Delegation of Nursing Tasks
The registered nurse transfers the performance of selected nursing tasks to competent individuals in selected situations. The registered nurse retains the responsibility and accountability for the nursing care of the client. The registered nurse delegating the task supervises the performance of unlicensed persons.
This guide outlines procedural guidance for many tasks the registered nurse may delegate in the school setting. It is important to note what is NOT allowed to be delegated by registered nurses.
WHAT CAN AND CANNOT BE DELEGATED BY THE REGISTERED NURSE:
The following is outlined in The Washington State Nurse Practice Act RCW 18.79.260:
What MAY BE DELEGATED by the Registered Nurse in the school setting (if, within nurse’s clinical judgment, the task may be safely delegated to an unlicensed person):
Exceptions to Nurse Practice Act in School Law and Nursing Commission Opinion:
•Administration of oral, topical, eye drops, ear drops and nasal spray medication in school (RCW 28A.210.260 TO 270).
•Gastrostomy tube feedings (Unlicensed Guidelines: March 1991).
•Administration of epinephrine to prevent anaphylactic shock in students with known allergic reactions (WASDA Policy 3416).
What MAY NOT BE DELEGATED by the Registered Nurse:
The registered nurse may not:
•Delegate the administration of rectal medications or injections (see exception above).
•Delegate acts requiring substantial skill.
•Delegate piercing or severing of tissues (except by epinephrine auto-injector).
•Delegate acts that require nursing judgment.
Some common requests in school that shall NOT be delegated by Registered Nurse:
•Administration of rectal or injectable (except epinephrine using auto-injectors) medication. These can only be administered by a student’s adult family members, registered nurses, licensed practical nurses, or official Parent-Designated adult (PDA).
•Medical procedures that the registered nurse determines are not in the best interest of the student.
•Testing a student’s blood glucose level.
•Administering insulin or glucagon
•The registered nurse is accountable to ensure safety of the student by assessment, critical analysis of data, clinical decision-making, planning, interventions, and client outcome of nursing care.
•The registered nurse may delegate specific tasks, allowed by law, after determining safety for the client.
•The registered nurse must always ask the question, “Am I willing to take responsibility for my actions?” before performing or delegating nursing care.
•Any student for whom the registered nurse is accountable for nursing care.
•Any non-licensed person who receives delegation from the registered nurse.
When a student is participating in school-sponsored activities, the school nurse is responsible as an employee or a contractor of the district. School-sponsored activities may occur during the school day, during non-school hours, on-campus activities, and off-campus activities.
Procedures to occur at any time:
Family requests and gives written authorization for medical orders to be performed at school.
Family obtains and brings signed orders and directions from their health care provider.
Family (or other adult) brings medication/equipment/supplies to school.
•School staff accepts and documents the receipt of medication/equipment/supplies.
•Registered nurse assesses student health status and need for medication/procedure at school.
•Registered nurse confirms appropriate orders of medication/procedure.
Registered nurse develops and completes a written care plan that describes explicit step-by-step actions of the procedure, signs of problems that might occur with the procedure, and what actions to take if problems occur.
Registered nurse completes or ensures that medication/procedure log matches health care provider orders.
If Registered nurse determines that delegation IS NOT APPROPRIATE for the administration of medication or performance of medical procedure:
Registered nurse performs or designates another registered nurse or a licensed practical nurse (LPN) to perform the procedure or administer the medication.
If Registered nurse determines that delegation IS APPROPRIATE for the administration of medication or performance of medical procedure:
Registered nurse, in collaboration with building administrator, identifies appropriate, competent, available, and willing school staff to accept responsibility to administer oral medication or perform procedure for student.
Registered nurse delegates (one-on-one) for school staff to administer medication or perform procedure with written, explicit instructions that includes step-by-step actions of the procedure, signs of problems that might occur with the procedure, and what actions to take if problems occur.
Registered nurse provides and documents ongoing monitoring and supervision of staff members who perform nursing procedures under nurse delegation.
·Registered Nurse Delegation in School Settings (2019)
•RCW 18.79 and RCW 18.130
Nurse Practice Act of Washington State
Nursing Care and Regulation of Health Professions – Uniform Disciplinary Act
•OSPI Health Services Website
•Guidelines for Administering Medication in School
•Staffing Model download from OSPI Website
•Nursing Care Quality Assurance Commission: Scope of Practice Decision Tree
•National Association of Nurses: Delegation Position Statement (2019)
•SNOW Delegation Position
https://higherlogicdownload.s3.amazonaws.com/NASN/91d5318d-5fc3-486f-ab03-74aaca783c82/UploadedImages/SNOW%20Documents/Delegation_SNOW_Position_Statement_05-17.pdf•National Council of State Boards of Nursing: Delegation Position Statement