may delegate - Nevada State Board of Nursing

The Nevada
Nurse Practice Act
Chris Sansom, MSN, RN
Director of Operations
Nevada State Board of Nursing
The Nevada Nurse Practice Act
• Nevada Revised Statutes – NRS 632
 Bill passed by the Assembly and Senate and signed
into law by the Governor
• Nevada Administrative Code – NAC 632
 Adopted by the Board of Nursing to carry out the
intent of the law
• Practice Decisions
• Scope of Practice
Roles and Responsibilities
• Registered Nurse
 Independent, dependent and interdependent
• Licensed Practical Nurse (LPN)
 At the direction of RN, APN, licensed
physician, licensed physician assistant, or
licensed podiatric physician
Roles and Responsibilities
• Certified Nursing Assistant (CNA)
 At the direction and under supervision of RN
or LPN
• Unlicensed Assistive Personnel (UAP)
But in both [hospitals and private
houses], let whoever is in charge keep
this simple question in her head, (not,
how can I always do this right thing
myself, but) how can I provide for this
right thing to be always done?
- Florence Nightingale
• NAC 632.047 Delegation defined.
“Delegation” means entrusting the
performance of a delegable nursing duty to
a person who is qualified and competent to
perform the duty.”
What does it mean?
Nurses possess the knowledge, skill
and ability to coordinate and
supervise the delivery of nursing care,
which includes the assignment of
nursing tasks to others.
Nursing Process: assess, diagnose,
outcomes, plan, implement, evaluate.
ANA’s Definition
• The transfer of responsibility for the performance
of an activity from one individual to another while
retaining accountability for the outcome.
Example: The nurse, in delegating an activity to an
unlicensed individual, transfers the responsibility
for the performance of the activity but retains
professional accountability for the overall care.
Responsibility – Allocated and accepted
The Nurse Practice Act (NPA)
NAC 632.212 (2) An RN shall
demonstrate competence in:
(f) Delegating appropriate duties to
other persons;
(g) Supervising a person to whom the
RN has delegated nursing duties;
(h) Maintaining accountability in the
delegation of care
NPA Continued
NAC 632.222
(1) RN may delegate nursing care to other
personnel and supervise other personnel in the
provision of that care if those persons are
qualified to provide that care.
(2) RN shall perform or supervise any act
necessary to ensure the quality and
sufficiency of delegated care provided to a
NPA Continued
NAC 632.222
(3) Before delegating the RN shall determine:
(a) Amount of direction
(b) Complexity of care
(c) Educational preparation and
(d) Policy and procedures
(4) The RN who delegates nursing care or
duties is responsible for the care.
Still confused?
• Case study:
Right task – is it safe, predictable outcome
Right circumstance – client condition/setting,
Right person – within their scope of practice,
Right direction/communication – clear,
Right supervision – follow-up
Not Delegable
• Nursing judgment except to another RN
• Nursing assessment
• Evaluation of patient outcomes based on
• Any act not within the persons scope of
• Any act that another reasonable and
prudent nurse would not delegate
RN – Delegation Regulations
• NAC 632.212
RN duties
• NAC 632.220
Medications and treatment
• NAC 632.224
• NAC 632.244
Unauthorized acts prohibited
• NAC 632.248
Assignment to UAPs
• NAC 632.340
Exemptions from required
licensing or certification
LPN – Delegation Regulations
• NAC 632.230 Limitations; Supervision;
• NAC 632.450 Procedures delegable to
• NAC 632.455 Procedures not delegable
to LPNs
Nurse Apprentices
• NAC 632.063
• NAC 632.252
• NAC 632.253
Nursing student
Performance of tasks
Prohibited acts
Unlicensed Assistive Personnel
• NAC 632.226 (2-4)(8) – Employment
as school nurse; Qualified person
Medication Aides-Certified (MA-C)
• RN delegates medication administration
to the MA-C
• Long term care facilities only
• May not give: enteral or parenteral, NG or
G-tube, controlled substances
• May not take/transcribe orders, calculate
dosages, destroy meds, perform
treatments, assess, evaluate errors,
conduct patient teaching
Responsibility of the nurse
• Patient advocacy
• Maintain accountability
• Choose to delegate (assign) or not to
delegate (assign)
• Know the skill level of the healthcare
team to provide safe and competent care
to your patients
• Evaluate outcomes
Unprofessional Conduct
• The following acts related to delegation
are considered unprofessional conduct by
the Board and are grounds for disciplinary
• NAC 632.890 (6-8), (15), (19), (24)
(27-28), (30), (31), (33), (34), (39)
Delegation Decision-making Tree,
National Council of State Boards of
Scope of Practice Decision Tree
Nevada State Board of Nursing
American Nurses Association
Draft Principles for Delegation by Registered Nurses
to Unlicensed Assistive Personnel (UAP), 2012
National Council of State Boards of Nursing
Working with Others: A Position Paper, 2005
Delegating Effectively Video (on their website and
Nevada State Board of Nursing