Continuing Education National Guidelines for Nursing Delegation

www.journalofnursingregulation.com 5 Volume 7/Issue 1 April 2016

National Guidelines for Nursing

Delegation

National Council of State Boards of Nursing

In early 2015, the National Council of State Boards of Nursing convened two panels of experts representing education, research,

and practice. The goal was to develop national guidelines based on current research and literature to facilitate and standardize

the nursing delegation process. These guidelines provide direction for employers, nurse leaders, staff nurses, and delegatees.

Keywords: Delegation, evidence-based, guidelines, nursing assignment, regulation, research

Objectives

⦁ Understand evidence-based, state-of-the-art standards for

delegation.

⦁ Explain the differences between assignment and delegation

and the responsibilities of the employer, nurse leader, delegat-

ing nurse, and delegatee in the process of delegation.

H ealth care is continuously changing and this includes

the roles and responsibilities of licensed health

care providers and assistive personnel. The num-

ber of licensed nurses (i.e., advanced practice registered nurses

[APRNs], registered nurses [RNs], or licensed practical nurse/

vocational nurses [LPN/VNs]) may be limited in certain regions

and/or institutions. Therefore, care may need to extend beyond

the traditional role and assignments of RNs, LPN/VNs, and

unlicensed assistive personnel (UAP). When certain aspects of

nursing care need to be delegated beyond the traditional role

and assignments of a care provider, it is imperative that the del-

egation process and the state nurse practice act (NPA) be clearly

understood so that it is safely and effectively carried out.

The delegation process is multifaceted. It begins with

decisions made at the administrative level of the organization

and extends to the staff responsible for delegating, overseeing

the process, and performing the responsibilities. It involves

effective communication, empowering staff to make deci-

sions based on their judgment and support from all levels of

the health care setting. The employer/nurse leader, individual

licensed nurse, and delegatee all have specific responsibili-

ties within the delegation process. (See Figure 1.) It is crucial

to understand that states/jurisdictions have different laws and

rules/regulations about delegation, and it is the responsibility

of all licensed nurses to know what is permitted in their state

NPA, rules/regulations, and policies.

In early 2015, the National Council of State Boards of

Nursing (NCSBN) convened two panels of experts representing

education, research, and practice to discuss the literature and key

issues, and evaluate findings from delegation research funded

through NCSBN's Center for Regulatory Excellence Grant

Program. The goal was the development of national guidelines

to facilitate and standardize the nursing delegation process.

They build on previous work by NCSBN and the American

Nurses Association, and provide clarification on the responsi-

bilities associated with delegation.

Additionally, these guidelines are meant to address del-

egation with respect to the various levels of nursing licensure

(i.e., APRN, RN, and LPN/VN, where the state NPA allows).

Delegation Versus Assignment

Delegation has been a source of significant debate for many years

and includes many philosophical discussions over the differences

between assignment and delegation. Much of the literature sur -

rounding nursing delegation has focused on the nursing home

setting. The Centers for Medicare & Medicaid Services (CMS)

requires nursing homes to employ certified nursing assistants or

aides (CNAs) as part of a mechanism to ensure higher standards

of care. Through this mechanism, CMS supports federal regu-

lations concerning CNA training and competency, which were

established by the Omnibus Budget Reconciliation Act of 1987.

These regulations require nursing homes to employ CNAs who

complete state-approved CNA programs, outline the funda-

mental skills that should be included in all CNA programs, and

require the CNA to pass a competency evaluation administered

and evaluated only by the state or by a state-approved entity

and be added to the state registry. The interpretation of these

guidelines by the nursing practice community has likely led to

some confusion about what activities, skills, or procedures can

be delegated to CNAs. The regulations define the minimum

curriculum to be included in a CNA program but do not nec-

essarily define all the activities, skills, or procedures that can

Continuing Education

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Source: https://www.studocu.com/en-ca/document/university-of-regina/social-political-and-economic-perspectives-in-nursing/ncsbn-delegation-guidelines/5307471

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