Nurse Reporter Summer 2007 - Wyoming State Board of Nursing

NurseR E P O R T E RSummer 2007WYOMINGVOL. 2 NUMBER 5Nursing Assistant Exams-Raises for ResultsThe Meaning ofDelegation

It’s a New Day!We are Cheyenne Regional Medical Center and weare passionate about moving healthcare forward forour region.We are the premier regional healthcare system servingover 100,000 people in Larimer County, Northern Coloradoand Western Nebraska. Cheyenne Regional is a 218- bedLevel II Trauma Center that prides itself on delivering thehighest standard of quality care to meet the region’sgrowing healthcare needs.Our Staff consists of over 150 physicians, 1700+ employeesand 400 volunteers, all dedicated to improving outcomes,patient satisfaction and quality of life for individuals andfamilies throughout the Cheyenne region.Our commitment to providing extraordinary patient careremains our top priority. Our highly trained physiciansand employees, state-of-the-art facilities and advancedtechnologies ensure our patients will receive exceptionalcare close to home.We offer our nurses:Defined Career pathways• Tuition Assistance (up to 80% tuition and books)• Sign-On Bonuses (varies depending on years of experience)• Relocation Assistance (in state as well as out of state)• Student Loan payback bonus (for first time graduate nurses)• Outstanding Patient Provider ratios (due in part to our In-House C.N.A. program)• Flex scheduling - Weekend coverage and evening/night differential paysCONTACT:Bob JohnsonRN RecruiterBob.Johnson@crmcwy.org Come join us as we move ahead!307-633-6814 (direct)Toll Free: 88.967.5862Visit our website to apply: www.crmcwy.org

WYOMINGPublished by theWyoming State Board of Nursing1810 Pioneer Ave.Cheyenne, Wyoming 82002Phone: 307-777-7601Fax: 307-777-3519Web Address: http://nursing.state.wy.usAgency Mission: The Wyoming State Board ofNursing is responsible for the protection of the public’shealth, welfare, and safety through the regulation ofnursing, nursing education, nursing practice, and disciplinarystandards. The responsibility of the Board ofNursing is to implement a cost-effective and efficientsystem of regulation , which meets the consumerdemand for safe, competent, ethical practitioners ofnursing which includes advanced practice nurses, registeredprofessional nurses, licensed practical nurses, andcertified nursing assistants.Nurse WSummer 2007VOL. 2 NUMBER 5R E P O R T E R“protecting the public through excellence in nursing...”T ABLE OF C ONTENTS4 Notice of Board Vacancies7 What is the Holdup?8 If Disaster Strikes11 Scope of Practice Issues13 Disciplinary Actions13 Nursing Assistant Exams- Raises for Results15 The Meaning of DelegationEXECUTIVE DIRECTORCheryl Koski, MN, RNPRACTICE AND EDUCATION CONSULTANT ANDASSISTANT EXECUTIVE DIRECTORDr. MaryBeth StepansCOMPLIANCE CONSULTANTVacantFINANCIAL AND HUMAN RESOURCES OFFICERDeebs SullivanEXECUTIVE ASSISTANTJoAnn ReidLICENSING COORDINATORDebra GotschallLICENSING COORDINATORLaVelle OjedaDISCIPLINARY ASSISTANTGwen PechacekBOARD OF NURSING MEMBERSBaerbel Merrill, MS, BSN, RNC PresidentKellie Clausen, FNP, WHCNP, RN Vice-PresidentMarguerite Herman, Consumer SecretaryKim Williamson, LPNMemberVacantMemberVacantMemberWyoming Nurse Reporter does not necessarilyendorse advertisements contained herein. Thepublisher reserves the right to accept or rejectadvertisements for Wyoming Nurse Reporter.FOR ADVERTISING INFORMATION:Greg Jonesgjones@pcipublishing.com501.221.9986 or 800.561.4686CREATED BY:Publishing Concepts, Inc.Virginia Robertson, Presidentvrobertson@pcipublishing.comwww.thinkaboutitnursing.comPublishing Concepts, Inc.14109 Taylor Loop RoadLittle Rock, AR 72223EDITION 9GreetingsFROMThe past few months have beenextremely busy for the Board. Twonew Board Members have beenappointed. They are Marguerite Hermann, aConsumer Member from Cheyenne, Wyoming,who has an extensive background as a lobbyist, ajournalist, and working with women’s issues.The other appointee is Jennifer Zettl, who is aRegistered Nurse in the Intensive Care Unit atWyoming Medical Center in Casper, WY. Bothof them have become actively involved in theBoard activities and are a welcome addition.There are two vacancies on the Board at thepresent time, one for a nurse educator and onefor a nurse administrator. Interested personsshould contact the Governor’s office.The Board has been working hard on revisingall the Board Administrative Rules andRegulations. Please watch the Board’s web siteat http://nursing.state.wy.us for notice of releaseof these Rules for Public Comment, which istentatively scheduled following the July BoardMeeting.C HERYLK OSKI, MN, RNTHEE XECUTIVED IRECTORThe Board has continued to work on theexpanded role of the certified nursing assistantwith the assistance of a sub-committee and Dr.Marcia Dale, who has devoted many hours tothis issue. The development of a Level II CNAis proposed. A Level II CNA will be able to performadditional functions that may be delegatedby a licensed nurse following additional educationand training.The Board also continues to work with theDepartment of Employment, Office of Researchand Planning on the Nursing Study which willlook at both supply and demand issues for nurses.Surveys to both employers of nurses and to nursesare planned to be sent by the Department ofEmployment.The Board looks forward to the coming yearand welcomes comments, suggestions, or questions.Please do not hesitate to visit our web siteat http://nursing.state.wy.us, e-mail us at wynursing@state.wy.us,or telephone us at 307-777-7601.W Y O M I N G N U R S E R E P O R T E R 3

NOTICE OFBOARDVACANCIESThe Wyoming State Board of Nursing has two(2) vacancies on the Board. One vacancy is for aregistered nurse in nursing education and is a twoyear term to complete an unexpired term. Theother vacancy is for a registered nurse in nursingadministration and is to complete an unexpiredthree year term. Board Members are appointed bythe Governor and must meet the statutory and eligibilityrequirements for each specific vacancy inorder to serve.Members appointed may be re-appointed toserve an additional three year term. BoardMembers appointed to fill an unexpired term maybe re-appointed to serve two additional consecutivethree year terms. Membership on the Board isrestricted to no more than one person who is associatedwith a particular agency, educational institution,corporation, or other enterprise or subsidiaryat one time.Complete statutes detailing the qualifyingrequirements for membership on the Board ofNursing can be found athttp://legisweb.state.wy.us/statutes/statutes.htm, orat the Board of Nursing web site athttp://nursing.state.wy.us. The Governor is veryinterested in giving as many citizens as possible theopportunity to participate on Boards andCommissions. Geographic diversity is a prioritywith the Governor.The following positions are vacant on the Board ofNursing:1) Registered Nurse – the RN position must bea resident of the state, licensed in good standing,currently engaged in the practice of registered nursingwith no less than five years experience in thisposition, at least three of which immediately precedeappointment. This applicant shall have atleast two years of experience in an administrativeor teaching position in a nursing education program.2) Registered Nurse – the RN position must bea resident of the state, licensed in good standing,currently engaged in the practice of registered nursingwith no less than five years experience in thisposition, at least three of which immediately precedeappointment. This applicant shall have had atleast two (2) years of experience in administrationin nursing service or public health nursing.Persons interested in applying for one of thevacancies on the Board or for an applicationshould contact Patti Burns in the Governor’sOffice at 307-777-5647, or visit the Governor’sweb site at http://www.state.wy.us/governor.Completed applications must be into theGovernor’s Office one month before the vacancydate (January 28, 2005). Persons may also contactCheryl Koski at the Board Office at 307-777-6121or ckoski@state.wy.us for further informationregarding these vacancies.4 W Y O M I N G N U R S E R E P O R T E R

3rdAnnualWho said Continuing Education can’t be fun? We are changing that forever. Join ThinkAboutItNursing and Poe Travel for aCE Cruise that will cure your overworked blues with some salsa and sun on board Carnival’s ” Valor”. While you’re soakingup the Caribbean culture, you can earn your annual CE credits AND write the trip off on your taxes. How is that for paradise?Prices for this cruise and conference are based on double occupancy (bring your friend, spouse or significant other please!)and start as low as $868 per person (not including airfare). If you won’t be attending the conference, you can deduct $75.A $250 non-refundable per-person deposit is required to secure your reservation for the cruise, BUT please ask us about ourCruise Lay Away Plan.What a week! From the beautiful Port of Miami you’re off to an island-hopping adventure. Your first stop is Nassau in TheBahamas where the beaches are uncrowded while the narrow streets are full of duty-free shops. In St. Thomas, more fabulousbeaches and a hillside of shops at Charlotte Amalie. Then the Caribbean with more than a dash of Europe in half-French half-Dutch St. Maarten, an island that charms in a thousand different ways. On this cruise, you’ll enjoy one fun experience afteranother.7 Day Eastern Caribbean ItineraryDAY PORT ARRIVE DEPARTSun. Miami 4:00 P.M.Mon. Nassau 7:00 A.M. 2:00 P.M.Tues. “Fun Day” at SeaWed. St. Thomas/ St. John* 9:00 A.M. 8:00 P.M.Thurs. St. Maarten 7:00 A.M. 6:00 P.MFri. “ Fun Day” at SeaSat. “ Fun Day” at SeaSun. Miami 8:00 A.M.*Optional shore excursion to St. John available.THE 2008 NURSING CARIBBEAN EDUCATION CRUISEAPRIL 6 -13th, 2008For more information about the cruise and thecurriculum, please log on to our website atwww.thinkaboutitnursing.com or callTeresa Grace at Poe Traveltoll-free at 800.727.1960.W Y O M I N G N U R S E R E P O R T E R 5

2007 HIGH FIVE AWARDWINNERIn a national survey of 1,600hospitals, Lander Valley Medical Center(LVMC) scored in the 90th percentile inpatient satisfaction, an extraordinarilyhigh score. LVMC’s parent company,LifePoint Hospitals, Inc., proudly gaveits top honor, the High Five Award toLVMC, which is ranked number one oftheir 51hospitals.Staff RN/LPN - Behavioral HealthPineRidge at Lander Valley is an inpatientbehavioral health unit that offersa safe haven in a warm,therapeutic environment, wherepatients can take time out from life toaddress theiremotional, psychological, orsubstance abuse issues.Staff RN – Med/Surg UnitProvide direct and indirect care to ourmedical and surgicalpatients. Work with other team membersto provide high qualitypatient care in a compassionateenvironment.What is the hold up?You want to hire a nurse or CNAWhat are some of the things that can hold up a license/certificate?Board staff often hear complaints from employers that it’s taking too long toissue a license or certificate to a potential employee. Unless the applicanthas given formal authorization to release information to employers, theBoard cannot discuss an individual’s application with anyone but the individual.However, we can tell you that if application is complete and meets the criteriafor issuance of a license/certificate, we can generally issue a (temporary orpermanent) license/certificate within one week of receipt of the application.There are many reasons that it may take the Board longer than a week toissue the license/certificate. The list below (which is included in the applicationinstructions) describes the most common reasons for delay:an unresolved “Yes answer” to the Eligibility Screening Questionsa pending complaint investigation or a Board disciplinary action againsta licensee/certificate holder;did not graduate from an approved school of nursing with a nursing certificate(LPN), degree or diploma (RN), or completed an approved CNAtraining program;has not submitted a copy of nursing education program transcript,diploma, or certificate;did not pass the SBTPE or NCLEX licensing examination, or the CNAcompetency examination;does not hold a current, permanent license from another state;has not submitted proof of U.S. Social Security number ;has not completed or submitted fingerprint cards, or delayed submittingcards;did not follow the fingerprint instructions.Please note: while an individual’s application process with the Board is confidential,we are happy to answer any questions or concerns you may haveregarding our general processes.Full time Benefits• Paid time off• Sign-on bonus• Medical, Dental, Vision, Life, Long &short term disability• 401(k) Retirement PlanContact Human ResourcesLander Valley Medical Center1320 Bishop Randall Drive, Lander, WY82520Phone 307/335-6580FAX 307/335-6237Web site: www.landerhospital.comEmail: carolyn.livingston@LPNT.netEOE.NurseSummer 2007VOL. 2 NUMBER 5WYOMINGR E P O R T E RNursing Assistant Exams- The Meaning ofRaises for ResultsDelegationFor AdvertisingInformationGreg JonesPublishing Concepts, Inc.1.800.561.4686gjones@pcipublishing.comW Y O M I N G N U R S E R E P O R T E R 7

If Disaster StrikesBy Sue HowardClinical Education SupervisorCampbell County Memorial HospitalSamantha is assisted by Paul Williams Paramedic, to ‘don’ Level C protectivesuit. Beginning from the feet up this suit requires assistance.Is your community prepared to deal with a community wide exposure to hazardousmaterials? Everyone hopes it will never happen near our homes andfamilies, but each Wyoming healthcare facility is required to have a plan andmust be prepared to activate the plan. Gillette, Wyoming is prepared. On April25, Campbell County Memorial Hospital Mission Division presented a daylongdecontamination training program involving 25 staff persons, local policeand fire personnel and the county disaster planning office. Hospital-basedhealthcare providers and environmental services staff participated in the training.The group received information on potential hazards relative to our location,which may require decontamination and treatment of victims and firstresponders. In the morning the group learned to assemble the PAPR and theLevel C protective suits. Level C suits are water resistant and have a self containedbreathing apparatus (PAPR). Instructions for the decon practice includedselecting “non-essential” staff to be in these suits. Doctors, Nurses, EMTsand Paramedics will be needed to treat victims after decontamination. A second person is needed to ‘don’ the suit. Samantha King, a CertifiedNursing Assistant, was assisted to don her suit.The Level C suit is donned on from the feet tocover the arms and head. Normal hospital glovesare worn under the suit and heavy water resistantgloves are placed over the hands and up the arms ofthe suit. Then the suit is placed over the head andzipped. An adhesive flap covers the zipper. Thegloves and booties are then taped to seal them fromoutside contamination and water.In the afternoon a larger group rehearsed setting upthe decontamination tent. A hospital plan outlinesand designates responsibilities of each task inpreparing for a Haz-Mat Drill or event.“The suit is hot and may causeclaustrophobia. The air circulatingaround your face and makes it morecomfortable.” said Samantha.Bottom right:The tent was not difficultfor a team of four to assemble.Getting ready to unfold“Decon Tent”8 W Y O M I N G N U R S E R E P O R T E R

Here it goes. . .Nonambulatory victims inthe center tunnel.The decontamination tent has 3 ‘tunnels;’ One for ambulatory male victims,one for ambulatory female victims who are able to perform selfdecon after instruction from hospital staff. A center tunnel with a showersystem is used to decontaminate non-ambulatory victims. This centertunnel has a roller system; victims are placed on back boards and rolledthrough the tunnel.WalkingMalesvictimsWalkingFemalevictimsFor all persons with potential contamination by a hazardousmaterial the first step is to remove all clothing. An assistant inthe Level C suit assists with clothing removal and givesinstructions. All clothing is red bagged and disposed of. Thenext step is the shower and scrub. Basic dish soap and warmwater are used. Every part of the body must be scrubbed. This‘shower’ takes 15 minutes.Participants in the drill were also instructed how to assist withsafe removal of the Level C suits. When removing these contaminatedsuits care must be taken to protect the person inthe suit and the person assisting with removal. Each suit is aone-time use only.For our decon training thevolunteer victims woreswim suits. In the event ofan actual Haz-Mat spill,victims would remove allclothing. Clothing wouldthen be bagged and markedas “Contaminated”. Allpersonal items would beplaced in a zip-lock bag.The victims are met at the end of the tunnelsand assisted to dry off and dress in a simplecoverall. Then the ECD staff meets each victimas they emerge from the tent, a secondtriage is performed and each victim is directedto the level of care he or she needs.So is your facility prepared? ? ?W Y O M I N G N U R S E R E P O R T E R 9

Beautiful Phoenix, AZUp To $8,000 Relo BonusAll RNS & New Grads Welcome• Join Medical Center rated “Best in the Nation”-Magnet Recognized• $3,000 additional Relo Bonus• Comprehensive Benefits w/401k• Ask about Free Medical Plan!• Base up to $38.90 per hour Plus 15% ShiftDiffs!, Double time!!• Full-Time RN Positions-not travel • Day Shiftsavailable…Call now!• Phoenix, Glendale, Mesa, more • 300 + SunnyDays per yearJeff Martin 800.304.3095 Ext-16jmartin@beck-field.com10 W Y O M I N G N U R S E R E P O R T E R

S COPE OF P RACTICE I SSUESCheryl Koski, MN, RN, Executive DirectorThe following Advisory Opinions were issued at the April9–12, 2007 Board MeetingEXPEDITED PARTNER THERAPY - APRNAdvisory Opinion Number:06 - 175Board Meeting Date:April 9-12, 2007The Practice Committee reviewed a request from theWyoming Department of Health, STD/Hepatitis Programregarding Expedited Partner Therapy. Male partners ofdiagnosed female patients are treated using clear writtenstanding orders to follow protocol.Upon recommendation of the Practice Committee, theBoard voted that it is within the scope of nursing practicefor an APRN to provide Expedited Partner Therapy. TheBoard recognizes that it is not a customary standard of practice,but supports the practice of Expedited Partner Therapyby APRNs as an optional form of STD case management inorder to address the national rise in gonorrhea and chlamydiamorbidity.Approved: April 11, 2007Reviewed:Revised:ADMINISTRATION OF PRE-PACKAGED ANTI-VIRAL MEDICATIONS DURING A FLU PANDEMIC– LICENSED NURSESAdvisory Opinion Number:07 - 173Board Meeting Date:January 8–11, 2007flu pandemic, as long as there is no mixing or repackagingof medications from the manufacturer.Approved: January 10, 2007Reviewed:Revised:RESPIRATORY FIT TESTING – MEDICAL CLEAR-ANCE – RN, LPN, APRNAdvisory Opinion Number: 07 - 176Board Meeting Date: April 9-12, 2007The Practice Committee reviewed a request fromWyoming Medical center regarding scope of practice ofthe RN and medical clearance for respiratory fit testing.Upon recommendation of the Practice Committee, theBoard voted it is not within the scope of practice of anRN or LPN to clear a patient with an identified healthproblem for respiratory fit testing. However, it is withinthe scope of practice of an APRN. The RN may completethe OSNA survey, and if there are no identifiedhealth problems, may clear the patient for respiratory fittesting.Approved: April 11, 2007Reviewed:Revised:The Practice Committee reviewed a request for anAdvisory Opinion from Tom Henry, RN, as to whether itis within the scope of practice for a licensed nurse toadminister a pre-packaged course of antiviral medicationsfor mass antiviral dispensing in a flu pandemic.Upon review of the information, the Practice Committeerecommended and the Board voted that it is within thescope of practice of a licensed nurse to administer prepackagedmedications under the lawful order of the county/statehealth officer for mass antiviral dispensing in aW Y O M I N G N U R S E R E P O R T E R 11

Powell Valley Healthcare is seeking individuals committed to being part of anorganization where customers come first. Compassionate, team players pleaseapply! Competitive wages, excellent benefits.Powell, Wyoming is located in a beautiful valley just a short drive from theentrance to Yellowstone National Park. Wildlife and sunshine abound. A paradisefor outdoor enthusiasts and those who love small town living yet still closeenough to the bigger city. Only 90 miles from Billings, Montana.RN's, LPN's, and C.N.A.'s-Full and part time positions, flexibleschedules.Call 754-2267 or 1-800-428-1398 ext. 728 for moreinformation or an application.www.pvhc.org2100 W. Sunset, Riverton, WY 82501Riverton Memorial Hospital is a 70-bed, acute care facility,located near the Wind River Mountains. We offer excellentbenefits, 401(k)/ESOP/ESPP, and a $6,000 recruitment bonusfor Registered Nurses.We are presently looking for an ER/ICU Manager, and ER/ICUNurses, current WY License, BLS, ACLS and previous experiencedesired. If you are interested in being part of our progressiveteam, contact Human Resources at (307) 857-3465or fax your resume and application to (307) 857-3586.Application available online at www.riverton-hospital.com,EEOC Employer.EQUAL OPPORTUNITY EMPLOYERValuedAt Wyoming Medical Center, webelieve in the value of eachperson.TrustedNurses are encouraged toparticipate in the sharedgovernance process because wetrust their insight.SkilledWe provide the tools and trainingto ensure nurses are confident intheir skills.Join us as we complete ourjourney to Magnetcertification.1233 E 2nd Street, Casper, Wyomingwww.wyomingmedicalcenter.comSammie Stephens, RNNurse Recruiter307.577.2669sstephens@wmcnet.org12 W Y O M I N G N U R S E R E P O R T E R

DISCIPLINARY ACTIONSWYOMING STATE BOARD OF NURSINGNancy Flury, RN5 year Conditional License Impairment 4/12/07Joseph Piccoli, CNARevoke Sexual Battery 6/8/07Nursing Assistant Exams –Raises for ResultsBy Toni Decklever, MA, RNCNA Exam Coordinatortonisrn@gmail.comInstant everything is the name of the game these days. The faster the better!Speed and more speed is what we want and demand. Sometimes it ispossible, sometimes not. It all depends on the reliability of the technologywe are working with.Remember the days when we had to wait six to eight weeks to find outwhether we passed our state board exam? I remember a fellow nursetelling me, “If you get something from the board of nursing in a big manilaenvelope, that’s a good thing – because it means you passed and got yourlicense. If something comes in a regular white envelope, that’s bad news.”Having to wait for things helped teach us patience – well for some of us.But, like everything else in our modern technological world, this is alsochanging. Now, nursing board exams are computerized and the candidateknows in relatively short order whether they will receive their license.The state exam for nursing assistants has also undergone changes usingcomputer technology and the speed of receiving results has improved.The process is fairly simple, but not without possible glitches.The exam for nursing assistants consists of a written and skills exam.Once completed, the answer sheets are faxed to a waiting computer,scored, and the results are faxed back to the testing site, USUALLY withinfifteen minutes of being sent. Notice the word USUALLY. USUALLYmeans – if technology is working on this end AND on the other end, thecandidate will know that day whether they passed the exam. If fax technologyis not working, the candidate will have to wait because the testshave to be sent to the testing company to be hand scored.HOWEVER, and I must emphasize again, HOWEVER – passing the CNAexam DOES NOT mean that the candidate is a Certified NursingAssistant. What this means is they have completed this portion of thecertification process. To be certified, official results from the testingagency must be sent to the board of nursing, all paperwork must be completed,and the candidate must have a clean background check. Oncethis is done, the candidate receives their certificate in the mail.A few months ago, a candidate answer sheet was faxed according to procedure.The evaluator waited longer than the normal time limit and did notreceive the results. A phone call to the help desk revealed that somethinghad happened within the system and the results would not be accessiblethat day. The exam coordinator was informed that the test would have tobe mailed and hand scored.When the candidate was told this news, he became furious and indignanttowards the evaluator. The reason for his angry outburst? His facility hadtold him he would receive a raise as soon as he had the results of hisexam. Having to wait a couple of weeks was denying him of money hewould have started receiving that day if everything had worked correctly.As the Exam Coordinator for the state, this is not the first time I haveheard about “raises for exam results.” Increasing pay once the nursingassistant becomes certified is a more common practice and is a better andfair way of implementing this benefit. Having this type of policy wouldhave prevented the above situation from occurring.As a nursing assistant exam evaluator, one of the best parts of the job ishanding the candidate the piece of paper that states they have passed theexam. They are happy and excited, as to be expected. Though, sometimesthings happen that are beyond the evaluator’s control and gettingresults might not happen that day. For facilities that have a “raise forresults” type policy, maybe this could be reconsidered to a “raise upon certification”policy. Certificates are normally issued about two to threeweeks after a candidate has tested, if the entire process is complete.As a reminder, if the candidate does not pass either portion of the nursingassistant exam, they must be removed from a patient care position andmay not return to this type of work until they receive their certification.Technology is a wonderful thing. It allows us to progress, advance, andmake improvements in record time. But, it is not perfect yet. We need toallow for that and not create situations that make the experience negativefor the all those involved.W Y O M I N G N U R S E R E P O R T E R 13

ThanksTo our advertisers!Without your help thismagazine would not bepossible!NEXT CLASS BEGINS JUNE 4, 2007OnlineneRNRefresher er Course Latest updates in nursing care and Self-paced learning resources and activitiescomplement content presentations Preceptored clinical experience in yourhome community Learner support available viaWeb, e-mail, phone, and faxApproved by theWyoming Boardof NursingFor complete info, visit www.udel.edu/DSP/rnrefresherFREECLASSROOMDEMOCONTINUING EDUCATION COURSES @ LEARNINGEXT.COMTHERIGHTTIME.THERIGHTPROGRAM.GET YOUR BSN –Without Putting Your Life on Hold.See for yourself with a free virtual classroom demo.Call 800-571-4934Visit JacksonvilleU.com/PC06Jacksonville University’s School of Nursing is accredited by the Commissionon Collegiate Nursing Education (CCNE). | Financial aid opportunitiesavailable. | Made available by University Alliance Online. | ©2006 BiskEducation, Inc. All rights reserved. | SC 191734ZJ1 | MCID 2742AcclimationofInternationalNursesintoUS Nursing Practice6.6ContactHours | $40Confronting ColleagueChemical Dependency3.3ContactHours| $20Delegating Effectively4.2ContactHours | $25Disciplinary Actions: What Every NurseShould Know4.8 Contact Hours | $29Diversity: Building Cultural Competence6.0ContactHours | $36UNLIMITED, 24-HOUR ACCESSTO ENGAGING NURSING CE CONTENT@ LEARNINGEXT.COMDocumentation:ACriticalAspectofClientCare5.4ContactHours|$32End-of-Life Care and Pain Management3.0ContactHours | $18Ethics of Nursing Practice4.8 Contact Hours | $29Medication Errors: Detection & Prevention6.9ContactHours | $41NursePracticeActsCECoursesParticipants: AR, IA, ID, KY, MA, MN,MO,NC,ND,NM,NV,OH,VA,WV-PN/RN2.0ContactHours | $12Patient Privacy5.4ContactHours | $32Professional Accountability&LegalLiabilityforNurses5.4ContactHours | $32Respecting Professional Boundaries3.9ContactHours | $23Sharpening Critical Thinking SkillsforCompetentNursingPractice3.6ContactHours | $22E-LEARNING FOR THE NURSING COMMUNITY14 W Y O M I N G N U R S E R E P O R T E R

The Meaning of DelegationIn the last issue of The Reporter, anarticle proposed expanding the role ofthe certified nursing assistant/nurse aideto include more advanced skills. Thistopic is being considered because of the nursing shortage andthe need to have an assistant for the licensed nurse, so thatmore time can be spent performing those responsibilities thatrequire the education of a licensed practical nurse or a registerednurse. It is a known fact that each level of care provider,registered nurse, licensed practical nurse, or certified nursingassistant completes a specified curriculum. The new level ofcertified nursing assistant/nurse aide would complete a new curriculumthat is now being developed for approval, just as thecurrent certified nursing assistant/nurse aide completes anapproved curriculum. All levels of care providers completetheir education in an educational institution (or a healthcarefacility for a Nurse Aide Training and Competency Evaluationprogram) and practice within the scope of practice or scope offunctions for a certified nursing assistant determined by theWyoming State Board of Nursing. In reality, it is the registerednurse (RN) that holds the responsibility and accountability forthe provision of nursing care, regardless of who performs thenursing function. However, the RN may delegate componentsof care.The American Nurses Association and the NationalCouncil of State Boards of Nursing have clearly stated thatdecisions related to delegation are based on the fundamentalprinciples of protection of the health, safety, and welfare of thepublic. The RN is the one responsible and accountable for theprovision of nursing practice. Direction of care is made by theRN, and the RN determines the appropriate utilization of anyassistant involved. The nursing process, commonly brokendown into assessment, nursing diagnosis, implementation, andevaluation, requires nursing judgment that precludes delegation.These functions cannot be delegated. It is components ofcare that may be delegated based upon the RN’s judgment ofthe condition of the patient, competence of those members onthe nursing team, and the degree of supervision that will berequired of the RN if a task is delegated. Before delegation canoccur, the RN must know the level of training the nursing assistant/nurseaide has, the cultural competence, and experience.The nursing assistant/nurse aide must be able to articulate backto the RN what expectation the RN has for the performance ofa task and must be willing to accept the responsibility for completingthe task. Communication must be an open channelgoing both directions so that explanations can be given andquestions asked. A task or function that has been delegated bythe licensed nurse to a certified nursing assistant cannot be redelegatedto another by the certified nursing assistant.The RN applies five Rights of Delegation. These are theright task, under the right circumstance, to the right person,with the right directions and communication, and under theright supervision and evaluation. Professional judgment andcritical thinking are the essence of making the process of delegationlead to efficiency and the best utilization of members ofthe nursing team. The RN remains accountable for the nursingcare to ensure patient safety; decision to delegate; verificationof the delegatee’s competency to perform the tasks; providingdirection; performance of the delegated task; and evaluation ofthe effectiveness of the delegated nursing task or interventionsperformed.In order for delegation to work, there must be standards onwhich to base the concept of delegation. The first standard isthat the RN must assess the needs and condition of the patient,potential for harm, stability of the patient’s condition, complexityof the task, predictability of the outcomes, ability of the staffto whom the task is delegated, and the context of other patientneeds.Administration must understand and abide by the principlethat nursing assistants/nurse aides may complement theRN/LPN in performing nursing functions, but not substitute forthe licensed personnel. The delegating nurse shall be readilyavailable either in person or by telecommunication. One of thegoals of increasing the skills of a Level II certified nursing assistant/nurseaide is to increase the one-on-one time of theRN/LPN and patient. The assessment, nursing diagnosis, planning,implementation, and evaluation that only the RN can dorequires time that might be made available if those tasks thatcan be properly and safely performed by the nursingassistant/nurse aide are delegated. Licensed personnel and nursingassistants/nurse aides should work as a team, within theirscope of practice, to give the highest level of patient care forthe protection of the health, safety, and welfare of the public.W Y O M I N G N U R S E R E P O R T E R 15

WYOMING STATE BOARD OF NURSING1810 Pioneer Ave.Cheyenne, Wyoming 82002Presorted StandardU.S. Postage PaidLittle Rock, ARPermit No. 2437