No. 30208 (Amendment): R156-31b. Nurse Practice Act Rules

DAR File No.: 30208
Filed: 07/19/2007, 09:47
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division and the Board of Nursing are proposing amendments to clarify the delegation of nursing tasks by a registered nurse in a school setting. School nurses have expressed concern that they are being asked to delegate medication administration to unlicensed individuals by school personnel and parents, regardless of whether the nurse believes the delegation is appropriate. Given the uniqueness of the school setting, members of the Board of Nursing and the division agreed to propose a rule amendment that specifically addresses this issue and setting.

Summary of the rule or change:

In Section R156-31b-102, new definitions for "school setting" and "student health care plan" are being added. Subsection R156-31b-701(6) is being deleted and moved to the new Section R156-31b-701a. Section R156-31b-701a regarding delegation of nursing tasks in a school setting is being added. Proposed amendments provide a registered nurse (RN) in a school setting may not delegate the administration of any medication which requires nursing assessment or judgment prior to administration, evaluation, or followup unless expressly permitted by law. Also an RN in a school setting may not delegate the administration of medication for the first dose of a new medication or dosage change, or insulin via any route.

State statutory or constitutional authorization for this rule:

Section 58-31b-101 and Subsections 58-1-106(1)(a) and 58-1-202(1)(a)

Anticipated cost or savings to:

the state budget:

If these proposed amendments are made effective, the division will incur minimal costs of approximately $100 to reprint the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the division's current budget. Given the limited number of RN school nurses throughout the state, the legislature may be asked to provide more funding to the school districts to hire more nurses to administer medications in the school setting.

local governments:

A school district may be required to hire more nurses to administer medications in the school setting, or may need to contract with independent nurses or home health care agencies to provide the knowledge and skill necessary to administer medications safely. The division is unable to determine any exact amount of costs related to possibly hiring more nurses or contracting with nurses.

small businesses and persons other than businesses:

SMALL BUSINESS: If a private school did not have the necessary nurse employees to administer medications in the school, then the school would be required to hire and/or contract with an RN to provide this nursing tasks to students. The average full-time yearly salary for an RN in Utah is $38,000 - $52,000. OTHER PERSONS: According to the Utah Nurses Association, the ratio of an RN to student in Utah is 1:6,500, whereas the national standard is 1:750. As more and more children are mainstreamed and the number of children receiving prescribed medication increases, schools will be required to hire/contract with more nurses to administer medications in the school setting. The personnel budgets of schools and school districts will increase, but employment opportunities for licensed nurses will also increase, which has a positive effect on the state's economy.

Compliance costs for affected persons:

Depending on the number of students receiving medications and the number of RNs currently working in schools, schools and school districts will need to obtain additional RN positions to provide for the nursing care needs of the student. The division is unable to determine an exact cost to schools or school districts due to a number of varying factors. However, the average full-time yearly salary for an RN in Utah is $38,000 - $52,000.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing prohibits a nurse from delegating duties relating to the administration of medications in a school setting. Thus, pursuant to Section 53A-11-601, where a school chooses to provide for the administration of medication to students, it could experience costs if additional nurses are needed to administer medications since that duty can no longer be delegated. That fiscal impact is difficult to ascertain as Section 53A-11-601 is permissive rather than mandatory, and of those schools that choose to provide for the administration of medications, it is not known how many will need to hire additional nurses. Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

09/14/2007

Interested persons may attend a public hearing regarding this rule:

8/24/2007 at 9:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 474 (fourth floor), Salt Lake City, UT

This rule may become effective on:

09/21/2007

Authorized by:

F. David Stanley, Director

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-31b. Nurse Practice Act Rules.

R156-31b-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 31b, as defined or used in these rules:

(1) "Absolute discharge", as used in Subsection 58-31b-302(5)(b), means the completion of criminal probation or parole.

(2) "Affiliated with an institution of higher education", as used in Subsection 58-31b-601(1), means the general and science education courses required as part of a nursing education program are provided by an educational institution which is approved by the Board of Regents or an equivalent governmental agency in another state or a private educational institution which is regionally accredited by an accrediting board recognized by the Council for Higher Education Accreditation of the American Council on Education; and the nursing program and the institution of higher education are affiliated with each other as evidenced by a written contract or memorandum of understanding.

(3) "APRN" means an advanced practice registered nurse.

(4) "Approved continuing education" in Subsection R156-31b-303(3) means:

(a) continuing education that has been approved by a professional nationally recognized approver of health related continuing education;

(b) nursing education courses taken from an approved education program as defined in Section R156-31b-601; and

(c) health related course work taken from an educational institution accredited by a regional institutional accrediting body identified in the "Accredited Institutions of Postsecondary Education", 2003-04 edition, published by the American Council on Education.

(5) "Approved education program" as defined in Subsection 58-31b-102(3) is further defined to include any nursing education program published in the documents entitled "Directory of Accredited Nursing Programs", 2003, published by the National League for Nursing Accrediting Commission, which are hereby adopted and incorporated by reference as a part of these rules.

(6) "CCNE" means the Commission on Collegiate Nursing Education.

(7) "CGFNS" means the Commission on Graduates of Foreign Nursing Schools.

(8) "COA", as used in these rules, means the Council of Accreditation of Nurse Anesthesia Education Programs.

(9) "Clinical mentor/preceptor", as used in Section R156-31b-607, means an individual who is employed by a clinical health care facility and is chosen by that agency, in collaboration with the Parent-Program, to provide direct, on-site supervision and direction to a nursing student who is engaged in a clinical rotation, and who is accountable to both the clinical agency and the supervisory clinical faculty member.

(10) "Comprehensive nursing assessment", as used in Section R156-31b-704, means an extensive data collection (initial and ongoing) for individuals, families, groups and communities addressing anticipated changes in patient/client conditions as well as emergent changes in patient's/client's health status; recognizing alterations to previous patient/client conditions; synthesizing the biological, psychological, spiritual and social aspects of the patient's/client's condition; evaluating the impact of nursing care; and using this broad and complete analysis to make independent decisions and identification of health care needs; plan nursing interventions, evaluate need for different interventions and the need to communicate and consult with other health team members.

(11) "Contact hour" means 50 minutes.

(12) "CRNA" means a certified registered nurse anesthetist.

(13) "Delegation" means transferring to an individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

(14) "Direct supervision" is the supervision required in Subsection 58-31b-306(1)(a)(iii) and means:

(a) the person providing supervision shall be available on the premises at which the supervisee is engaged in practice; or

(b) if the supervisee is specializing in psychiatric mental health nursing, the supervisor may be remote from the supervisee if there is personal direct voice communication between the two prior to prescribing a prescription drug.

(15) "Disruptive behavior", as used in these rules, means conduct, whether verbal or physical, that is demeaning, outrageous, or malicious and that places at risk patient care or the process of delivering quality patient care. Disruptive behavior does not include criticism that is offered in good faith with the aim of improving patient care.

(16) "Focused nursing assessment", as used in Section R156-31b-703, means an appraisal of an individual's status and situation at hand, contributing to the comprehensive assessment by the registered nurse, supporting ongoing data collection and deciding who needs to be informed of the information and when to inform.

(17) "Licensure by equivalency" as used in these rules means licensure as a licensed practical nurse after successful completion of course work in a registered nurse program which meets the criteria established in Sections R156-31b-601 and R156-31b-603.

(18) "LPN" means a licensed practical nurse.

(19) "NLNAC" means the National League for Nursing Accrediting Commission.

(20) "NCLEX" means the National Council Licensure Examination of the National Council of State Boards of Nursing.

(21) "Non-approved education program" means any foreign nurse education program.

(22) "Other specified health care professionals", as used in Subsection 58-31b-102(13), who may direct the licensed practical nurse means:

(a) advanced practice registered nurse;

(b) certified nurse midwife;

(c) chiropractic physician;

(d) dentist;

(e) osteopathic physician;

(f) physician assistant;

(g) podiatric physician;

(h) optometrist;

(i) certified registered nurse anesthetist;

(j) naturopathic physician; or

(k) mental health therapist as defined in Subsection 58-60-102(5).

(23) "Parent-program", as used in Section R156-31b-607, means a nationally accredited, Board of Nursing approved nursing education program that is providing nursing education (didactic, clinical or both) to a student and is responsible for the education program curriculum, and program and student policies.

(24) "Patient surrogate", as used in Subsection R156-31b-502(4), means an individual who has legal authority to act on behalf of the patient when the patient is unable to act or decide for himself, including a parent, foster parent, legal guardian, or a person designated in a power of attorney.

(25) "Postsecondary school", as used in Section R156-31b-607, means a program registered and in good standing with the Utah Department of Commerce, Division of Consumer Protection, that offers coursework to individuals who have graduated from high school or have been awarded a GED.

(26) "Psychiatric mental health nursing specialty", as used in Subsection 58-31b-302(3)(g), includes psychiatric mental health nurse specialists and psychiatric mental health nurse practitioners.

(27) "RN" means a registered nurse.

(28) "School setting", as used in Section R156-31b-701.5, means any pre-school through grade 12 and special education programs in private and public schools.

(29) "Student health care plan", as used in this rule, means a document developed by a registered nurse working in a school setting that guides school personnel in the care of a student with medical needs.

([28]30) "Supervision" in Section R156-31b-701 means the provision of guidance or direction, evaluation and follow up by the licensed nurse for accomplishment of a task delegated to unlicensed assistive personnel or other licensed individuals.

([29]31) "Supervisory clinical faculty", as used in Section R156-31b-607, means one or more individuals employed by an approved nursing education program who meet the accreditation and Board of Nursing specific requirements to be a faculty member and are responsible for the overall clinical experiences of nursing students and may supervise and coordinate clinical mentors/preceptors who provide the actual direct clinical experience.

([30]32) "Unprofessional conduct" as defined in Title 58, Chapters 1 and 31b, is further defined in Section R156-31b-502.

 

R156-31b-701. Delegation of Nursing Tasks.

In accordance with Subsection 58-31b-102(11)(g), the delegation of nursing tasks is further defined, clarified, or established as follows:

(1) The nurse delegating tasks retains the accountability for the appropriate delegation of tasks and for the nursing care of the patient/client. The licensed nurse shall not delegate any task requiring the specialized knowledge, judgment and skill of a licensed nurse to an unlicensed assistive personnel. It is the licensed nurse who shall use professional judgment to decide whether or not a task is one that must be performed by a nurse or may be delegated to an unlicensed assistive personnel. This precludes a list of nursing tasks that can be routinely and uniformly delegated for all patients/clients in all situations. The decision to delegate must be based on careful analysis of the patient's/client's needs and circumstances.

(2) The licensed nurse who is delegating a nursing task shall:

(a) verify and evaluate the orders;

(b) perform a nursing assessment;

(c) determine whether the task can be safely performed by an unlicensed assistive personnel or whether it requires a licensed health care provider;

(d) verify that the delegatee has the competence to perform the delegated task prior to performing it;

(e) provide instruction and direction necessary to safely perform the specific task; and

(f) provide ongoing supervision and evaluation of the delegatee who is performing the task.

(3) The delegator shall evaluate the situation to determine the degree of supervision required to ensure safe care.

(a) The following factors shall be evaluated to determine the level of supervision needed:

(i) the stability of the condition of the patient/client;

(ii) the training and capability of the delegatee;

(iii) the nature of the task being delegated; and

(iv) the proximity and availability of the delegator to the delegatee when the task will be performed.

(b) The delegating nurse or another qualified nurse shall be readily available either in person or by telecommunication. The delegator responsible for the care of the patient/client shall make supervisory visits at appropriate intervals to:

(i) evaluate the patient's/client's health status;

(ii) evaluate the performance of the delegated task;

(iii) determine whether goals are being met; and

(iv) determine the appropriateness of continuing delegation of the task.

(4) Nursing tasks, to be delegated, shall meet the following criteria as applied to each specific patient/client situation:

(a) be considered routine care for the specific patient/client;

(b) pose little potential hazard for the patient/client;

(c) be performed with a predictable outcome for the patient/client;

(d) be administered according to a previously developed plan of care; and

(e) not inherently involve nursing judgment which cannot be separated from the procedure.

(5) If the nurse, upon review of the patient's/client's condition, complexity of the task, ability of the unlicensed assistive personnel and other criteria as deemed appropriate by the nurse, determines that the unlicensed assistive personnel cannot safely provide care, the nurse shall not delegate the task.[

(6) In accordance with Section 53A-11-601 and a student care plan, it is appropriate for a nurse to provide training to an unlicensed assistive personnel which includes the administration of glucagon in an emergency situation provided any training regarding the administration of glucagon is updated at least annually.]

 

R156-31b-701a. Delegation of Nursing Tasks in a School Setting.

In addition to the delegation rules found in Section R156-31b-701, the delegation of nursing tasks in a school setting is further defined, clarified, or established as follows:

(1) In accordance with Section 53A-11-601 and a student health care plan, it is appropriate for a nurse to provide training to unlicensed assistive personnel, which training includes the administration of glucagon in an emergency situation, provided that any training regarding the administration of glucagon is updated at least annually.

(2) In accordance with a student health plan, a registered nurse may not delegate the administration of any medication which requires nursing assessment or judgment prior to administration, evaluation, or follow-up, unless expressly permitted by law such as glucagon and an epipen.

(3) A registered nurse working in a school setting may not delegate the administration of medication in the following circumstances:

(a) first dose of a new medication or a dosage change; or

(b) insulin via any route.

 

KEY: licensing, nurses

Date of Enactment or Last Substantive Amendment: [January 23, 2006]2007

Notice of Continuation: June 2, 2003

Authorizing, and Implemented or Interpreted Law: 58-31b-101; 58-1-106(1)(a); 58-1-202(1)(a)