PERFORMANCE OF NURSING TASKS BY SUPPORT WORKERS IN COMMUNITY SETTINGS

Size: px
Start display at page:

Download "PERFORMANCE OF NURSING TASKS BY SUPPORT WORKERS IN COMMUNITY SETTINGS"

Transcription

1 2003 PERFORMANCE OF NURSING TASKS BY SUPPORT WORKERS IN COMMUNITY SETTINGS

2 This Interpretive Document was approved by ARNNL Council in 2003 and replaces Delegation of Nursing Tasks and Procedures to Support Workers in Community Settings (1995) and Performance of Tasks by Auxiliary Workers (1991).

3 Performance of Nursing Tasks by Support Workers in Community Settings Acknowledgements This document was developed following extensive consultation with registered nurses and other key stakeholders from around this province who are involved with support workers in community settings. Members of the ARNNL Provincial Working Group are: Judy Davis, Maxine Isaacs, Edwina Kirkland, Lisa Hoddinott, Terri Lynn Ricketts, Theresa Dyson, Rosarii Patey, Beverly Griffiths, Debbie Morris, Bernice Blake-Dibblee, Wally Pardy, and Lynn Power (ARNNL Staff Resource). i 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

4 Association of Registered Nurses of Newfoundland and Labrador Preamble Over the past decade the range of health services provided in the community has rapidly expanded. As much as possible, individuals with acute, continuing, or rehabilitative health needs are supported to live independently in community settings. This philosophical shift has resulted in a growing number of support workers providing care in a continually increasing variety of settings. Today, community based support services are considered an essential part of the continuum of health care services. Community Support Services address three main functions: maintenance and prevention: support individuals with health problems or functional deficits to live independently, and prevent hospitalization and/or institutionalization. This includes the opportunity to attend educational and recreational programs. long term care substitution: meet the needs of individuals who otherwise would require placement in a nursing home or other residential setting. acute care substitution: meet the needs of individuals who otherwise would have to be admitted to or remain in hospital for an extended period. Registered Nurses have indicated that ARNNL s guidelines for the Delegation of Nursing Tasks and Procedures to Support Workers in Community Settings (1995) and Performance of Tasks by Auxiliary Workers (1991) required revision to adequately reflect current trends and practices. Specifically nurses asked ARNNL to: clarify roles and responsibilities of all stakeholders, provide greater flexibility for professional judgment, recommend a framework for preparing and monitoring support workers performance of nursing tasks, acknowledge clients, families, and designated other s role in determining and/or contributing more significantly to monitoring community health care services. These new guidelines continue to emphasize the importance of clients receiving quality, safe community support services. ii ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

5 Performance of Nursing Tasks by Support Workers in Community Settings Table of Contents Introduction...1 Authorization...1 Authorization: Performance by Assistance...2 Authorization: Performance under Direction...2 Authorization: Performance through Delegation...3 Framework for Decision-Making...4 Step 1: Assessment...4 Step 2: Authorization...4 Step 3: Implementation...5 Shared Roles... 6 Documentation...6 Unexpected and Emergency Situations...8 Unsafe Care...8 Resources... 9 Appendices: Appendix A: Glossary Appendix B: Methods of Authorization Flow Sheet Appendix C: Sample Verification of Competency Appendix D: Sample Verification of Supervision / Ongoing Competency Appendix E: Example of the Three (3) Levels of Authorization for Support Worker Medication Administration Appendix F: Framework for Professional Decision-Making Flowsheet iii 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

6 Association of Registered Nurses of Newfoundland and Labrador Introduction The Association of Registered Nurses of Newfoundland and Labrador (ARNNL) recognizes the valuable role that support workers play in facilitating independence and autonomy of individuals with health care needs or functional deficits in community settings. Through the provision of personal and behavioral support, household management, and respite care, support workers assist clients and their families to manage basic activities of daily living. At times it may also be necessary for support workers to perform selected nursing tasks for specific clients. The following guidelines advocate for safe, quality client care, while acknowledging the importance of professional judgment and client/family/ designated care monitor s involvement in the process where support workers are authorized to perform nursing tasks. The ARNNL recognizes that other health professionals may be involved in authorizing support workers to perform tasks that are not exclusive to the domain of nursing (e.g., medication administration). We further acknowledge that more than one health professional may be involved in the preparation, supervision and ongoing monitoring of the support worker s performance, client s health status, and care situation (i.e. shared roles). These guidelines specifically address responsibilities of the Registered Nurse* when he/she authorizes support workers to perform nursing tasks for clients, and/or collaborates with client, family members, designated care monitors, and other health care professionals to achieve this end. This document describes three different methods for authorizing support workers to perform nursing tasks, a decision-making framework to guide nurses professional judgment about when authorization is appropriate, roles and responsibilities of key stakeholders, actions to take in emergency or unsafe situations, and guidelines for documentation. Flow-charts and examples are included to illustrate the methods of authorization and the decision-making framework. A glossary defining the key terms (highlighted by italics) used in this document is provided as Appendix A. Boards and/or agencies employing nurses and/or support workers are responsible for setting agency specific policies. These policies should describe in more detail the educational, monitoring, and documentation practices expected within each board or agency. Authorization Authorization refers to the formal agreement whereby a support worker is permitted to perform, for an individual client (client specific, non-transferable), a select nursing task that is outside the support worker s scope of practice (see Appendix A for definitions). There are three methods whereby this can occur: performance by assistance, performance under direction, and performance through delegation. All three methods require assessment and verification of support worker s competence to perform the identified nursing task(s), and a process for monitoring overall performance. The method of authorization selected must ensure safe and competent client care and as such, might need to be altered if there is a change in the client s health status, client care situation, and/or the nurse s assessment of support worker s competence. A flowchart depicting the three methods for authorization is provided in Appendix B. * The term nurse here-after refers to a Registered Nurse 1 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

7 Performance of Nursing Tasks by Support Workers in Community Settings Authorization: Performance by Assistance Clients who are competent to independently direct their own care, or family assuming this responsibility, may request that a support worker perform a required nursing task associated with the client s activities of daily living by assistance. The client/family retains responsibility for the education, supervision, and monitoring of the ongoing performance of the support worker. The support worker is directly accountable to the client/family for the nursing task provided. The client/family may request assistance with the educational preparation of the support worker from a nurse. The content and type of education and/or supervision provided must reflect the nurse s professional judgment of the situation, his/her agency s policies, and the wishes of the client/family. If the nurse has any concerns about the support worker s ability to perform the identified task, or the client s/family s ability to monitor the situation without ongoing professional supervision, the performance under direction or performance through delegation method of authorization must be implemented. Example - A support worker assists a mentally competent client with arthritic hands to prepare and give insulin. Upon request, the nurse demonstrates to the support worker how to administer a subcutaneous injection. Authorization: Performance under Direction Clients residing in established residential arrangements (e.g. personal care home), or those attending formal educational programs whereby a person other then the client/family is designated responsibility for providing ongoing monitoring of the client s health status and/or care situation, may, through authorization under direction, have a support worker perform an identified nursing task associated with the client s activities of daily living. Designated Care Monitors include Alternate Family Care (AFC) providers, operators of licensed personal care homes and in select circumstances designated education professionals in school settings. Performance under direction involves a sharing of roles between the nurse and the designated care monitor. The designated care monitor retains responsibility for ongoing monitoring of the client s general health status, the care situation, and the overall monitoring of the performance of the support worker. The nurse involved in preparing a support worker to perform a nursing task in this situation is responsible for: providing or arranging by an appropriate health care professional for the education of the support worker(s); instructing the designated care monitor and support worker on what to observe, report and actions to take if an adverse response to care occurs or if there is a change in the client s health status and/or situation; identifying the parameters for the performance of the nursing task by the support worker, including any restrictions of performance Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

8 Association of Registered Nurses of Newfoundland and Labrador The support worker is accountable to the client, designated care monitor, and as appropriate to the nurse. If the nurse has any concerns about the support worker s ability to perform the identified nursing task or the designated care monitor s ability to monitor the situation without ongoing professional supervision, the performance through delegation method of authorization must be implemented. Example A support worker, following education and supervision by an appropriate health professional, performs the tube feeding while the designated care monitor (e.g., AFC provider, home operator, teacher) assumes the care monitoring role. Authorization: Performance through Delegation Performance through delegation is initiated when the client is unable to manage his/her care and there is no family member available or designated care monitor assigned responsibility for the ongoing monitoring of the support worker. Therefore, the nurse is required to authorize the support worker to perform the identified nursing task through delegation. The nurse determining the need for a support worker to perform a nursing task in this situation is responsible for: providing or arranging for the education of the support worker; monitoring the client s health status, care situation and support workers performance on an ongoing basis; instructing the support worker on what to observe, report and actions to take if an adverse response to care occurs or if there is a change in the client s health status and/or situation; identifying the parameters for the performance of the nursing task, including any restrictions of performance. The support worker is accountable to the nurse or identified health professional deemed responsible for the ongoing monitoring. If the nurse is not able to provide the appropriate level of monitoring, delegation should not occur. Appendix C and D provide examples of forms that could be used to document education, supervision, and verification of initial and ongoing competency. Example A support worker, following appropriate education and supervision, provides daily wound care to a blind individual, with a diabetes related foot ulcer, who resides alone in his/her own home with no immediate family involvement. An illustration of the role that support workers can assume with medication administration, under the three methods of authorization, is provided as Appendix E. 3 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

9 Performance of Nursing Tasks by Support Workers in Community Settings Framework for Decision-Making There is no established list of nursing tasks that support workers can perform. A three step framework to assist nurses decision-making about the appropriateness of authorizing a support worker to perform a client specific, non-transferable nursing task is presented. A flowsheet of the decision-making framework is provided as Appendix F. Client health assessment, care planning, and evaluation of support worker s competency must always be performed by a health care professional. These responsibilities cannot be transferred to support workers. Step 1. Assessment Nurses must be satisfied that it is appropriate and safe for the support worker to perform the identified nursing task for the specific client. Nurses must reflect upon: The Client Status and Care Situation What are the client specific care needs? Is the client s health perceived to be stable? Are the care needs and outcomes of care predictable? Is the identified nursing task considered to be a part of the client s activities of daily living? Is there a process to follow when there are changes in the client s health status, the situation, or if there is an unexpected emergency? Employer Policy Are there policies and procedures within the nurse s employing agency, and if applicable the home support agency, to support authorization of nursing tasks to support workers? Are these policies clear, concise, and comprehensive? Are roles and responsibilities of all stakeholders understood and communicated? Support Worker Competency Does the support worker have the competence to successfully learn the required knowledge and skill to safely perform the nursing task? Will the nursing task be performed routinely enough to maintain the support worker s competency? Can the support worker perform the task independently without risk of harm to the client? Are the necessary supports available to monitor the support worker s performance and provide assistance if required? Step 2. Authorization Once it has been identified that it is appropriate for a support worker to perform a nursing task, the nurse must determine the most appropriate category of authorization: performance by assistance, performance under direction, or performance through delegation. The level of authorization is not static, it can change depending on the client s care needs and situation, as well as the learning needs of the support worker Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

10 Association of Registered Nurses of Newfoundland and Labrador Step 3. Implementation The nurse must determine the most appropriate method(s) for educating/ preparing the support worker to obtain competency, and as necessary establish a process for supervising maintenance of competency and monitoring overall performance of the nursing task by the support worker. Support Worker Education The nurse or health professional designated to educate/prepare the support worker must be competent in the particular nursing task to be taught. The professional has the responsibility of determining the most appropriate method of teaching and verifying theoretical and practical competency as well as determining the level of supervision required. Education/preparation includes both theoretical and practical components. The options presented are applicable for all three levels of authorization. Theoretical education can be provided through group, one-on-one, self-learning methods and/or a combination of either approach. Theory must include relevant client specific data. When selecting the method(s) for teaching, consideration is given to the support worker s past experience with the task and the complexity of implementing the task for the specific client. Theoretical learning can be assessed through verbal and/or written testing. Practical education is required to ensure that the support worker obtains competency in the assigned nursing task (s). When support workers are required to learn a new task for a new client, practical education/preparation should involve one-on-one direct supervision. When a support worker is required to perform a task which he/she is currently competent to perform but for a different client, the need and/or level of practical supervision is to be determined by the nurse s professional judgment of the situation and client-specific assessment. Example - A support worker currently competent to perform insulin administration for a client is only permitted to perform that task for that specific client. Should another client require insulin administration, it is the responsibility of the nurse/client and/or care monitor to ensure that the support worker receives client specific education, required practical education, and is deemed competent before the support worker is authorized to perform the task for the second client. Supervision The type and frequency of supervision is based upon the nurses professional judgment of the specific situation. Definitions of direct and in-direct supervision are contained in Appendix A. Factors to consider include: the complexity of the assigned nursing task, the condition of the client, the knowledge and the competency of the support worker, and stipulations in relevant agency policies. If monitoring data identifies a concern with the support worker s performance of the task, the nurse must provide or arrange for another health professional to provide the necessary education (theory and/or practice) and supervision. Ongoing liaison with the health professional responsible for the initial education may be necessary. Monitoring Monitoring includes ongoing assessment of the client s overall health status and the client care situation as well as verification that the support worker completes the authorized nursing tasks. Ongoing monitoring is required to ensure that the performance of nursing tasks by support workers is safe and appropriate. The health professional, who identified the need for the required nursing task, is expected to determine who is responsible for monitoring and for providing the identified care monitor with the necessary information on what to monitor and with whom to follow-up, if there is a concern or change in the client s health status or the care situation. 5 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

11 Performance of Nursing Tasks by Support Workers in Community Settings Shared Roles and Responsibilities The responsibility for authorizing and preparing support workers to perform nursing tasks can be shared among health care professionals/stakeholders. For example, a family physician may determine the need for a client to receive an identified nursing task, the community health nurse may assess the situation and determine the method of authorization, the agency employing the support worker may arrange for a health professional in another agency to implement the education program, and the Department of Health and Community Services may assist with funding. In such situations, communication of responsibilities between the professionals/stakeholders is critical. This includes identification of which health care professional will determine the method of authorization, who will do the education, who will instruct the designated care monitor, and who is responsible for ongoing monitoring. Accountabilities will therefore vary accordingly. Table 1 provides an overview of the various roles of each stakeholder. Documentation Documentation of health services is a professional and legal obligation of all health care professionals. As there may be more than one health care professional involved in educating and supervising support workers to perform the nursing task, and in some cases nonprofessionals involved in monitoring, it is essential that accurate and timely documentation be done by all health professionals involved. Documentation should be done by the health professional who is responsible for implementing the various activities. The following information should be recorded: Assessment data that supported the selection of the method of authorization for support workers to perform the nursing task; The identification of the persons responsible for i) education ii) ongoing supervision of the support worker s competency, and iii) monitoring of the client care situation; The methods utilized for, and outcomes of, support worker education and supervision; The parameters for the performance of the nursing task by the support worker and any restrictions of performance; All instructions given to the person designated responsibility for ongoing monitoring; Information shared with the client/family member regarding the performance of the nursing task by a support worker; Ongoing assessment of the client s health status, plan of care, and evaluation of outcomes. Boards and/or agencies employing nurses and/or support workers are responsible for setting agency specific policies on documentation Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

12 Association of Registered Nurses of Newfoundland and Labrador Table 1. Key Stakeholder Roles in Authorization Process for Support Workers Performing Nursing Tasks in Community Settings Support Worker STAKEHOLDER Registered Nurse (Independently or in collaboration with other Health Care professionals) ROLES Identify and address own learning needs Provide safe, competent care Report relevant observations (i.e. change in client status/ situation) Adhere to relevant policies and pertinent instructions Assess client situation, validate need for support worker to perform the task Determine method of authorization Inform client/family on who will be providing the required nursing task Provide or arrange for relevant education Provide or arrange for initial verification of competence and as required, ongoing competence Respond as required to requests for additional education and/or supervision In all cases nurses are responsible to intercede if and when they become aware of unsafe situations (ARNNL Standards for Nursing Practice in Newfoundland and Labrador, 1995). Employers of Support Workers Verify that support workers have the necessary education and information to perform task Develop policies/processes on reporting and responding to changes in client status, and documentation. Regional/Integrated Health and Community Services Boards Department of Health and Community Services As appropriate, develop service plan and monitor delivery of publicly funded services to clients in the community Develop relevant nursing policies Approval of home support agencies, licensing of personal care homes Set policy directives for governing home support services and personal care homes 7 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

13 Performance of Nursing Tasks by Support Workers in Community Settings Unexpected and Emergency Situations In the event that a client s health status suddenly changes, such that the support worker performance of a nursing task may need to be reassessed, it is the responsibility of the person designated to monitor the client s health status and care situation to contact the identified health professional to have the situation reassessed. The health professional is then responsible to determine if it safe for the support worker to continue to perform the nursing task. If necessary the health professional must also provide (or arrange for another health professional to provide) any required additional education or supervision. Instructions for support workers on how and when to contact the nurse or health professional responsible for supervising the competency of the support worker and responding to changes in the client s status, should be clearly articulated. Authorization for support workers to perform nursing tasks in an emergency situation is not appropriate as the client situation is no longer stable and the task may not be performed on a regular basis to obtain and maintain proficiency. However, it may be necessary for the nurse to instruct support workers to act appropriately in emergency situations to maximize client safety. This may involve instruction on the performance of a nursing task that has not been authorized, for example, the administration of medications, such as an epipen or glucagen tablets. The frequency of occurrence of emergency situations and client outcomes should be evaluated to maximize client safety. If necessary, nursing tasks identified to occur on a frequent basis may need to be authorized to specific support workers. Unsafe Care All nurses have a professional obligation to promptly address situations of unsafe care as outlined in the ARNNL Protocol Regarding Concerns About Client Care (1995) and Duty to Report Inappropriate Behavior (1995). In all cases the safety of the client must be the nurse s utmost concern. This may mean refusing to permit the support worker to perform or continue to perform nursing tasks until action can be taken to resolve the issue of unsafe care. In situations where unsafe care is observed and the nurse is not directly involved in supervising or monitoring the client s care, the nurse must report the unsafe care to the appropriate health professional and person designated to monitor care (e.g., the family physician, the client who hired the support worker, the owner of a private agency). Once the concern regarding unsafe care has been reported, it is the responsibility of the nurse to assure that the appropriate person takes all necessary actions to seek a safe resolution. The nurse should document his/her assessment, actions, and plans for follow-up Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

14 Association of Registered Nurses of Newfoundland and Labrador Resources Association of Registered Nurses of Newfoundland. (1995). Guidelines: Duty to Report Inappropriate Behavior. St. John s: Author. Association of Registered Nurses of Newfoundland. (1995). Protocol Regarding Concerns About Client Care. St. John s: Author. Association of Registered Nurses of Newfoundland & Labrador. (1998). Competencies Required by Registered Nurses for Entry to Nursing Practice, St. John s: Author. Association of Registered Nurses of Newfoundland & Labrador. (2000). Guidelines Regarding Shared Scope of Practice with Licensed Practical Nurses. St. John s: Author. Canadian Nurses Association. (1995). Unregulated Health Care Workers Supporting Nursing Care Delivery: Policy Statement. Ottawa: Author. Canadian Nurses Protective Society. (2000). Delegation to Other Health Care Workers. InfoLAW, 9(2). Ottawa: Author. Department of Health and Community Services. (1995). Policy Directive Manual Governing Home Support Workers. St. John s: Author. Department of Health and Community Services. (2001). Policy Directive Manual Governing Personal Care Homes. St. John s: Author. ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca 9

15 Performance of Nursing Tasks by Support Workers in Community Settings Appendix A Glossary Client Specific and Non-Transferable: Authorization for a support worker to perform a nursing task(s) is permitted for that particular client and is not permitted to be transferred to another client without the appropriate assessment and preparation. Competence is defined as having the necessary skill, knowledge, judgment, and attitude to safely provide a client service (ARNNL, 1998). Delegation is the formal process where a nurse transfers authority to a support worker to perform a task that is traditionally performed by a nurse (CNPS, 2000). Designated Care Monitor: persons (i.e., alternate family care provider, operators of a personal care home and in select circumstances designated education professionals in school settings) who have been designated the responsibility for monitoring the client s care and health status and the overall performance of the support worker(s). For example, the care monitor ensures the support worker completes authorized nursing task(s). Education: refers to the process whereby the appropriate health professional prepares the support worker to perform the specific nursing task for a specific client. It includes both a theoretical and practical component. Health Professional: all of the regulated health care providers who could be involved in the decision and/or the process of preparing support workers to perform nursing tasks. Examples include: registered nurses, physicians, dieticians, licensed practical nurses, respiratory therapists, physiotherapists, etc. Monitoring: refers to the overall assessment of the support worker s performance, the client s general care, health status, and home/school situation. Monitoring may be done by the client/family, assigned care monitor, or by a health professional. Changes or concerns are reported to the appropriate health care professional. Ongoing: periodic, but never ending. Routine Activity of Daily Living: Tasks are considered routine activities of daily living when the need, response and outcome of performing the procedure have been established over time and are predictable. These procedures are done frequently enough to enable the support worker to maintain the knowledge and skill necessary to safely perform the task. For example a client has a colostomy and requires assistance to change the appliance or the client has a permanent stable tracheostomy and requires suctioning to maintain a clear airway provided, the client s care needs and response to suctioning is predictable. Stable and Predictable Client Health Status: The client s health status is considered stable and predictable if it can be anticipated, the plan of care is readily established and is managed with interventions that have predictable outcomes (ARNNL 2000, Guidelines regarding the shared scope of practice with Licensed Practical Nurses). Supervision: refers to the ongoing methods whereby the appropriate health professional assesses and validates initial and continuing competence of the support worker to ensure safe and appropriate performance of the nursing task Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

16 Association of Registered Nurses of Newfoundland and Labrador Direct Supervision: the competent individual is immediately present to direct and guide performance of the task and to evaluate or follow-up on performance. Indirect Supervision: the competent individual is not immediately present during the performance of the task but is available if required to evaluate or follow-up on performance. Support Worker: non-regulated, non-licensed care providers employed by clients residing in the community, home support agencies, and/or community or educational facilities that provide personal care and assist clients to meet their needs for everyday living. These workers may be employed in a client s own residence, school, group home, or personal care home. Examples of titles currently used to refer to this role include: home support worker, home-health aide, personal care attendant, and student assistant. 11 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

17 Performance of Nursing Tasks by Support Workers in Community Settings Appendix B Methods of Authorization Flow Chart CLIENT Capable of self/family-directed care Incapable of self/family-directed care Care monitor available No care monitor available Support Worker performs task by assistance Support Worker performs task under direction Support Worker performs task through delegation Physical Assistance (e.g. give medications, apply dressings) Verbal Assistance (cue/remind) Care and competency monitored by client/family Care monitor and support worker receive education from appropriate health professional Care monitored by designated person Competency monitored by Registered Nurse PRN Additional Education PRN Support Worker receives education from Registered Nurse Care and competency monitored by Registered Nurse Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

18 Association of Registered Nurses of Newfoundland and Labrador Appendix C Verification of Competency Sample Record This is to certify that has completed the Name of Support Worker Instruction for the task to be Name of Nursing Task Performed for. Name of Client Instructions: I hereby verify to be competent to perform Name of Support Worker The task as instructed for the client named above. Signature of Registered Nurse/Health Care Professional Date 13 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

19 Performance of Nursing Tasks by Support Workers in Community Settings Appendix D Supervision/Recertification Sample Record Client s Name: Support Worker: Nursing Task : Date Instruction Completed: Registered Nurse: DATE TYPE OF VISIT Supervision Ongoing Monitoring COMMENTS (Record performance level and/or need for additional in-service etc.) REGISTERED NURSE S SIGNATURE Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

20 Association of Registered Nurses of Newfoundland and Labrador Appendix E Example of the Three Levels of Authorization For Support Workers to Administer Medications Medication administration is outside the approved scope of practice of the support worker role. However, there may be occasions when an RN s assessment of the client s health status, the support workers competency, and the care situation (according to the framework for decision-making) justifies authorization of the nursing task of medication administration to a support worker on a client-specific and non-transferable basis. Authorization must occur in accordance with all of the guidelines identified in this document. All three levels of authorization require that the support worker receives the necessary educational preparation, supervision, and monitoring. Medication Administration by Assistance It is appropriate for a support worker to assist and/or remind the client to take prescribed medications, and to observe and report to the appropriate professional the client s compliance or non-compliance with the established regime. For example a client is unable to physically access or self-administer a medication (e.g., a client with arthritic hands who needs another individual to either open blister pack or draw up and administer insulin). In this situation, the client/ family member retains the responsibility for knowing why the medication has been prescribed, the desired therapeutic effect, and when to contact the physician for monitoring therapeutic effect or when side effects occur. Consequently the client/family member is responsible to educate (or arrange for the education), supervise and monitor the performance of the support worker. Medication Administration Under Direction It is also appropriate for a nurse to authorize a support worker to administer medications under direction. This could occur in situations where clients are unable to independently retain responsibility for self-administration of medications (e.g. mentally challenged client) but a care monitor (i.e., personal care owner/ manager, teacher etc.) retains the responsibility for monitoring the client s status and overall performance of the support worker. In these situations the nurse is responsible to provide (or arrange for another health professional) the necessary education of the support worker and instructions for monitoring, such as when to contact a health care professional. The person designated to monitor care assumes responsibility for ongoing monitoring. Medication Administration through Delegation If there is no person (e.g., client, family or care monitor) available to monitor the client s status and the overall performance of the support worker, the RN authorizes the administration of the medications to the support worker through delegation. In this situation the RN retains responsibility for monitoring and supervision of the support worker s performance and the client s health status (i.e., therapeutic effects of the medication). Support Worker Responsibilities When a support worker is authorized to administer medications through either method, the support worker is not responsible for monitoring the therapeutic effects of the prescribed medication regime as this is beyond the support worker s scope of practice. The support worker will however be responsible for carrying out their role safely, which includes but is not limited to; a) ensuring the correct medication is given to the client at the proper time b) assisting the client to take the medication c) reporting if the client was unable to follow the prescribed regime d) reporting any observable changes in a client s condition e) documenting in accordance with the employer policies and/or practices Agency Responsibilities Employing agencies of the nurse, and where appropriate, the support worker are responsible for establishing policies on the role of support workers in medication administration. They should identify procedures that support workers are to follow when monitoring client s adherence to medication schedules, documentation requirements, and reporting of any changes to a health care professional. 15 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca

21 Performance of Nursing Tasks by Support Workers in Community Settings Appendix F Framework for Professional Decision-Making STEP 1 Need for support worker(s) to perform nursing task identified by RN Do Not Authorize. Seek appropriate resources with Board/Agency No Assess Own Competence Regarding Task Yes Review Criteria for Authorization Review Employer Policies Policies written/clear Process for supervision & monitoring satisfactory Process for addressing unexpected client problems established Assess Client/Situation Client health needs stable & predictable Task is routine activity of daily life Assess Support Worker Competency Support worker s ability to obtain competency in task Safeguards & resou rces available No Yes Yes Yes No Do Not Authorize Discuss with appropriate manager/supervisor Do Not Authorize RN to perform task No Do Not Authorize RN to perform task Discuss with appropriate manager/supervisor STEP 2 Determine the most appropriate method of authorization (See Appendix B) STEP 3 Implement Authorization Process Educational Pr ogram (Group/Individual) Supervised Practice Assign Monitoring responsibilities Implement appropriate follow up processes Military Road St. John s NL Canada A1C2C5 Tel: (709) (800) Fax: (709) info@arnnl.ca ARNNL.CA

22 55 Military Road St. John's NL Canada A1C 2C5 Tel (709) (800) (NL only) Fax (709) info@arnnl.ca arnnl.ca

INSULIN DOSAGE ADJUSTMENT

INSULIN DOSAGE ADJUSTMENT 2016 INSULIN DOSAGE ADJUSTMENT This Interpretive Document was approved by ARNNL Council in 2016 and replaces Insulin Dosage Adjustment 2003. Insulin Dosage Adjustment This interpretive document describes

More information

MEDICAL DIRECTIVES AND PRE-PRINTED ORDERS: AUTHORIZATION FOR REGISTERED NURSE PRACTICE

MEDICAL DIRECTIVES AND PRE-PRINTED ORDERS: AUTHORIZATION FOR REGISTERED NURSE PRACTICE 2008 MEDICAL DIRECTIVES AND PRE-PRINTED ORDERS: AUTHORIZATION FOR REGISTERED NURSE PRACTICE This Interpretive Document was approved by ARNNL Council in 2008. Medical Directives and Pre-Printed Orders:

More information

INFLUENZA VACCINATION BY REGISTERED NURSES

INFLUENZA VACCINATION BY REGISTERED NURSES INFLUENZA VACCINATION BY REGISTERED NURSES 2004 This Position Statement was approved by ARNNL Council in 2004. Influenza Vaccination by Registered Nurses Immunization programs are recognized to be one

More information

REGISTERED NURSES AND NURSE PRACTITIONERS - AIDING IN MEDICAL ASSISTANCE IN DYING

REGISTERED NURSES AND NURSE PRACTITIONERS - AIDING IN MEDICAL ASSISTANCE IN DYING 2016 REGISTERED NURSES AND NURSE PRACTITIONERS - AIDING IN MEDICAL ASSISTANCE IN DYING This document was approved by the ARNNL Council in July 2016. Registered Nurses and Nurse Practitioners - Aiding in

More information

COLLABORATIVE NURSING PRACTICE GUIDING PRINCIPLES

COLLABORATIVE NURSING PRACTICE GUIDING PRINCIPLES 2008 COLLABORATIVE NURSING PRACTICE GUIDING PRINCIPLES This Position Statement was approved by ARNNL Council in 2008. Collaborative Nursing Practice Guiding Principles Developed by The Association of Registered

More information

DISPENSING BY REGISTERED NURSES (RNs) EMPLOYED WITHIN REGIONAL HEALTH AUTHORITIES (RHAs)

DISPENSING BY REGISTERED NURSES (RNs) EMPLOYED WITHIN REGIONAL HEALTH AUTHORITIES (RHAs) 2017 DISPENSING BY REGISTERED NURSES (RNs) EMPLOYED WITHIN REGIONAL HEALTH AUTHORITIES (RHAs) This Interpretive Document was approved by ARNNL Council in 2017 and replaces Dispensing by Registered Nurses

More information

DISPENSING BY REGISTERED NURSES

DISPENSING BY REGISTERED NURSES 1999 DISPENSING BY REGISTERED NURSES This Interpretive Document was approved by ARNNL Council in 1999. Dispensing By Registered Nurses Dispensing is a practice of pharmacy in the province of Newfoundland

More information

STANDARDS OF PRACTICE FOR REGISTERED NURSES (2013)

STANDARDS OF PRACTICE FOR REGISTERED NURSES (2013) STANDARDS OF PRACTICE FOR REGISTERED NURSES (2013) This Standards document was approved by ARNNL Council in 2013, and edited March 2015. Standards of Practice for Registered Nurses Table of Contents Introduction...

More information

NURSE PRACTITIONERS PROVIDING MEDICAL ASSISTANCE IN DYING (MAID)

NURSE PRACTITIONERS PROVIDING MEDICAL ASSISTANCE IN DYING (MAID) 2018 NURSE PRACTITIONERS PROVIDING MEDICAL ASSISTANCE IN DYING (MAID) This document was approved by the ARNNL Council in June 2018. Nurse Practitioners - Providing Medical Assistance in Dying (MAID) Introduction

More information

Delegated Functions. Guidelines for Registered Nurses. College of Registered Nurses of Nova Scotia

Delegated Functions. Guidelines for Registered Nurses. College of Registered Nurses of Nova Scotia Delegated Functions Guidelines for Registered Nurses College of Registered Nurses of Nova Scotia Delegation Functions: Guidelines for Registered Nurses 31 October 2017, 2012, College of Registered Nurses

More information

SASKATCHEWAN ASSOCIATIO. RN Specialty Practices: RN Guidelines

SASKATCHEWAN ASSOCIATIO. RN Specialty Practices: RN Guidelines SASKATCHEWAN ASSOCIATIO N RN Specialty Practices: RN Guidelines July 2016 2016, Saskatchewan Registered Nurses Association 2066 Retallack Street Regina, SK S4T 7X5 Phone: (306) 359-4200 (Regina) Toll Free:

More information

STANDARDS FOR NURSING PRACTICE

STANDARDS FOR NURSING PRACTICE STANDARDS FOR NURSING PRACTICE November 2016 Association of Registered Nurses of Prince Edward Island Unit 6 161 Maypoint Rd Charlottetown PE C1E 1X6 Tel: 902-368-3764 Fax: 902-628-1430 Email: info@arnpei.ca

More information

A Guide for Self-Employed Registered Nurses 2017

A Guide for Self-Employed Registered Nurses 2017 A Guide for Self-Employed Registered Nurses 2017 Introduction In 2013, 72 Registered Nurses reported their workplace as self-employed when they registered for the 2014 licensure year. The College of Registered

More information

Entry-to-Practice Competencies for Licensed Practical Nurses

Entry-to-Practice Competencies for Licensed Practical Nurses Entry-to-Practice Competencies for Licensed Practical Nurses Foreword The Canadian Council for Practical Nurse Regulators (CCPNR) is a federation of provincial and territorial members who are identified

More information

Guidelines for Delegated Medical Functions & Medical Directives

Guidelines for Delegated Medical Functions & Medical Directives Guidelines for Delegated Medical Functions & Medical Directives Acknowledgements These Guidelines for Delegated Medical Functions & Medical Directives have been approved by the: College of Physicians and

More information

Standards for Community-Based Care Registered Nurse Delegation

Standards for Community-Based Care Registered Nurse Delegation Division 47 Standards for Community-Based Care Registered Nurse Delegation 851-047-0000 Rule Summary, Statement of Purpose and Intent These rules provide standards and guidance for nurses to delegate specific

More information

NURSE PRACTITIONER STANDARDS FOR PRACTICE

NURSE PRACTITIONER STANDARDS FOR PRACTICE NURSE PRACTITIONER STANDARDS FOR PRACTICE February 2012 Acknowledgement The College of Registered Nurses of Prince Edward Island gratefully acknowledges permission granted by the Nurses Association of

More information

SASKATCHEWAN ASSOCIATIO

SASKATCHEWAN ASSOCIATIO SASKATCHEWAN ASSOCIATIO N Standards & Competencies for RN Specialty Practices Effective May 1, 2018 Table of Contents Background Introduction Requirements for RN Specialty Practices RN Procedures and RN

More information

Supervising Support Personnel

Supervising Support Personnel College of Occupational Therapists of British Columbia 2011 Supervising Support Personnel COTBC practice guidelines are published by the college to assist occupational therapists in meeting the Essential

More information

Assignment Of Client Care: Guidelines for Registered Nurses

Assignment Of Client Care: Guidelines for Registered Nurses Assignment Of Client Care: Guidelines for Registered Nurses May 2014 Approved by the College and Association of Registered Nurses of Alberta (CARNA) Permission to reproduce this document is granted; please

More information

Standards of Practice for. Recreation Therapists. Therapeutic Recreation Assistants

Standards of Practice for. Recreation Therapists. Therapeutic Recreation Assistants Standards of Practice for Recreation Therapists & Therapeutic Recreation Assistants 2006 EDITION Page 2 Canadian Therapeutic Recreation Association FOREWORD.3 SUMMARY OF STANDARDS OF PRACTICE 6 PART 1

More information

SASKATCHEWAN ASSOCIATIO. Program Approval for New & Dissolving RN or RN Re-Entry Education Programs

SASKATCHEWAN ASSOCIATIO. Program Approval for New & Dissolving RN or RN Re-Entry Education Programs SASKATCHEWAN ASSOCIATIO N Program Approval for New & Dissolving RN or RN Re-Entry Education Programs Original: 1999 Revised: September 2015 2015, Saskatchewan Registered Nurses Association 2066 Retallack

More information

NEW STANDARD OF PRACTICE PRESCRIBING

NEW STANDARD OF PRACTICE PRESCRIBING NEW STANDARD OF PRACTICE PRESCRIBING Notice to College Members June 21, 2018 Following consultation with College Members, on June 16, 2018 Council of the College approved a new Standard of Practice on

More information

DELEGATION OF DUTY POLICY

DELEGATION OF DUTY POLICY DELEGATION OF DUTY POLICY The OHC&AT Board of Directors has agreed this Policy and as such, it applies across the organisation 29 th June 2018. Jay Mercer Darren Coghlan Chair of OHCAT Board Chair of OHC

More information

Collaborative Nursing Practice in BC. Nurses* Working Together for Quality Nursing Care

Collaborative Nursing Practice in BC. Nurses* Working Together for Quality Nursing Care Collaborative Nursing Practice in BC Nurses* Working Together for Quality Nursing Care March 2006 1 st Edition *Registered Nurses, Registered Psychiatric Nurses, Licensed Practical Nurses Collaborative

More information

RN Delegation ALF & RCF

RN Delegation ALF & RCF RN Delegation ALF & RCF Raeann J Voorhies RN, MBA, AL-C & Heather Madden RN, AL-C VOORHIES AND ASSOCIATES SENIOR LIVING MANAGEMENT AND CONSULTING OUTLINE Definitions- Delegation Definition- Unlicensed

More information

Medical Review Criteria Skilled Nursing Facility & Subacute Care

Medical Review Criteria Skilled Nursing Facility & Subacute Care Medical Review Criteria Skilled Nursing Facility & Care Subject: Skilled Nursing Facility and Care Background: Skilled nursing facilities () provide facility-based skilled nursing care and related services

More information

NURSE PRACTITIONER (NP) APPLICATION FOR LICENSURE ELIGIBILITY

NURSE PRACTITIONER (NP) APPLICATION FOR LICENSURE ELIGIBILITY OFFICE USE ONLY Approved: : Director of Regulatory Services / Regulatory Officer PART 1 NURSE PRACTITIONER (NP) APPLICATION FOR LICENSURE ELIGIBILITY 1. Personal Information Surname Given Name(s) Maiden

More information

PROFESSIONAL STANDARDS FOR MIDWIVES

PROFESSIONAL STANDARDS FOR MIDWIVES Appendix A: Professional Standards for Midwives OVERVIEW The Professional Standards for Midwives (Professional Standards ) describes what is expected of all midwives registered with the ( College ). The

More information

Medication Administration

Medication Administration Delegating Medication Administration to Licensed Nursing Assistants Gina Balkus HCANH Private Duty Directors Meeting March 8, 2017 HB 484 Expanded the Scope of Practice for LNAs in New Hampshire HB 484,

More information

Delegation of Controlled Acts Direct Orders and Medical Directives

Delegation of Controlled Acts Direct Orders and Medical Directives Delegation of Controlled Acts Direct Orders and Medical Directives The Regulated Health Professions Act, 1991 (RHPA) identifies thirteen controlled acts that may only be performed by an authorized regulated

More information

Guidance on Delegation for Colorado School Nurses & Child Care Consultants

Guidance on Delegation for Colorado School Nurses & Child Care Consultants School district s responsibility for the student with special health needs All students attending public schools must have access to health care during the school day and for extracurricular school activities,

More information

Practice Guidelines for Medication Practices

Practice Guidelines for Medication Practices Practice Guidelines for Medication Practices Guidelines for Social Work and Social Service Work Members of the Ontario College of Social Workers and Social Service Workers Effective September 1, 2009 2009

More information

Medication Management Policy and Procedures

Medication Management Policy and Procedures POLICY STATEMENT This policy establishes guidelines for ensuring safe and correct management of client medications in accordance with legislative and regulatory requirements and professional practice competency

More information

Structured Practical Experiential Program

Structured Practical Experiential Program 2017/18 Structured Practical Experiential Program PHARMACY STUDENT AND INTERN ROTATIONS RESOURCE COLLEGE OF PHARMACISTS OF MANITOBA COLLEGE OF PHARMACY RADY FACULTY OF HEALTH SCIENCES UNIVERSITY OF MANITOBA

More information

Students with Special Health Care Needs Medically Fragile Children

Students with Special Health Care Needs Medically Fragile Children Students with Special Health Care Needs Medically Fragile Children A. Regulations As used in this chapter unless the context requires otherwise: 1) Children with disabilities means those school-age children

More information

SASKATCHEWAN ASSOCIATIO

SASKATCHEWAN ASSOCIATIO SASKATCHEWAN ASSOCIATIO N Interpretation of the RN Scope of Practice February 10, 2015 Acknowledgements The Saskatchewan Registered Nurses Association (SRNA) thanks the registered nursing regulatory bodies

More information

Alberta First Nations Continuing Care Needs Assessment - Health and Home Care Program Staff Survey -

Alberta First Nations Continuing Care Needs Assessment - Health and Home Care Program Staff Survey - Alberta First Nations Continuing Care Needs Assessment p. 1 Alberta First Nations Continuing Care Needs Assessment - Health and Home Care Program Staff Survey - Definition of Terms Continuing Care: As

More information

HOME AND COMMUNITY CARE POLICY MANUAL

HOME AND COMMUNITY CARE POLICY MANUAL SECTION: PAGE: 1 OF 9 For the purpose of this document, the following definitions have been used: adult day services are provided through an organized program of personal care, health care and therapeutic

More information

Collaborative. Decision-making Framework: Quality Nursing Practice

Collaborative. Decision-making Framework: Quality Nursing Practice Collaborative Decision-making Framework: Quality Nursing Practice SALPN, SRNA and RPNAS Councils Approval Effective Sept. 9, 2017 Please note: For consistency, when more than one regulatory body is being

More information

Administration of Medications A Self-Assessment Guide for Licensed Practical Nurses

Administration of Medications A Self-Assessment Guide for Licensed Practical Nurses Administration of Medications A Self-Assessment Guide for Licensed Practical Nurses March 2018 College of Licensed Practical Nurses of Nova Scotia http://clpnns.ca Starlite Gallery, 302-7071 Bayers Road,

More information

CHAPTER 13 RULES AND REGULATIONS REGARDING THE DELEGATION OF NURSING TASKS

CHAPTER 13 RULES AND REGULATIONS REGARDING THE DELEGATION OF NURSING TASKS CHAPTER 13 RULES AND REGULATIONS REGARDING THE DELEGATION OF NURSING TASKS 1. STATEMENT AND BASIS OF PURPOSE The rules contained in this Chapter are adopted pursuant to authority granted the Board by section

More information

What is this Guide for?

What is this Guide for? Continuing NHS Healthcare (CHC) is a package of services that is arranged and funded solely by the NHS, for those people who have been assessed as having a primary health need. The issue is one of need.

More information

The Regulation of Counselling Therapy in Newfoundland-Labrador 2018 FACT-NL Steering Committee

The Regulation of Counselling Therapy in Newfoundland-Labrador 2018 FACT-NL Steering Committee The Regulation of Counselling Therapy in Newfoundland-Labrador 2018 FACT-NL Steering Committee Introduction NADTA- North American Drama Therapy Association The Federation of Associations of Counselling

More information

Policies and Procedures. I.D. Number: 1145

Policies and Procedures. I.D. Number: 1145 Policies and Procedures Title: VENTILATION CHRONIC- CARE OF MECHANICALLY VENTILATED ADULT PERSON RNSP: RN Clinical Protocol: Advanced RN Intervention LPN Additional Competency: Care of Chronically Mechanically

More information

The Regulation of Counselling Therapy in Newfoundland-Labrador 2018 FACT-NL Steering Committee

The Regulation of Counselling Therapy in Newfoundland-Labrador 2018 FACT-NL Steering Committee The Regulation of Counselling Therapy in Newfoundland-Labrador 2018 FACT-NL Steering Committee Introduction The Federation of Associations of Counselling Therapists in Newfoundland-Labrador (FACT-NL) is

More information

Major Features of the Legislation 3 The Health Care Consent Act, 1996 (HCCA) 3 The Substitute Decisions Act, 1992 (SDA) 4

Major Features of the Legislation 3 The Health Care Consent Act, 1996 (HCCA) 3 The Substitute Decisions Act, 1992 (SDA) 4 PRACTICE GUIDELINE Consent Table of Contents Introduction 3 Major Features of the Legislation 3 The Health Care Consent Act, 1996 (HCCA) 3 The Substitute Decisions Act, 1992 (SDA) 4 Definitions 4 Basic

More information

CANADIAN OTA AND/OR PTA STUDENT FIELDWORK EVALUATION FORM

CANADIAN OTA AND/OR PTA STUDENT FIELDWORK EVALUATION FORM REHABILIATION ASSISTANTS PROGRAM (OTA and PTA) CANADIAN OTA AND/OR PTA STUDENT FIELDWORK EVALUATION FORM Lucy Miller B.Sc. OT(c), M.Ed. and Frank Knox B.Sc. PT, FCAMT Rehabilitation Assistants Program,

More information

Clinical Transition Practicum Packet General Information Policies and Procedures Preceptor and Nursing Student Forms

Clinical Transition Practicum Packet General Information Policies and Procedures Preceptor and Nursing Student Forms Clinical Transition Practicum Packet General Information Policies and Procedures Preceptor and Nursing Student Forms Fall 2014 1 Description The McLennan Community College Clinical Transition Practicum

More information

MODULE 01 INTRO TO RN & RPN PRACTICE: THE CLIENT, THE NURSE AND THE ENVIRONMENT

MODULE 01 INTRO TO RN & RPN PRACTICE: THE CLIENT, THE NURSE AND THE ENVIRONMENT RN & RPN PRACTICE: THE CLIENT, THE NURSE AND THE ENVIRONMENT College of Nurses of Ontario (2014) MODULE 01 INTRO TO RN & RPN PRACTICE: THE CLIENT, THE NURSE AND THE ENVIRONMENT Prepared by: Donna Rothwell,

More information

Newfoundland and Labrador Pharmacy Board

Newfoundland and Labrador Pharmacy Board Newfoundland and Labrador Pharmacy Board Standards of Practice Prescribing by Pharmacists August 2015 Table of Contents 1) Introduction... 1 2) Requirements... 1 3) Limitations... 1 4) Operational Standards...

More information

5/1/2017 THE BEST DEFENSE IS A GOOD OFFENSE OBJECTIVES. Preparing for a Home Health Medicare Recertification Survey

5/1/2017 THE BEST DEFENSE IS A GOOD OFFENSE OBJECTIVES. Preparing for a Home Health Medicare Recertification Survey THE BEST DEFENSE IS A GOOD OFFENSE Preparing for a Home Health Medicare Recertification Survey OBJECTIVES To gain an understanding how the Medicare Conditions of Participation (CoPs), the individual G-tags,

More information

Table of. Clinical Manual. Dalhousie University School of Nursing

Table of. Clinical Manual. Dalhousie University School of Nursing Table of Clinical Manual Dalhousie University School of Nursing 1 2 Table of Contents Preamble 4 Introduction 5 BScN Program Clinical Course Descriptions 5 Year One Clinical Courses 5 Year Two Clinical

More information

POSITION DESCRIPTION

POSITION DESCRIPTION POSITION DESCRIPTION POSITION TITLE: DEPARTMENT: CLASSIFICATION: UNION: SPEECH LANGUAGE PATHOLOGIST - ADULT ALLIED HEALTH SERVICES SPEECH LANGUAGE THERAPIST/ PATHOLOGIST MGEU TECHNICAL PROFESSIONAL REPORTING

More information

DEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SKILLED NURSING SERVICES

DEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SKILLED NURSING SERVICES DEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SCOPE: All Ascension At Home, LLC colleagues. For purposes of this policy, all references to colleague or colleagues include temporary, part-time

More information

RN & LPN Scope of Practice

RN & LPN Scope of Practice RN & LPN Scope of Practice Siobhainn Lewis RN, MN Association of Registered Nurses of NL Janice O Neill LPN College of Licensed Practical Nurses of NL Presentation Date: January 21, 2014 Overview Accountability

More information

HOME AND COMMUNITY CARE POLICY MANUAL

HOME AND COMMUNITY CARE POLICY MANUAL CHAPTER: 4 HOME HEALTH SERVICES NUMBER: 4 SECTION: CHAPTER CONTENTS PAGE: 1 OF 1 SUBSECTION: EFFECTIVE: JUNE 19, 2018 4.A General Description and Definitions 4.B Home Support Services 4.B.1 Service Needs

More information

Policies and Procedures. ID Number: 1138

Policies and Procedures. ID Number: 1138 Policies and Procedures Title: VENTILATION Acute-Care of Mechanically Ventilated Patient - Adult RN Specialty Practice: RN Clinical Protocol: Advanced RN Intervention ID Number: 1138 Authorization: [X]

More information

Introduction...2. Purpose...2. Development of the Code of Ethics...2. Core Values...2. Professional Conduct and the Code of Ethics...

Introduction...2. Purpose...2. Development of the Code of Ethics...2. Core Values...2. Professional Conduct and the Code of Ethics... CODE OF ETHICS Table of Contents Introduction...2 Purpose...2 Development of the Code of Ethics...2 Core Values...2 Professional Conduct and the Code of Ethics...3 Regulation and the Code of Ethic...3

More information

Community Nurse Prescribing (V100) Portfolio of Evidence

Community Nurse Prescribing (V100) Portfolio of Evidence ` School of Health and Human Sciences Community Nurse Prescribing (V100) Portfolio of Evidence Start date: September 2016 Student Name: Student Number:. Practice Mentor:.. Personal Tutor:... Submission

More information

SASKATCHEWAN ASSOCIATIO. Program Approval for Established RN Education Programs

SASKATCHEWAN ASSOCIATIO. Program Approval for Established RN Education Programs SASKATCHEWAN ASSOCIATIO N Program Approval for Established RN Education Programs Original: 1999 Revised: June 2015 2015, Saskatchewan Registered Nurses Association 2066 Retallack Street Regina, SK S4T

More information

SPE III: Pharmacy 403W Preceptor s Evaluation of Student

SPE III: Pharmacy 403W Preceptor s Evaluation of Student SPE III: Pharmacy 403W Preceptor s Evaluation of Student School of Pharmacy Student: Site: Preceptor: As a preceptor, you play a vital role in the education of our students and in assessing their competency

More information

Collaborative. Decision-making Framework: Quality Nursing Practice

Collaborative. Decision-making Framework: Quality Nursing Practice Collaborative Decision-making Framework: Quality Nursing Practice December 7, 2016 Please note: For consistency, when more than one regulatory body is being discussed in this document, the regulatory bodies

More information

Mental Health Accountability Framework

Mental Health Accountability Framework Mental Health Accountability Framework 2002 Chief Medical Officer of Health Report Injury: Predictable and Preventable Contents 3 Executive Summary 4 I Introduction 6 1) Why is accountability necessary?

More information

DELEGATION OF CARE POLICY FOR NURSES, MIDWIVES AND ALLIED HEALTH PROFESSIONALS

DELEGATION OF CARE POLICY FOR NURSES, MIDWIVES AND ALLIED HEALTH PROFESSIONALS ` DELEGATION OF CARE POLICY FOR NURSES, MIDWIVES AND ALLIED HEALTH PROFESSIONALS Page 1 of 19 CONTENTS EXECUTIVE SUMMARY 3 1. INTRODUCTION 5 2. AIM OF POLICY 5 3. SCOPE 5 4. ACCOUNTABILITY 6 5. RESPONSIBILITY

More information

Provincial Home Support Program

Provincial Home Support Program Provincial Home Support Program Client Handbook What is the Provincial Home Support Program? The Home Support Program can support you to live independently in your home for as long as possible. Whether

More information

Felpham Community College Medical Conditions in School Policy

Felpham Community College Medical Conditions in School Policy Felpham Community College Medical Conditions in School Policy The Governing Body of Felpham Community College adopted the Medical Conditions in School Policy on 6 July 2016. 1. Introduction Statement of

More information

SPE IV: Pharmacy 500X Preceptor s Evaluation of Student 2018

SPE IV: Pharmacy 500X Preceptor s Evaluation of Student 2018 School of Pharmacy SPE IV: Pharmacy 500X Preceptor s Evaluation of Student 2018 Student: Site: Preceptor: Rotation: First Second As a preceptor, you play a vital role in the education of our students and

More information

PATIENT RIGHTS, PRIVACY, AND PROTECTION

PATIENT RIGHTS, PRIVACY, AND PROTECTION REGIONAL POLICY Subject/Title: ADVANCE CARE PLANNING: GOALS OF CARE DESIGNATION (ADULT) Approving Authority: EXECUTIVE MANAGEMENT Classification: Category: CLINICAL PATIENT RIGHTS, PRIVACY, AND PROTECTION

More information

JOINT STATEMENT ON PREVENTING AND RESOLVING ETHICAL CONFLICTS INVOLVING HEALTH CARE PROVIDERS AND PERSONS RECEIVING CARE

JOINT STATEMENT ON PREVENTING AND RESOLVING ETHICAL CONFLICTS INVOLVING HEALTH CARE PROVIDERS AND PERSONS RECEIVING CARE JOINT STATEMENT ON PREVENTING AND RESOLVING ETHICAL CONFLICTS INVOLVING HEALTH CARE PROVIDERS AND PERSONS RECEIVING CARE This joint statement was developed cooperatively and approved by the Boards of Directors

More information

Review/Guidance for RN QA Review form: Reminder that the Review is of locations/sites not of people. The Review tool looks at agency

Review/Guidance for RN QA Review form: Reminder that the Review is of locations/sites not of people. The Review tool looks at agency Review/Guidance for RN QA Review form: Reminder that the Review is of locations/sites not of people. The Review tool looks at agency processes/procedures to determine if they are effective in making sure

More information

RN Specialty Practices

RN Specialty Practices Subject/Title Manual: RN Specialty Practices Approving Authority: Interprofessional Clinical Quality Committee Classification: Contact for Interpretation: Director, Clinical Quality & Professional Practice

More information

Complementary and Alternative Health Care and Natural Health Products Standards

Complementary and Alternative Health Care and Natural Health Products Standards Standards Complementary and Alternative Health Care and Natural Health Products Standards Month Year NATURAL HEALTH PRODUCTS i Approved by the College and Association of Registered Nurses of Alberta ()

More information

DEFINITIONS (c)(1) Discharge Planning : Home Health Agency (HHA) : Inpatient Rehabilitation Facility (IRF) : Local Contact Agency :

DEFINITIONS (c)(1) Discharge Planning : Home Health Agency (HHA) : Inpatient Rehabilitation Facility (IRF) : Local Contact Agency : F660 483.21(c)(1) Discharge Planning Process The facility must develop and implement an effective discharge planning process that focuses on the resident s discharge goals, the preparation of residents

More information

POLICY AND PROCEDURE: MEDICATION

POLICY AND PROCEDURE: MEDICATION POLICY AND PROCEDURE: MEDICATION Cheshire does not administer medication. However, front line staff provide physical assistance with medication at the consumer/client s direction. (Exception: Cheshire

More information

Foreword. The CCPNR approves and adopts the code of ethics for LPNs outlined in this document.

Foreword. The CCPNR approves and adopts the code of ethics for LPNs outlined in this document. As s oc i a t i onofne wbr uns wi c k Li c e ns e dpr a c t i c a lnur s e s Foreword The Canadian Council for Practical Nurse Regulators (CCPNR) is a federation of provincial and territorial members who

More information

NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.

NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section. TITLE ADVANCE CARE PLANNING AND GOALS OF CARE DESIGNATION SCOPE Provincial APPROVAL AUTHORITY Clinical Operations Executive Committee SPONSOR Seniors Health PARENT DOCUMENT TITLE, TYPE AND NUMBER Not Applicable

More information

Home Health Agency or a Home Care Agency?

Home Health Agency or a Home Care Agency? Arizona Association for Home Care 2009 Annual Education Conference Arizona Department of Health Services Update June 12, 2009 Home Health Agency or a Home Care Agency? Home Health Agency Home Care Agency

More information

Guide to the Continuing NHS Healthcare Assessment Process

Guide to the Continuing NHS Healthcare Assessment Process Guide to the Continuing NHS Healthcare Assessment Process Continuing NHS Healthcare (CHC) is a package of care arranged and funded solely by the NHS, where it has been assessed that the person s primary

More information

Mateus Enterprises Limited

Mateus Enterprises Limited Mateus Enterprises Limited Introduction This report records the results of a Surveillance Audit of a provider of aged residential care services against the Health and Disability Services Standards (NZS8134.1:2008;

More information

Medication Administration Policy Community Health & Social Care

Medication Administration Policy Community Health & Social Care Medication Administration Policy Community Health & Social Care Social Care Workers Version 2 April 2016 For review April 2018 NHS SHETLAND DOCUMENT DEVELOPMENT COVERSHEET* Name of document Medication

More information

TITLE: Processing Provider Orders: Inpatient and Outpatient

TITLE: Processing Provider Orders: Inpatient and Outpatient POLICY and PROCEDURE TITLE: Processing Provider Orders: Inpatient and Outpatient Number: 13211 Version: 13211.10 Type: Patient Care Author: Carol Vanetti; Provider Order Policy Committee Effective Date:

More information

Guidelines. Working Extra Hours. Guidelines for Regulated Members on Fitness to Practise and the Provision of Safe, Competent, Ethical Nursing Care

Guidelines. Working Extra Hours. Guidelines for Regulated Members on Fitness to Practise and the Provision of Safe, Competent, Ethical Nursing Care Guidelines Working Extra Hours Guidelines for Regulated Members on Fitness to Practise and the Provision of Safe, Competent, Ethical Nursing Care September 2011 WORKING EXTRA HOURS: FOR REGULATED MEMBERS

More information

STANDARDS OF PRACTICE 2018

STANDARDS OF PRACTICE 2018 STANDARDS OF PRACTICE nurse pr ac titioner 2018 RESPONSIBILITY AND ACCOUNTABILITY ASSESSMENT AND DIAGNOSIS COLLABORATION, CONSULTATION AND REFERRAL LEADERSHIP AND ADVOCACY CLIENT CARE MANAGEMENT CRNNS

More information

Using Clinical Criteria for Evaluating Short Stays and Beyond

Using Clinical Criteria for Evaluating Short Stays and Beyond Using Clinical Criteria for Evaluating Short Stays and Beyond Georgeann Edford I. History A. Social Security Act Medical Necessity and Utilization Review 1. Items or services necessary for the diagnosis

More information

SUBJECT: Policy for Administration of Medications Permitting the Delegation of Nursing Tasks and the Giving or Applying of Medications.

SUBJECT: Policy for Administration of Medications Permitting the Delegation of Nursing Tasks and the Giving or Applying of Medications. Carroll County Board of MRDD Policy Reference: Administration of Medications Permitting the Delegation of Nursing Tasks and the Giving or Applying of Medications Ohio Administration Code Reference: OAC

More information

DATE APPROVED SEPTEMBER 2010

DATE APPROVED SEPTEMBER 2010 REASON FOR POLICY To delineate the Most Responsible Physician (MRP) key accountabilities and responsibilities for the admission, ongoing care, transfer of care, consultation and discharge processes for

More information

Personal Care Home Regulation

Personal Care Home Regulation Summary Introduction The Health and Community Services Act (the Act) provides the Department of Health and Community Services (the Department) with the overall responsibility of regulating Personal Care

More information

PERSON CENTERED CARE PLANNING HONORING CHOICE WHILE MITIGATING RISK

PERSON CENTERED CARE PLANNING HONORING CHOICE WHILE MITIGATING RISK PERSON CENTERED CARE PLANNING HONORING CHOICE WHILE MITIGATING RISK The purpose of the Rothschild Person-Centered Care Planning process is to support long term care communities in their efforts to honor

More information

Guidelines. Effective Utilization of RNs and LPNs in a Collaborative Practice Environment

Guidelines. Effective Utilization of RNs and LPNs in a Collaborative Practice Environment Guidelines Effective Utilization of RNs and LPNs in a Collaborative Practice Environment Acknowledgements These Guidelines - Effective Utilization of RNs and LPNs in a Collaborative Practice Environment

More information

Personal Assistance Services Self-assessment Worksheet

Personal Assistance Services Self-assessment Worksheet Personal Assistance Services Self-assessment Worksheet Purpose The purpose of this worksheet is to help you assess the extent to which you offer personal assistance in any one of six service areas: activities

More information

Delegation in Assisted Living. Prepared for: Wisconsin Health Care Association

Delegation in Assisted Living. Prepared for: Wisconsin Health Care Association Delegation in Assisted Living Prepared for: Wisconsin Health Care Association Summary and Objectives Those who manage people and tasks cannot manage everything themselves. Because of the pressure to reduce

More information

PART 226 SPECIAL EDUCATION SUBPART A: GENERAL

PART 226 SPECIAL EDUCATION SUBPART A: GENERAL TITLE 23: EDUCATION AND CULTURAL RESOURCES SUBTITLE A: EDUCATION CHAPTER I: STATE BOARD OF EDUCATION SUBCHAPTER f: INSTRUCTION FOR SPECIFIC STUDENT POPULATIONS PART 226 SPECIAL EDUCATION SUBPART A: GENERAL

More information

COLORADO MEDICAL BOARD RULES

COLORADO MEDICAL BOARD RULES RULE 800 3 CCR 713-30 RULES REGARDING THE DELEGATION AND SUPERVISION OF MEDICAL SERVICES TO UNLICENSED PERSONSHEALTH CARE PROVIDERS PURSUANT TO SECTION 12-36-106(3)(l), C.R.S. Table of Contents Introduction:

More information

2. Unlicensed assistive personnel: any personnel to whom nursing tasks are delegated and who work in settings with structured nursing organizations.

2. Unlicensed assistive personnel: any personnel to whom nursing tasks are delegated and who work in settings with structured nursing organizations. XVIII. A. General Information: The judgments that you make in about coordinating and facilitating client care situations have to be based on knowledge. You MUST know your content, and then you can move

More information

Subject: Skilled Nursing Facilities (Page 1 of 6)

Subject: Skilled Nursing Facilities (Page 1 of 6) Subject: Skilled Nursing Facilities (Page 1 of 6) Objective: I. To ensure that Tuality Health Alliance (THA) and delegated Providence Health Plan Medicare members are appropriately placed in skilled nursing

More information

National Competency Standards for the Registered Nurse

National Competency Standards for the Registered Nurse National Competency Standards for the Registered Nurse INTRODUCTION DESCRIPTION OF REGISTERED NURSE DOMAINS NATIONAL COMPETENCY STANDARDS GLOSSARY OF TERMS Introduction The Australian Nursing and Midwifery

More information

NEW YORK STATE MEDICAID PROGRAM HOME HEALTH MANUAL

NEW YORK STATE MEDICAID PROGRAM HOME HEALTH MANUAL NEW YORK STATE MEDICAID PROGRAM HOME HEALTH MANUAL POLICY GUIDELINES Table of Contents SECTION I - REQUIREMENTS FOR PARTICIPATION IN MEDICAID...2 RECORDS AND REPORTS...3 SECTION II - CERTIFIED HOME HEALTH

More information

Table of Contents. Introduction: Basis, purpose and statutory provision

Table of Contents. Introduction: Basis, purpose and statutory provision RULE 800 COLORADO BOARD OF MEDICAL EXAMINERS RULES REGARDING THE DELEGATION AND SUPERVISION OF MEDICAL SERVICES TO UNLICENSED HEALTH CARE PROVIDERS PURSUANT TO SECTION 12-36-106(3)(l), C.R.S. Table of

More information

Assisted Living Services for High Risk Seniors Policy, 2011 An updated supportive housing program for frail or cognitively impaired seniors

Assisted Living Services for High Risk Seniors Policy, 2011 An updated supportive housing program for frail or cognitively impaired seniors Assisted Living Services for High Risk Seniors Policy, 2011 An updated supportive housing program for frail or cognitively impaired seniors January 2011 (as updated September 2012) Ministry of Health and

More information