Objective: Discuss the RNs responsibility for delegating to staff members with various levels of training and experience while balancing patient needs and workload.
The Board of Nurse Examiners discusses in detail the role of the RN and LVN in Rule 217 Our BHS Scope of Practice is in alignment with the BNE rules. It includes both LVN and C.N.A. Scope of practice.
Passage of HB 1483 consolidated all licensed nurses under one regulatory board. Since then the Board has combined and revised the two sets of rules into one, thereby providing consistent regulatory guidance to all nurses in Texas. Rule 217.11 provides the framework for the minimum acceptable standards of nursing practice and serves for determining a nurse’s scope of practice. This guideline includes comparison between LVN and RN practice. Interpretive Guideline for Differentiating Vocational Nurse Scope of Practice Comprehensive nursing assessment (RNs responsibility) : is an extensive data collection (initial and ongoing) for individuals, families, groups, communities addressing anticipated changes in client conditions as well as emergent changes in a client’s health status; recognizing alterations to previous conditions, synthesizing the biological, psychological, spiritual and social aspects of The client’s conditions; evaluating the impact of nursing care, and using this broad and complete analysis to make independent decisions and nursing diagnoses; plan nursing interventions, evaluate need for different interventions, and the need to communicate and consult with other health team members. What this means to you is that the RN must complete the initial assessment and plan of care and that the RN must assess a patient’s readiness for discharge. Focused assessment: is an appraisal of an individual client’s status and situation at hand, contributing to the comprehensive nursing assessment by the RN, supporting ongoing data collection.
What can an RN delegate? The Texas BNE requires that the registered nurse develop the plan of care and perform a comprehensive assessment of the client, including whether or not some aspects of the care may be provided by another health care worker. (Delegated) Nursing practice is knowledge-based, not task-based. While tasks or procedures may delegated to other members of the health-care team or the client's family, responsibility for nursing cannot be delegated.
RN must assess the competency of staff to provide care and provide supervision. Type and amount of supervision (direct or indirect) should match client population and expected outcomes of care. When functions are delegated, the nurse should be satisfied those fulfilling these functions are competent. The nurse has a duty to provide continuing supervision.
There are several important considerations when making team assignments: 1. The needs of the patient is the primary consideration 2. You must understand and match the competencies of the staff with the needs of the patient. This requires you know each staff member and their competencies or that you review competencies of those staff members you do not know (This includes agency staff, floaters, etc.) Tools we have in place that can help (competency grids). 3. Using an acuity scale helps even out the workload between team members This means at times your assignment will need to be switched because of either competency issues or patient needs.
On routine patients the RN’s responsibilities include: documenting the patient’s progress on their plan of care in the multidisciplinary progress notes or nurses notes.
It is imperative that you understand your legal responsibility when delegating. It depends on who did the wrong thing! If the RN delegated an unstable patient, or a procedure the LVN was not competent to perform, both may be liable. If neither of those things is true, the LVN is liable. When delegating the RN must make sure that the nurse you are delegating to is competent to provide that care and is practicing within their Scope of Practice (LVN). In the next 20 minutes we will look at some of the key points to the LVN Scope of Practice and how this will impact the delegation process and assignment of patients. Scope of Practice Jeopardy.
Legal aspects of delegating within a team model
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