| (a) Tasks Which are Most Commonly Delegated. By way
of example, and not in limitation, the following nursing tasks are
ones that are most commonly the type of tasks within the scope of
sound professional nursing practice to be considered for delegation,
regardless of the setting, provided the delegation is in compliance
with §224.6 of this title (relating to General Criteria for Delegation)
and the level of supervision required is determined by the RN in accordance
with §224.7 of this title (relating to Supervision):
(1) non-invasive and non-sterile treatments;
(2) the collecting, reporting, and documentation of
data including, but not limited to:
(A) vital signs, height, weight, intake and output,
capillary blood and urine test;
(B) environmental situations;
(C) client or family comments relating to the client's
care; and
(D) behaviors related to the plan of care;
(3) ambulation, positioning, and turning;
(4) transportation of the client within a facility;
(5) personal hygiene and elimination, including vaginal
irrigations and cleansing enemas;
(6) feeding, cutting up of food, or placing of meal
trays;
(7) socialization activities;
(8) activities of daily living; and
(9) reinforcement of health teaching planned and/or
provided by the registered nurse.
(b) Discretionary Delegation Tasks.
(1) In addition to General Criteria for Delegation
outlined in §224.6 of this title, the nursing tasks which follow
in paragraph (2) of this subsection may be delegated to an unlicensed
person only:
(A) if the RN delegating the task is directly responsible
for the nursing care given to the client;
(B) if the agency, facility, or institution employing
or utilizing unlicensed personnel follows a current protocol for the
delegation of the task and for the instruction and training of unlicensed
personnel performing nursing tasks under this subsection and that
the protocol is developed with input by registered nurses currently
employed in the facility and includes:
(i) the manner in which the instruction addresses the
complexity of the delegated task;
(ii) the manner in which the unlicensed person demonstrates
competency of the delegated task;
(iii) the mechanism for reevaluation of the competency;
(iv) an established mechanism for identifying those
individuals to whom nursing tasks under this subsection may be delegated;
(v) how the unlicensed person will report back to the
delegating RN or supervising RN; and
(vi) periodic re-demonstration of competency.
(C) if the protocol recognizes that the final decision
as to what nursing tasks can be safely delegated in any specific situation
is within the specific scope of the RN's professional judgment.
(2) the following are nursing tasks that are not usually
within the scope of sound professional nursing judgment to delegate
and may be delegated only in accordance with, §224.6 of this
title and paragraph (1) of this subsection. These types of tasks include:
(A) sterile procedures--those procedures involving
a wound or an anatomical site which could potentially become infected;
(B) non-sterile procedures, such as dressing or cleansing
penetrating wounds and deep burns;
(C) invasive procedures--inserting tubes in a body
cavity or instilling or inserting substances into an indwelling tube;
and
(D) care of broken skin other than minor abrasions
or cuts generally classified as requiring only first aid treatment.
(c) Nursing Tasks Prohibited from Delegation By way
of example, and not in limitation, the following are nursing tasks
that are not within the scope of sound professional nursing judgment
to delegate:
(1) physical, psychological, and social assessment
which requires professional nursing judgment, intervention, referral,
or follow-up;
(2) formulation of the nursing care plan and evaluation
of the client's response to the care rendered;
(3) specific tasks involved in the implementation of
the care plan which require professional nursing judgment or intervention;
(4) the responsibility and accountability for client
health teaching and health counseling which promotes client education
and involves the client's significant others in accomplishing health
goals; and
(5) administration of medications, including intravenous
fluids, except by medication aides as permitted under §224.9
of this title (relating to The Medication Aide Permit Holder).
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