As an RN, can I delegate to our unlicensed staff a CPAP or BiPAP procedure?
In January of 2012, the Texas Board of Nursing (BON) approved noninvasive ventilation (NIV), such as continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapy as additional tasks that RNs may determine are safe and appropriate to delegate in accordance with Chapter 225, RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions. The tasks RNs may decide to delegate are listed in Rule 225.10; and specifically, Rule 225.10 (13) now permits RNs to delegate NIV procedures to unlicensed personnel.
The BON is aware that in independent living environments the use of NIV has increased for the treatment of numerous chronic respiratory disorders, such as chronic obstructive pulmonary disease, asthma, sleep apnea and cystic fibrosis. In order for clients to achieve optimal health benefits in the least restrictive environments as possible, RNs may use the delegation process in collaboration with the client or the client’s responsible adult (CRA) to decide if NIV procedures are safe to delegate in home settings.
RNs are responsible for adequately and accurately assessing the needs of clients in order to ensure their safety in these settings. The delegation process can assist RNs to make decisions as to how unlicensed personnel will be utilized to accomplish safe and effective supportive services and care.
Are there any medications or procedures that may be delegated in an emergency situation in independent living environments such as in home health or school health?
In January 2013, the Board approved a list of life-sustaining medications and treatments that a RN may delegate in emergency situations for clients in independent living environments, provided the RN has an order to administer or perform the following and the client has received a diagnosis that required a prescription for:
Planning for emergencies in independent living environments requires the RN to utilize both Chapter 224 titled, Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments and Chapter 225 titled, RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions. RNs must use their nursing judgment to decide when it is safe and appropriate to delegate life-sustaining medications and treatments to unlicensed personnel in independent living environments such as community-based settings, client homes or schools.
While all the delegation criteria are important in Board Rule 224.6, the RN must take into consideration how the supervisory standards will be met as delegation decisions are made. The RN is required to provide adequate supervision while an unlicensed person is performing a task, particularly in emergency situations. The RN must consider his or her geographical distance and the time it takes to reach a client that is experiencing an emergency in order to direct unlicensed personnel when to notify the Emergency Medical System (EMS). RNs are also responsible for timely follow-up, which may include a face-to-face assessment depending on the emergency situation and the RN’s location to the individual. Delegation decisions and instructions to unlicensed personnel should be documented in the client’s record.
For additional information on the Board’s website regarding delegation, click on Nursing Practice, and then click on Delegation Resource Packet.
Posted on April 2013
I recently learned that the list of tasks that a RN may designate as health maintenance activities (HMAs) has been expanded. Is that true?
Yes, the Board approved expanding this list during the January 2013 Board Meeting, according to their authority under Board Rule 225.4(8) (E).
RNs in independent living environments such as, home and community-based settings or school health must utilize the rules in Chapter 225 titled, RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions when making decisions that pertain to delegation. The RN depending on the assessment of the client and the delegation criteria may decide to: designate a task a HMA that does not require delegation; delegate a task to an unlicensed person; or have a nurse perform the task.
HMAs are defined as “tasks that enable the client to remain in an independent living environment and that go beyond activities of daily living (ADLs) because of the higher skill level required to perform”, [See Board Rule 225.4(8)]. The Board believes that expanding the list of HMAs will foster a client’s independence and further supports a client or the client’s responsible adult (CRA) who is able to train and supervise unlicensed personnel in the performance of a HMA, thus enabling the client to remain in the least restrictive environment as possible. For a complete list of tasks that can be designated as HMAs please refer to Board Rule 225.4(8) (A-E). The additional tasks that may be designated as HMAs are:
Because all nurses are required to promote a safe environment for their clients and others [See Board Rule 217.11(1)(B)], the RN must always consider what is safest for the client when making decisions to designate a task a HMA that does not require delegation. Nurses are reminded to document their decisions concerning delegation in the client’s record. For additional information on the Board’s website regarding delegation, click on Nursing Practice, and then click on Delegation Resource Packet.
Posted April 2013