standards of practice, individual state statutes, and nurse practice acts, state regulations and organizational policy statements. The delegating RN retains accountability for the patient outcomes associated with nurse delegation, provided the person to whom the task was delegated performed it as instructed.

The RN may delegate selected nursing tasks and procedures to UAP NCP, if the following criteria are met. Nursing tasks shall only be delegated after an assessment is performed.

  1. In the judgement of the delegating nurse, the task or procedure can be properly and safely performed by the unlicensed person and the delegation does not jeopardize the health, safety and welfare of the patient.
  2. The delegating nurse retains responsibility and accountability for nursing care of the patient, including nursing assessment, planning, evaluation, documentation and supervision.
  3. Delegated tasks and procedures are within the knowledge, area of responsibility and skills of the delegating nurse.
  4. Delegated tasks and procedures are communicated on a patient specific basis to an unlicensed person with clear, specific instructions for performance of activities, potential complications, and expected results.
  5. The person to whom a nursing task has been delegated is clearly identified to the patient as an unlicensed person by a nametag worn while giving care to the patient and by personal communication by the delegating nurse when necessary.

 


Nursing tasks that shall not be delegated to any unlicensed person are:  

  • Nursing assessment, problem identification, and outcome evaluation which require independent nursing judgment
  • Counseling or teaching except for activities related to promoting independence in personal care and daily living
  • Coordination and management of care involving collaboration, consultation and referral
  • Emergency and non-emergency triage
  • Administration of medications except as specifically permitted by the Virginia Drug Control Act
  • Circulating duties in an operating room.

Nursing tasks that may be delegated (not exclusive):  

  • Managing drainage devices & documenting accordingly (hemovac, Jackson Pratt, wound vac, Penrose, chest tube, ileostomy/colostomy/urostomy)
  • 12 lead EKG
  • Operating bed/chair functions (weights, alarms, adjustments, etc.)
  • Blood glucose testing
  • i-stat testing
  • Clinitek testing
  • Collect urine/stool/sputum specimens
  • Assist with patient admission (admission kit, vitals, height & weight, orients to environment, patient belongings, etc.)
  • Assist with patient pulmonary hygiene (cannot initiate, disconnect or discontinue oxygen therapy-O2 considered a drug)
  • Provide patient care for telemetry (electrodes, battery replacement)
  • Assistance with personal care needs (bathing, CHG treatment, oral care, linen change, peri-care, shaving, range of motion exercises, documentation)
  • Assist with nutrition (cutting foods, arranging trays, positioning, documentation of intake)
  • Maintaining patient safety (hourly rounding, bed alarms, fall precautions, brakes on beds/chairs, call bell in reach, skin care/prevention)
  • Providing safe transport of patients
  • Performing post mortem care
  • Promoting physical comfort (positioning, adjusting lights, limiting noise)
  • Implementing and maintaining VTE prophylaxis (apply compression stockings or sequential compression device stockings, connect & run equipment, observe skin and report areas of pressure to nurse)
  • Assist with safe mobilization (transfers, assists & ambulating with use of assistive devices)
  • Use safety measures to prevent injuries (for patients under direct observation/seclusion/restraint-use safe room guidelines, communication to RN if physical/behavioral condition changes)
  • Assist with patient discharge (possessions and transport to vehicle)
  • Maintain organized work environment
  • Call a code, medical alert, fire, or plain language event
  • Apply device (splint, sling, orthopedic boot/shoe or immobilizer)
  • Perform phlebotomy
  • Assist with wound care (non-sterile dressings, wound care products-NS, hydrogel, hydrocolloid, ace wrap)
  • Remove peripheral IV
  • Insert/maintain or discontinue indwelling urinary catheter

 


Delegatee Responsibilities  

Everyone is responsible for the well-being of patients. While the nurse is ultimately accountable for the overall care provided to a patient, the delegatee shares the responsibility for the patient and is fully responsible for the delegated activity, skill or procedure.

  • The delegatee must accept only the delegated responsibilities that he or she is appropriately trained and educated to perform. The delegatee should confirm acceptance of the responsibility and once the delegatee verifies acceptance, the delegatee is accountable for carrying out the delegated responsibility correctly and completing timely and accurate documentation per facility policy.
  • The delegatee cannot delegate to another individual.
  • The delegatee must communicate with the licensed nurse in charge of the patient. This includes any questions, follow-up, concerns, or changes in a patient’s condition.

References:

American Nurses Association (ANA). (2012). ANA’s Principles for Delegation. Silver Spring, MD: Author.

American Nurses Association (ANA). (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: Author.

American Nurses Association (ANA). (2016). Nursing Scope and Standards of Practice 3rd Edition. Silver Spring, MD: Author.

ANA/NCSBM (2010). Joint Statement on Delegation American Nurses Association and the National Council of State Boards of Nursing. Retrieved from https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

NCSMB (2019). National Guidelines for Nursing Delegation. Retrieved from https://www.ncsbn.org/NGND-PosPaper_06.pdf

North Carolina Board of Nursing. (June 2016). Infusion Therapy/Insertion/Access Procedures.  Retrieved from https://www.ncbon.com/vdownloads/position-statements-decision-trees/infusion-therapy.pdf

North Carolina Board of Nursing. (February 2019). Position Statements.  Retrieved from https://www.ncbon.com/practice-position-statements-decisions-trees

Virginia Board of Nursing. (February 2019). Regulations Governing the Practice of Nursing. Retrieved from http://www.dhp.virginia.gov/nursing/nursing_laws_regs.htm