Public Health Nursing: What DO we need to know about Delegation, Supervision, Management and MORE? Linda Burhans, PhD, RN, FRE Associate Executive Director 1
OBJECTIVES 1. Explain authority and purpose of BON 2. Describe the roles and responsibilities of the RN, LPN, & UAP in the delegation process. 3. Discuss supervision, management, and administration 4. Discuss issues related to public health nursing Mission Statement The mission of the North Carolina Board of Nursing is to protect the public by regulating the practice of nursing. 2
Overview Purpose of Regulation-Protection of the Public Mandate to Regulate Nursing Practice-authority derived from legislative action through Law -- Nursing Practice Act (NPA) Rules and regulations promulgated through NC Administrative Code (NCAC) You Make the Difference! What do NC Nurses have that other nurses don t? The privilege to vote and elect the members to the Board of Nursing. VOTE: July 1 August 15 th 3
Definitions Assignment Designating responsibility for implementation of a specific activity or set of activities to a person licensed and competent to perform such activities. Delegation - Transferring to a competent individual the authority to perform a selected nursing activity in a selected situation. Accountability/Responsibility - answerable for actions or inactions of self in the context of assignment or delegation. Definitions Supervision - provision of guidance or direction, evaluation, and follow-up by the licensed nurse for the accomplishment of an assigned or delegated nursing task. Management on-going supervision, teaching, and evaluation of nursing personnel Administration identify, develop, update and implement standards; plan for and evaluate nursing care delivery system; manage licensed and unlicensed personnel who provide nursing care 4
Unlicensed Assistive Personnel (UAP) Unlicensed Assistive Personnel Any unlicensed persons who provide client services under the direction of a licensed nurse regardless of title - Nurse Aide I - Nurse Aide II - NAI + 4 - Medication Aides - Medical Office Assistants NPA - Delegation Laws RN - G.S. 90-171.20 (7) (d) Teaching, assigning, delegating to or supervising (i) Supervising, teaching and evaluating LPN - G.S. 90-171.20 (8) (d) Assigning or delegating under supervision of RN 5
RN Delegation Rules NCAC 36.0224 (c)(4), (d)(6), (i)(2,3,4) Developing plan of care Assigning, delegating, and supervising nursing activities Assessing capabilities of personnel Delegating responsibility to personnel qualified Accountable for nursing care assigned and delegated LPN Delegation Rules 21 NCAC 36.0225 (d) (1)(F) & (2) LPN may delegate specific nursing tasks as outlined in the plan of care when: UAP qualifications validated by RN Continuous supervision by RN LPN responsibilities: Maintains accountability On-going observation of clients Limited supervisory role 6
Criteria for Delegation of Tasks to UAP 1. Frequently recurs in the daily care of a client or group of clients. 2. Performed according to an established sequence of steps. 3. Involves little or no modification from one client situation to another. 4. Performed with a predictable outcome. 5. Does not involve assessment, interpretation or decision-making in the process. 6. Does not endanger life or well-being. Delegation - Variables 1. Knowledge & skills of UAP 2. RN-verified competence of UAP 3. Stability of client condition 4. Variables in service/practice setting ******************* Licensed nurse (RN or LPN) remains responsible for monitoring performance of delegated tasks Nurse must determine level of monitoring required and continues to have responsibility for overall nursing care of client 7
LPN Delegation Responsibilities Delegate under RN supervision and plan of care Ensure RN has validated UAP competence Monitor UAP s performance of tasks Participate in on-going observation of client response Recognize effectiveness of interventions ************************* LPN supervision is limited to assuring task are performed correctly Frequency, level and nature of monitoring may vary with: client s nursing care needs competence and experience of UAP Nursing Delegation of Medication Administration to UAP Nursing Law and Rules permit delegation Delegate TECHNICAL TASK ONLY Practice setting dependent RN is responsible for assuring education & training NCBON Medication Administration Teaching Modules 8
The Five Rights of Delegation Right Task - One that is delegable for a specific patient. Right Circumstances - Appropriate patient setting, available resources and other relevant factors considered. Right Person - Right person is delegating the task to the right person to be performed on the right patient. Right Direction/Communication(s) - Clear concise description of task, including objectives, limits and expectations by delegator. Right Supervision - Appropriate monitoring, evaluation, intervention as needed, and feedback to delegatee NEVER DELEGATE Planning Evaluation Assessment Nursing Judgment 9
Practice Violations 21 NCAC 36.0217 (c) (12) Failure to supervise (19) Inappropriate delegation Public Health Nursing Challenges/Issues in: Delegation Supervision Management Administration 10
Learn to Delegate, Supervise, & Manage - Skills Developed through Education, training, and practice Simulation sessions Skills in communication & conflict resolution Opportunities provided by staff development workshops Observing experienced supervisors, managers, and administrators Public Health Nursing Other issues: For health screening & referral purposes: - BIMANUAL PELVIC AND RECTAL EXAMS (RN) - PERFORMANCE OF BREAST ASSESSMENT (RN) - PROSTATE SCREENING (RN) - OBTAIN PAPANICOLAU SMEAR (RN & LPN) Standing Orders OTC Medications 11
STANDING ORDERS ASSESSMENT : SUBJECTIVE FINDINGS OBJECTIVE FINDINGs PLAN OF CARE: CONTAINS THE STANDING ORDER CONTAINS THE NURSING ACTIONS, FOLLOW UP, & MONITORING PHYSICIAN SIGNATURE OTC MEDICATIONS LEGEND DRUGS REQUIRE DULY AUTHORIZED PROVIDER SIGNATURE OTC DRUGS NOT SUBJECT TO PRESCRIBING AND DISPENSING LAWS CONSISTENT WITH AGENCY POLICIES RN MAY RECOMMEND OTC MEDICATIONS AND NON-PRESCRIPTIVE DEVICES RN HELD ACCOUNTABLE FOR ACTIONS LPNs DO NOT RECOMMEND OTC 12
Questions? Comments? 13