Delegation Project

INTRODUCTION:

Delegation is a process of authorizing an unlicensed person to provide a nursing service while retaining accountability of how the unlicensed person performs the task. It does not include situation in which an unlicensed person is directly assisting a Registered Nurse by carrying out nursing task in the presence of the Registered Nurse. (BNE Rule 224.4(3))

Delegation is widely viewed as a management tool that Registered Nurses use at their discretion. (BNE, 2005) The Registered Nurse is accountable for the delegation process and the choice to delegate belongs to the Registered Nurse. The Registered Nurse uses good working knowledge of Board of Nurse Examiners Rules and any other relevant regulations in making their decision to delegate. (BNE, 2005). Some hospital policy requires Registered Nurses to delegate some nursing service to unlicensed person but the Registered Nurse still makes the final decision to delegate. Delegation helps the Registered Nurse to get the job done on time and in a more productive way. Generally, delegation frees the Registered Nurse from performing jobs that does not require nursing judgment and hereby save a lot time to attend to other duties.

The scenes below are meant to treat situations where delegation of duties are appropriate or inappropriate according to the BNE's rule.

Independent Living Environment: (CASE I)

The client is a 25 year old home vented patient with severe Multiple Sclerosis, who is bed bound, unable to direct his own care but a parent is available 24/7 either in the home or telephonically and never more than 10 minutes from home; the parent is very willing to participate in care decisions. The unlicensed assistive person (UAP) has been with this client for 2 years and is very mature/reliable in carrying out activities for daily living (ADLs) and health maintenance activities (HMAs), as well as certain delegated nursing tasks (including trach care and suctioning). Up until now, the Home Care RN has been making routine visits every 90 days, and as needed to reassess if there are any changes in the client's condition.

The client developed an obstruction of his G-tube, which required an overnight hospital stay for placement of a new G-tube. At home again, his vital signs are stable, and the RN assesses his condition to be stable and non-fluctuating (i.e. no change from his previous condition).

1. Can the RN delegate the trach care and suctioning?

Yes, the RN can delegate trach care and suctioning to a UAP. BNE rule 225.10(7) specified trach care as one of the activities that can be delegated by a RN. However, before a RN can delegate any activity, BNE rule 225.9 criteria for delegation must be followed, which