Legal Aspects of DelegatingWithin a Team Model of Care Coleen R. Elmers, RN, MSN Leadership Educator Baptist Health System
Delegation & Supervision: Understanding the RN’s Responsibilities
Delegation Guidance Board of Nurse Examiners (BNE) Rule 217 (9/2004) BHS Scope of Practice LD-NA-10www.bne.state.tx.us
BNE-Interpretive Guidelines forLVN Scope of Practice (9/2004) Rule 217.11 Sets minimum standard of nursing practice Supervision: LVN functions “under the supervision” of an RN Comprehensive RN assessment LVN scope of practice cannot be expanded to RN level without formal program of study/licensure
RN As Coordinator of Care Makes assignments to licensed staff (LVN’s/RN’s,) Delegates tasks to unlicensed staff in accordance with BNE rules Requires continuous supervision of LVN (direct/indirect)
Principles of Delegation Staff Competence Complexity of Activity Job Description/Scope of Practice Continuity of Care Degree of Judgment
RN Responsibilities When Delegating Tasks Assess competency of staff member to perform delegated task Provide supervision based on staff members experience level/clients needs Ensure task delegated is within staff members scope of practice
RN Responsibilities As a Resource Receive report on all patients in the team Perform focused assessment (based on diagnosis) on patients assigned to LVN Establishes daily goals and interventions (Plan of Care) on the PCR Has knowledge of the medical plan of care, and the relevant goals of other disciplines
Making Assignments* Patient needs must Review staff be considered in competencies making assignments Agency nurses or Using an acuity scale nurses floating to can even out work unit must provide load same level of care*May require switching patient care assignments
Routine Patients Can the LVN assess his/her own patients? Yes Does the RN have to co-sign the LVNs assessment? No What does the RN document and where?RN must develop the plan of care and documentthe patient’s progress on the Nursing Plan of Caredocument or in the nurses notes. The RN mustreview and sign the graphics for that shift.
Who Is Legally Responsible? If an RN assigns a task or a patient to an LVN, and the LVN does something wrong, who is legally responsible for any negative outcome?
LVN Responsibilities Ensure RN is aware of changes in condition Ensure RN is aware of response to interventions Attend classes/complete competencies required to maximize your role in patient care After attending IV therapy class and completing competency may give IV push meds that are not Vasoactive: causing changes in heart rate, or BP (this includes drugs like Lasix, that have a vasodilative effect and may cause extreme drops in BP) Narcotic Chemotherapy
Advancing LVN Practice After completion of learning activity and competency, LVNs may give IV push Lasix (furosemide) IV push Demerol (meperidine) IV push Morphine IV push Dilaudid (hydromorphone)
Delegating Within TeamModel of Care Exercise Using delegation scenario provided identify: Legal responsibilities Measures to avoid legal pitfalls How 6 Rights of Delegation can help