Delegation in Practice- Texas Board of Nursing

Delegation in Practice- Texas Board of Nursing

The United States has a growing demand for healthcare services due to a growing aging and aged population, emergency of new diseases, and endemic chronic diseases (Atella et al., 2019). This has created an artificial shortage of healthcare providers. Unlicensed assistive personnel (UAP) have become pivotal paraprofessionals healthcare professionals in care delivery. UAPs take on delegated roles, majorly helping patients with their activities of daily living (ADLs). However, the scope of the roles of UAPs varies across states. This paper discusses the views of the Texas Board of Nursing on UAPs and their roles in Texas. It will also present the roles of registered nurses (RNs) in Texas and describe the responsibilities of registered nurses when delegating patient care tasks as defined by the Texas Board of Nursing. It will also discuss the differences in UAP assigned roles within the ICU environment and the general medical-surgical unit.

Texas Board of Nursing Views on Unlicensed Assistive Personnel and Their Roles

The Texas Board of Nursing (The Texas BON) recognizes the important roles UAPs play in the delivery of health care services. The roles of UAPs are well defined in the Board Rule 224-Delegation of Nursing Tasks by RNs to Unlicensed Personnel for Clients with Active Conditions or in Acute Care Environments (Texas Board of Nursing, n.d.-b). The Texas BON requires that UAPs accept the delegated roles that they are competent enough to perform.

The Texas BON allows registered nurses to delegate simpler tasks to UAPs, including preparing patient beds, supervising during wound dressing and amputations, maintaining hygiene, and clothing and feeding patients. UAPs can also perform care plan implementation roles. However, they cannot perform roles including patient assessment, diagnoses, care planning, the evaluation of the progress of the treatment plan, and other nurse-related judgments of the patient. RNs are not allowed to delegate to UAPs care tasks involving patients with morbid conditions, patients coming from surgery, or patients in critical conditions (Texas Board of Nursing, n.d.-

The Texas Board of Nursing and the Role of the Registered Nurse

Texas BON, via The Texas Nursing Practice Act (NPA), clearly defines the roles of registered nurses (RNs) licensed to practice in Texas. According to the Texas BON, RNs are required to observe, assess, develop and implement care interventions for patients and evaluate the progress of the interventions (Texas Board of Nursing, n.d.-a). RNs in Texas provide counseling and health education services to patients and maintain the health of the population through preventive approaches.

The scope of practice for RNs also includes working with physicians to administer medication and carry out other treatment processes as directed by the physician. RNs further supervise other nurses, nursing assistants, and UAPs and ensure that patients receive their medications as prescribed. Other roles that the Texas BON may require RNs to perform include evaluating nursing practices, policies, and procedures, as well as signing off prescriptions. Additionally, RNs carry out care roles that are delegated to them by physicians and collaborate with other healthcare professionals to develop individualized and patient-centered treatment and care plans.

The Responsibilities of the Registered Nurse When Delegating Patient Care Tasks

Before delegating the care tasks, the RNs must observe the rules of delegating, including assessing the care needs of the patient, the competency of the UAP to safely carry out the tasks with limited risk for patient harm, the nature of the task, expected outcomes, and the context of the care delivered (Texas Board of Nursing, n.d.-b).

Although the Texas BON allows RN to delegate certain care tasks to UAPs, they remain responsible for the safety and overall nursing care of the patient. Therefore, they are responsible for verifying and ensuring the UAP has the basic training and competency to carry out the delegated roles (Texas Board of Nursing, n.d.-b). They are also responsible for ensuring that the UAP can perform the care task without compromising the quality and safety of the care tasks and the patient. Additionally, RNs are responsible for supervising the UAP throughout the delegation period and monitoring their performance against the expected outcomes. Furthermore, although RNs may delegate the documentation roles for the care provided, they are responsible for ensuring that the UAP records and reports all aspects of the delegated care tasks.

Differences in Unlicensed Assistive Personnel Assigned within the ICU Environment and the General Medical-Surgical Unit

The ICU environment has fewer patients requiring specialized critical care compared to the general medical-surgical units. This means that the UAP working in the ICU environment will attend to fewer patients but will deal more with specialized nurses and physicians. Therefore, the UAP will work on specifically defined delegated tasks. The UAP will also need higher levels of competencies to perform the delegated care tasks, such as monitoring patients due to the settings of the ICU, including numerous monitoring equipment. The patients in ICU also need closer monitoring compared to patients in the general medical-surgical unit. Compared to the general medical-surgical unit with a higher number of patients, the UAP may be required to monitor a single patient within the ICU setting.

Conclusion

UAPs are vital in health care delivery. However, their responsibilities differ from those of RNs. The Texas BON allows RNs to delegate care tasks to UAPs within their authorized practice scope. Despite task delegation, RNs are responsible for patient safety and outcomes. As the authorized roles for UAPs may differ based on care settings, RNs are required to adhere to the Texas BON guidelines on task delegation when working with UAPs.

References

Atella, V., Piano Mortari, A., Kopinska, J., Belotti, F., Lapi, F., Cricelli, C., & Fontana, L. (2019). Trends in age-related disease burden and healthcare utilization. Aging Cell, 18(1), e12861. https://doi.org/10.1111/ACEL.12861

Texas Board of Nursing. (n.d.-a). Practice-Registered Nurse Scope of Practice. Retrieved November 11, 2022, from https://www.bon.texas.gov/practice_scope_of_practice_rn.asp.html

Texas Board of Nursing. (n.d.-b). Texas Board of Nursing-Delegation FAQ. Retrieved November 11, 2022, from https://www.bon.texas.gov/faq_delegation.asp.html#

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What does your State Board of Nursing say about Unlicensed Assistive Personnel and their role, and the role of the Registered Nurse? Describe the responsibilities of the Registered Nurse when delegating patient care tasks. I live in Texas so the Texas Board of Nursing

How does the ICU environment differ from a general medical-surgical unit as far as assigned responsibilities for Unlicensed Assistive Personnel?
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