The registered professional nurse shall provide supervision
of all nursing tasks delegated to unlicensed persons in accordance
with the following conditions. These criteria apply to all instances
of RN delegation and supervision of delegation for clients with acute
conditions or in acute care environments.
(1) The degree of supervision required shall be determined
by the delegating RN or the RN who assumes supervisory responsibilities
after an evaluation of appropriate factors involved including, but
not limited to, the following:
(A) the stability of the client's status in relation
to the task(s) to be delegated;
(B) the training, experience, and capability of the
unlicensed person to whom the nursing task is delegated;
(C) the nature of the nursing task being delegated;
and
(D) the proximity and availability of the RN to the
unlicensed person when the nursing task will be performed.
(2) The RN or an RN who assumes supervisory responsibilities
under this section shall be available in person or by telecommunications,
and shall make decisions about appropriate levels of supervision using
the following examples as guidelines:
(A) In situations where the RN's regularly scheduled
presence is required to provide nursing services, including assessment,
planning, intervention and evaluation of the client whose health status
is changing and/or to evaluate the client's health status, the RN
must be readily available to supervise the unlicensed person in the
performance of delegated tasks. Settings include, but are not limited
to acute care, long term care, rehabilitation centers, and/or clinics
providing public health services.
(B) In situations where nursing care is provided in
the client's residence but the client's status is unstable and unpredictable
and the RN is required to assess, plan, intervene, and evaluate the
client's unstable and unpredictable status and need for skilled nursing
services, the RN shall make supervisory visits at least every fourteen
calendar days. The RN shall assess the relationship between the unlicensed
person and the client to determine whether health care goals are being
met. Settings include, but are not limited to group homes, foster
homes and/or the client's residence.
(C) In situations where the RN assumes supervision
of UAPs performing tasks that have been delegated by another RN, if
performance of the tasks by the UAP poses a risk of patient harm,
the supervising RN must intervene as required to stabilize a patient's
condition and prevent complications and then communicate with the
delegating RN.
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