OAR 851-047-0045: Process for RN Initial Delegation

(1) The RN may proceed with delegation process only when they determine delegation is a safe care delivery option for their client. Delegation is a safe care delivery option for the client only when all the following are met: (a) The client’s condition for which the nursing procedure is ordered is stable and predictable; (b) The client does not require assessment during performance of the nursing procedure; (c) The performance of the nursing procedure does not require interpretation or independent decision-making; (d) The results of performing the nursing procedure are reasonably predictable; (e) The selected client and circumstances of the delegation are such that the consequences of performing the nursing procedure are not life- threatening and delegation of the nursing procedure’s performance to the UAP poses minimal risk to the client; (f) The client’s environment of care supports the safe performance of the nursing procedure for the client by the UAP; (g) The nursing procedure will be performed by the UAP at a frequency that allows for the UAP’s continued safe performance; (h) The UAP possesses the skills necessary for learning and safely performing the nursing procedure; (i) The UAP communicates they are willing and able to perform the nursing procedure for the client; and (j) The RN has the appropriate resources necessary to fulfill nursing practice and delegation process responsibilities with the client and the UAP including: (A) Availability to provide ongoing assessment of the client at the frequency deemed necessary by the RN to determine the ongoing stability and predictability of the client’s condition; and (B) Availability to provide ongoing competency validation of the authorized UAP’s performance of the nursing procedure for the client. (2) The RN must provide procedural guidance and initial direction to the UAP by : (a) Educating the UAP through providing information about the nursing procedure and why it is necessary in the management or treatment of the client’s condition; and (b) Providing documented step-by-step evidence-based instructions for the performance of the nursing procedure for the client. The documented instructions must: (A) Be respectful of the client’s needs, choices and dignity; (B) Be documented in a manner that is understood by the UAP, and (C) Identify: (i) How to perform the nursing procedure for the client; (ii) Infection control practices to follow when performing the nursing procedure; (iii) Client risks associated with the nursing procedure’s performance; (iv) Observation of the client including desired effects, side effects, potential adverse reactions and emergencies related to performance of the nursing procedure on the client; (v) Actions to take in response to observations; and (vi) Documentation requirements when performing the nursing procedure. (3) After providing procedural guidance and initial direction as required in section (2) of this rule, the RN must: (a) Evaluate the UAP’s performance of the nursing procedure; (b) Address questions the UAP and client may have; and (c) Amend the documented instructions as deemed appropriate by the RN. (4) The RN who validates the UAP’s accurate performance of the nursing procedure as outlined in section (3) of this rule may authorize the UAP to perform the nursing procedure for the client for a period not to exceed 90 days. The authorization period must be determined through clinical judgment and based on the RN’s evaluation of data that include but are not limited to: (a) The nursing procedure delegated; (b) Whether the RN has previously authorized the same UAP to perform the same nursing procedure; (c) The length of time the RN has worked with the UAP as a health care team member; (d) The frequency of client assessment deemed necessary to determine the ongoing stability and predictability of the client’s condition related to their assessed baseline; and (e) The client’s responses to other actual or potential health problems that may impact the client’s condition for which the nursing procedure is ordered. (5) The RN must: (a) Document the length of the UAP’s initial authorization period; (b) Provide documented instructions for the UAP to reference; (c) Instruct the UAP to adhere to the instructions when performing the nursing procedure for the client; (d) Instruct the UAP that the authorization to perform the nursing procedure is client specific, time limited, and not transferable; (e) Update the plan of care to identify that performance of the client’s nursing procedure has been delegated to a UAP; (f) Provide periodic inspection and evaluation of the delegation per OAR 851-047-0050; and (g) Continue to engage in nursing practice with the client.