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Helping People Live Better Lives.
Nursing Scope of Practice Decisions
Ann Oertwich RN, PhD
Executive Director, Nebraska Board of Nursing
Licensure Unit, Division of Public Health
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Helping People Live Better Lives.
ObjectivesDefine nursing scope of practice in the context of Nebraska statutory and regulatory provisions
Discuss the dialysis care tech legislative proposal as it relates to RN practice
Discuss the LPN-C legislative proposal as it relates to RN practice
Introduce/utilize the Nebraska Board of Nursing Scope of Practice Decision-Making Model
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Helping People Live Better Lives.
http://dhhs.ne.gov
--Licensure--Professions & Occupations--Nursing
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Helping People Live Better Lives.
http://dhhs.ne.gov/publichealth/Licensure/Documents/Nursing-NursePracticeAct.pdf
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Helping People Live Better Lives.
Nursing Scope of Practice
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Helping People Live Better Lives.
“…the rules, the regulations, and the boundaries within which a fully qualified practitioner with substantial and appropriate training, knowledge, and
experience may practice”
The scope of practice of a healthcare profession is the assurance of the safety of the services it provides.
Safe practice relies on competency and professional accountability.
Pew Health Profession Commission, 1995
Pohl, Hanson, Newland & Cronenwett, 2010
Scope of Practice…A Definition
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Helping People Live Better Lives.
Nursing Regulations
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Helping People Live Better Lives.
http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-099.pdf
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Helping People Live Better Lives.
DefinitionsDelegation
î The transfer of authority to perform some type of task or workî Care itself is not delegated – only the tasks
Supervisionî The active process of directing, guiding, and influencing the outcome of an individual’s
performance of an activity
Assignmentî Transfer of accountability and responsibility to another
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Helping People Live Better Lives.
Definitions
Accountabilityî Means that someone must be able to explain actions and resultsî Legally – the RN is accountable for nursing care
Responsibilityî Means the reliability, dependability and obligation to accomplish work
at an acceptable level
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Helping People Live Better Lives.
DelegationWhy delegate?
î To effectively expand your care giving ability to a large group of clients
To delegate, you MUST understand educational background and scope of practice for those involved
Nebraska Lawî www.dhhs.ne.govî Rules & Regulationsî Title 172, Chapter 99 Provision of Nursing Care
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Helping People Live Better Lives.
Nursing Assistant or UAP
National curriculum – 75 hoursTake a registry exam (this is NOT a license)
Basic tasks in support of nursing
î Bathing, feeding, I & O, vitals signs, ambulationî No legal scope of practice – but has knowledge of basic tasks
Medication Aideî Provide medications; state law defines
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Licensed Practical Nurse (LPN)
12 – 18 months educationHold a license to practice
A dependent role with limited scopeNo IV’s unless complete LPN-C*
Contribute to the plan of careScope of practice can not be expanded – only limited by
institutional policy
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Helping People Live Better Lives.
Registered Nurse (RN)
2 – 4 years of educationHold a license to practice
Independent and dependent functionsResponsible for developing, implementing and evaluating
the plan of careScope of practice can not be expanded – only limited by
institutional policy
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Helping People Live Better Lives.
Five Rights of DelegationRight task
Risk CircumstanceRight person
Right direction/communicationRight supervision
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Helping People Live Better Lives.
Supervising the Delegatee
RN is responsible for analyzing data gatheredRN is accountable for initial assessment
RN is accountable for intermittent evaluations
For the RN delegatorî The amount of direct care work may decreaseî However – supervisory work increases
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Helping People Live Better Lives.
4 Things You Can NOT Delegate
AssessmentPlanning
EvaluationNursing judgment
www.ncsbn.orgWorking with Others: Delegation and Other Healthcare Interfaces
(2005)
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Helping People Live Better Lives.
99-004.01A2 Only RNs licensed in accordance with the Act may delegate nursinginterventions to be performed by others on behalf of the nurse.
Delegated by a Registered Nurse means the transference from an RN to an unlicensed person…selected non-complex nursing interventions on behalf of the RN.
Non-complex interventions means those which can safely be performed according to exact directions, do not require alteration of the standard procedure, and for which the results and client/patient responses are predictable.
Complex interventions means those which require nursing judgment to safely alter standard procedures in accordance with the needs of the patient; or require nursing judgement to determine how to proceed from one step to the next; or require the multidimensional application of the nursing process.
Delegation decision includes determining which nursing intervention(s) may be delegated, selecting which unlicensed person(s) may provide the delegated interventions…
RNs retain accountability for the application of nursing process when making the decision to delegate nursing interventions, and for the adequacy of client/patient care and outcomes related to the delegation decision.
The standards applied at the organizational level must meet or exceed the standards for delegation as defined within these regulations.
http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-099.pdf
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Helping People Live Better Lives.
LB255 - Adopt the Patient Care Technician Registration Act
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--On-the-job training, national standardized curricula, and certification exam
--RN delegates non-complex nursing interventions
--Important precedent for nursing scope of practice decisions
--Asserts the authority of the RN as a licensed, autonomous health care professional to oversee and manage the care of patients
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Helping People Live Better Lives.
LB 283 - change & eliminate provisions relating to LPNs
î Proposes to repeal current LPN-C statute*
î Why?î NCLEX-PN current tests for IV therapy contentî PN Programs currently teach itî Dual licensure is expensive and unnecessary credentialingî Nebraska is one of 4-6 remaining states who require a separate credential, which creates
issues with the Licensure Compact
î What does this mean to a Registered Nurse?î Do we delegate, assign, direct?????
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Helping People Live Better Lives.
Scope of Practice Decision-Making Model (DMM)
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Helping People Live Better Lives.
http://dhhs.ne.gov/publichealth/Licensure/Documents/ScopeOfPracticeDecisionModel.pdf
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Helping People Live Better Lives.
Support for Your Practice of Nursingî The Nurse Practice Act defines the practice nursing
î Nursing regulations (172 NAC 99) clarify assignment & direction to licensed nurses
and delegation to unlicensed nursing/nursing support staff
î Decision-Making Model promotes a systematic examination of all elements related
to a scope of practice decisions
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Helping People Live Better Lives.
SummaryKnow what you know,
Know what you don’t know …
And DO NOT be afraid to ask questions!!