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

  In accordance with Subsection 58-31b-102(15)(g) and Subsection R156-31b-102(12), the delegation of nursing tasks in a non-school setting is further defined, clarified, or established as follows:

  (1) A delegator retains accountability for the appropriate delegation of tasks and for the nursing care of the patient.

  (2) Tasks Appropriate for Delegation - Prior Assessment Required.

  (a) A delegator may not delegate to unlicensed assistive personnel, including a medical assistant, any task requiring the specialized knowledge, judgment, or skill of a licensed nurse.

  (b) A delegator may not delegate a task that is:

  (i) outside the area of the delegator's responsibility;

  (ii) outside the delegator's personal knowledge, skills, or ability; or

  (iii) beyond the ability or competence of the delegatee to perform:

  (A) as personally known by the delegator; and

  (B) as evaluated according to generally accepted nursing practice standards of health, safety, and reasonable prudence.

  (c) A nursing task may be delegated if it meets the following criteria, as applied to each specific patient situation:

  (i) it is considered routine care for the specific patient;

  (ii) it poses little potential hazard for the patient;

  (iii) it is generally expected to produce a predictable outcome for the patient;

  (iv) it is administered according to a previously developed plan of care; and

  (v) it does not inherently involve nursing judgment that cannot be separated from the procedure.

  (d) Before determining which, if any, nursing tasks may be delegated, the delegator shall make a focused nursing assessment of the circumstances, and evaluate the following factors to determine the degree of supervision required to ensure safe care:

  (i) the stability and condition of the patient;

  (ii) the training, capability, and willingness of the delegatee to perform the delegated task;

  (iii) the nature of the task being delegated, including the complexity, irreversibility, predictability of outcome, and potential for harm inherent in the task;

  (iv) the proximity and availability to the delegatee of the delegator or other qualified nurse during the time(s) when the task will be performed; and

  (v) any immediate risk to the patient if the task is not carried out.

  (e) If a delegator, upon review of the criteria established in this Subsection, determines that a proposed delegatee cannot safely provide the requisite care, the delegator shall not delegate the task to the proposed delegatee.

  (3) Instruction and Demonstration of Competency Prior to Delegation.

  (a) In delegating a nursing task, the delegator shall:

  (i) provide instruction and direction necessary to allow the delagatee to safely perform the specific task;

  (ii) explain the delegation to ensure that the delegatee understands which patient is to be treated, and according to what time frame; and

  (iii) instruct the delegatee how to intervene in any foreseeable risks that may be associated with the delegated task.

  (b)(i) If the employing facility or agency requires initial and ongoing demonstration of competency of direct patient care tasks, and makes competency documentation available to the delegator, the delegator may use that competency documentation.

  (ii) If the employing facility or agency does not require demonstration of competency or does not provide competency documentation that is satisfactory to the delegator, or if a task falls outside tasks in which the proposed delegatee has previously been proven competent, the delegator or qualified educator shall:

  (A) require the proposed delegatee to provide to the delegator or qualified educator a physical or verbal demonstration of the delegated task; and

  (B) document the observed or spoken demonstration.

  (iii) Teaching of a task, demonstration of competency, and documentation may be conducted per individual or in a group training session.

  (4) Supervision and Monitoring. During delegation, the delegator shall:

  (a) provide ongoing appropriate supervision and evaluation of the delegatee;

  (b) ensure that the delegator or another qualified nurse is readily available, either in person or by telecommunication, to:

  (i) evaluate the patient'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; and

  (c) if the delegated task is to be performed more than once, establish a system for ongoing monitoring of the delegatee.

  (5) Further Delegation Prohibited. A delegatee may not:

  (a) further delegate to another person any task delegated to the individual by the delegator; or

  (b) expand the scope of the delegated task without the express permission of the delegator.

  (6) Internal Policies or Practices. Tasks that according to the internal policies or practices of a medical facility are required or allowed to be performed by an unlicensed person, shall not be deemed to have been delegated by a licensee.