D.C. Mun. Regs. tit. 17, r. 17-5515

Current through Register Vol. 71, No. 50, December 13, 2024

Rule 17-5515 - DELEGATION OF PRACTICAL NURSING INTERVENTIONS

5515.1

Nothing in this section shall be applicable to, restrict, or limit the gratuitous provision of care by self, family, or friends.

5515.2

Practical nurses may delegate nursing interventions to be performed by unlicensed assistive personnel. Such delegation shall be in a manner that does not conflict with the Act, this chapter, or with other District and federal laws and regulations which affect the practice of nursing in the District of Columbia.

5515.3

Nothing in this chapter shall be construed as permitting or authorizing an unlicensed person to perform duties beyond the scope permitted, or which are prohibited, by any other District or federal laws or regulations.

5515.4

A practical nurse may assume the responsibilities of delegating, assigning, directing, and evaluating nursing interventions to be performed by other practical nurses and unlicensed assistive personnel, after the supervisory registered nurse has met the following requirements:

(a) Developed a plan of nursing strategies to be integrated within the client-centered plan of care that identifies the needs of the client, nursing diagnoses, and prescribed nursing interventions; and

(b) Implemented a client-centered plan of care, including an identification of those interventions and activities that the practical nurse has the necessary skills and competence to accomplish safely.

5515.5

The Administrator for Nursing Services, or supervisor, shall be responsible for establishing policies and procedures for nursing practice. The policies and procedures shall include a mechanism for:

(a) Identifying those individuals, by position title and job description, to whom nursing interventions may be delegated based on education, training, and competency measurements; and

(b) Assisting the delegating practical nurse in verifying the competency of the unlicensed assistive personnel prior to assigning nursing interventions.

5515.6

If the delegating practical nurse determines that the unlicensed assistive personnel cannot safely perform the nursing intervention, the practical nurse shall not delegate the nursing intervention.

5515.7

The delegating practical nurse shall assign and delegate in a manner that protects the health, safety, and welfare of the client and others. The nursing tasks delegated shall:

(a) Be within the area of responsibility of the nurse delegating the act;

(b) Be such that, in the judgment of the nurse, it can be properly and safely performed by the unlicensed assistive personnel without jeopardizing the client welfare; and

(c) Be a task that a reasonable and prudent nurse would find is within the scope of sound nursing judgment.

5515.8

A practical nurse may assign and direct the following types of nursing activities and interventions:

(a) Activities and interventions whose results are predictable and whose potential for risk is minimal;

(b) Activities and interventions that frequently recur in the daily care of the client; and

(c) Activities and interventions that utilize a standard and unchanging procedure.

5515.9

A practical nurse that is responsible for assigning and directing other practical nurses and unlicensed assistive personnel shall do the following:

(a) Provide initial instructions;

(b) Monitor the nursing services;

(c) Evaluate the outcome of the assigned activity or intervention; and

(d) Provide feedback to the delegating or supervisory registered nurse.

5515.10

Unlicensed assistive personnel shall practice under general or immediate supervision of a licensed nurse.

5515.11

The delegating licensed nurse shall be fully responsible for providing supervision of the unlicensed assistive personnel. The supervision shall include:

(a) Instructing the unlicensed assistive personnel in the delegated nursing intervention(s);

(b) Monitoring the performance of the delegated nursing intervention(s);

(c) Verifying that the delegated nursing intervention(s) has been implemented; and

(d) Evaluating the client's response and the outcome of the delegated nursing intervention(s).

5515.12

The delegating practical nurse shall determine the required degree of supervision after an evaluation of appropriate factors including:

(a) The stability of the client's condition;

(b) The willingness and ability of the client to be involved in the management of his or her care;

(c) The training, experience, and competency of the unlicensed assistive personnel implementing the nursing intervention; and

(d) The nature of the nursing intervention.

5515.13

The delegating practical nurse shall be responsible at all times for all nursing interventions provided by the unlicensed assistive personnel to whom it was delegated, and is subject to disciplinary action for any violation of the Act or this chapter in connection with the nursing intervention performed by the unlicensed assistive personnel.

D.C. Mun. Regs. tit. 17, r. 17-5515

Final Rulemaking published at 54 DCR 701 (January 26, 2007)