ThanksTo our advertisers!Without your help thismagazine would not bepossible!NEXT CLASS BEGINS JUNE 4, <strong>2007</strong>OnlineneRNRefresher 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 the<strong>Wyoming</strong> <strong>Board</strong><strong>of</strong> <strong>Nursing</strong>For 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 <strong>of</strong> <strong>Nursing</strong> is accredited by the Commissionon Collegiate <strong>Nursing</strong> Education (CCNE). | Financial aid opportunitiesavailable. | Made available by University Alliance Online. | ©2006 BiskEducation, Inc. All rights reserved. | SC 191734ZJ1 | MCID 2742Acclimation<strong>of</strong>International<strong>Nurse</strong>sintoUS <strong>Nursing</strong> Practice6.6ContactHours | $40Confronting ColleagueChemical Dependency3.3ContactHours| $20Delegating Effectively4.2ContactHours | $25Disciplinary Actions: What Every <strong>Nurse</strong>Should Know4.8 Contact Hours | $29Diversity: Building Cultural Competence6.0ContactHours | $36UNLIMITED, 24-HOUR ACCESSTO ENGAGING NURSING CE CONTENT@ LEARNINGEXT.COMDocumentation:ACriticalAspect<strong>of</strong>ClientCare5.4ContactHours|$32End-<strong>of</strong>-Life Care and Pain Management3.0ContactHours | $18Ethics <strong>of</strong> <strong>Nursing</strong> Practice4.8 Contact Hours | $29Medication Errors: Detection & Prevention6.9ContactHours | $41<strong>Nurse</strong>PracticeActsCECoursesParticipants: AR, IA, ID, KY, MA, MN,MO,NC,ND,NM,NV,OH,VA,WV-PN/RN2.0ContactHours | $12Patient Privacy5.4ContactHours | $32Pr<strong>of</strong>essional Accountability&LegalLiabilityfor<strong>Nurse</strong>s5.4ContactHours | $32Respecting Pr<strong>of</strong>essional Boundaries3.9ContactHours | $23Sharpening Critical Thinking SkillsforCompetent<strong>Nursing</strong>Practice3.6ContactHours | $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 <strong>of</strong> DelegationIn the last issue <strong>of</strong> The <strong>Reporter</strong>, anarticle proposed expanding the role <strong>of</strong>the certified nursing assistant/nurse aideto include more advanced skills. Thistopic is being considered because <strong>of</strong> 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 <strong>of</strong> a licensed practical nurse or a registerednurse. It is a known fact that each level <strong>of</strong> care provider,registered nurse, licensed practical nurse, or certified nursingassistant completes a specified curriculum. The new level <strong>of</strong>certified 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 <strong>of</strong> care providers completetheir education in an educational institution (or a healthcarefacility for a <strong>Nurse</strong> Aide Training and Competency Evaluationprogram) and practice within the scope <strong>of</strong> practice or scope <strong>of</strong>functions for a certified nursing assistant determined by the<strong>Wyoming</strong> <strong>State</strong> <strong>Board</strong> <strong>of</strong> <strong>Nursing</strong>. In reality, it is the registerednurse (RN) that holds the responsibility and accountability forthe provision <strong>of</strong> nursing care, regardless <strong>of</strong> who performs thenursing function. However, the RN may delegate components<strong>of</strong> care.The American <strong>Nurse</strong>s Association and the NationalCouncil <strong>of</strong> <strong>State</strong> <strong>Board</strong>s <strong>of</strong> <strong>Nursing</strong> have clearly stated thatdecisions related to delegation are based on the fundamentalprinciples <strong>of</strong> protection <strong>of</strong> the health, safety, and welfare <strong>of</strong> thepublic. The RN is the one responsible and accountable for theprovision <strong>of</strong> nursing practice. Direction <strong>of</strong> care is made by theRN, and the RN determines the appropriate utilization <strong>of</strong> 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 <strong>of</strong>care that may be delegated based upon the RN’s judgment <strong>of</strong>the condition <strong>of</strong> the patient, competence <strong>of</strong> those members onthe nursing team, and the degree <strong>of</strong> supervision that will berequired <strong>of</strong> the RN if a task is delegated. Before delegation canoccur, the RN must know the level <strong>of</strong> 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 <strong>of</strong>a 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 <strong>of</strong> 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. Pr<strong>of</strong>essional judgment andcritical thinking are the essence <strong>of</strong> making the process <strong>of</strong> delegationlead to efficiency and the best utilization <strong>of</strong> members <strong>of</strong>the nursing team. The RN remains accountable for the nursingcare to ensure patient safety; decision to delegate; verification<strong>of</strong> the delegatee’s competency to perform the tasks; providingdirection; performance <strong>of</strong> the delegated task; and evaluation <strong>of</strong>the effectiveness <strong>of</strong> the delegated nursing task or interventionsperformed.In order for delegation to work, there must be standards onwhich to base the concept <strong>of</strong> delegation. The first standard isthat the RN must assess the needs and condition <strong>of</strong> the patient,potential for harm, stability <strong>of</strong> the patient’s condition, complexity<strong>of</strong> the task, predictability <strong>of</strong> the outcomes, ability <strong>of</strong> the staffto whom the task is delegated, and the context <strong>of</strong> 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 <strong>of</strong> thegoals <strong>of</strong> increasing the skills <strong>of</strong> a Level II certified nursing assistant/nurseaide is to increase the one-on-one time <strong>of</strong> 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 <strong>of</strong> practice, to give the highest level <strong>of</strong> patient care forthe protection <strong>of</strong> the health, safety, and welfare <strong>of</strong> the public.W Y O M I N G N U R S E R E P O R T E R 15
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