Nurse Delegation to LNAs

1
Nurse Delegation to LNAs Unlicensed Personnel in
the Ambulatory Care Settings

• Margaret Walker, Ed.D., RN
• NH Board of Nursing

2
What are we seeing as trends in the ambulatory
settings

• Increased responsibility questions have been
  coming to the board.
  
• Unlicensed and nursing assistant staff are
  providing a scope of practice that is more
  intense which, challenges the educational
  experience of personnel.

3
What do we need to keep in mind?

• The delegation rules in Nur 400
• These rules allow nurse delegation of nursing
  tasks to individuals for care to individuals who
  are stable.

4
Where do I find Nur 400?

• www.state.nh.us/nursing
• Go to Nurse Practice Act
• Open Administrative Rules Chapters 100-800.
• Note The NH Legislature gives approval for these
  rules that govern our practice through
  legislative process.

5
What does the Delegation rule say?

• The licensed nurse can delegate tasks to LNAs and
  unlicensed persons provided the patient does not
  have an acute problem rendering them unstable.
  
• The nurse must make sure the delegatee has the
  competencies to perform the task.
  
• The nurse is ultimately responsible and
  accountable for delegated tasks.

6
What if the nurse is simply teaching a task and
delegating?

• The nurse can teach and must make it clear that
  she/he is not delegating but simply teaching the
  skills.

7
Where can I find board clinical practice answers
already processes?

• The quick link section on the boards home page
  connects you to the nursing practice page. This
  page contains board opinions for the last several
  years. Older decisions are located in archived
  newsletters located in the Applications, Forms,
  and Publications section of the website.

8
Recent board advisories related to the expanding
roles of licensee

• Go to the website and click on Nursing
  Practice.
  
• There is a section where the board has provided
  practice opinions at its board meeting. The
  questions are posted for 30 days or longer for
  public comments.

9
What is the process for board advisories?

• Individuals with questions go to the Nursing
  Practice section of the website and use the
  Decision Tree to determine if the task is part
  of their practice.
• If, after completing the decision tree and
  researching the question it is still not
  clearthe person can ask the board.

10
Completing a Clinical Practice Inquiry Form

• The form is located on the Nursing Practice page
  of the website.
  
• Please complete all sections and make sure you
  provide as much information as possible to allow
  full board understanding of your question.
  
• Also provide information regarding your research
  of the question.

11
What next?

• There are several avenues/options you can take
• Attend the OPEN FORUM of the board meeting to
  present your question and/or
  
• Mail or email (boardquestions_at_nursing.state.nh.us)
  your form and watch for the board minutes and
  Nursing Practice page for the final results.
  

12
Board action on advisory questionshow does it
work?

• The board receives the board packet in advance of
  the meeting for review and research
  
• The board may answer the question at the meeting
  or
  
• Refer the question to the Practice and Education
  Committee for additional research.

13
Practice and Education Committee

• This committee is an important part of the board
  process.
  
• After careful study and deliberation of the
  question, the committee develops and presents a
  recommendation to the next board meeting.
  
• The questions are becoming numerous!!

14
What is the definition of stable patient

• The concept of predictable outcomes is
  important.
  
• Stability is defined as the expectation of the
  individual patients level of predictable
  outcomes.
  
• Delegation can occur with individuals who are
  stable and have predictable outcomes of care.

15
What if my patient has serious health issues but
we know about their condition?

• If the condition of the patient is known and
  consistently occurs, it is considered a
  predictable outcome for that patient.
  
• If the patient suddenly has a condition they have
  never experienced and is not part of the care
  plan, we have an unpredictable outcome.

16
The constantly changing health care delivery
system

• This is a work environment that is impacted by
  new technologies
  
• Health care systems are continually changing to
  improve patient outcomes
  
• Financial/economic issues have created an
  environment that changes to adapt to
  reimbursement, costs, and effective care.

17
Prediction for the Future

• The board is aware that we need to adapt to the
  changing healthcare needs and at the same
  time---
  
• Maintain optimal patient care.
• Maintain patient safety.
• Assure quality care systems.

18
So, how do I keep up on all of these changes?

• Review the boards website on a regular basis.
• Continue to learn new skills.
• Continue to maintain a good knowledge base and
  keep up with changes in the healthcare options
  for patients.
  
• Ask questions to make sure you are working within
  your scope of practice.

19
Thank you

• Margarets email Mwalker_at_nursing.state.nh.us
• Norma Blake norma.blake_at_nursing.state.nh.us
• Board staff member for LNAs is Mary Lou Moreen RN
  at marylou.moreen_at_nursing.state.nh.us