The Importance Of A Nurse Practice Act

The Nurse Practice Act of Maryland defines “Delegation” as “The act of authorizing an unlicensed individual, a certified nursing assistant (CNA), licensed practical nurse (LPN) or a medication technician to perform acts of registered nursing or licensed practical nursing (Code of Maryland Regulations 10.27.11.02)”. As a registered nurse there are many instances that delegation to an unlicensed individual will be essential in order to provide optimal care to the patient and learning how to be successful in delegation is perhaps one of the hardest things to learn. To ensure that the delegation process is done as safely and smoothly as possible, there are five (5) rights of delegation that should be followed.

Nursing is a profession that requires specialized training, knowledge, skills, and judgment to foster an independent decision making. Practicing nursing is a right granted by the state to safeguard those in need of care and efficient nursing practice is substantiated by the state Nurse Practice Act (NPA). The NPA is ratified by each state based on set guidelines and passed by the state legislature (Russell, 2012). The NPA serves as a corner stone in regulating the duties and responsibilities of the professional nurse. The NPA is founded on set guidelines, however, the states’ board of nursing (BON) has the authority to modify the laws and regulations to fit the desired practice expectations set forth (Russell, 2012). The state of Virginia (VA), where this writer currently practices, has laws and regulations that govern the nursing practice of the Registered Nurse (RN) and the Clinical Nurse Specialist (CNS). The purpose of this paper is to discuss the similarities and differences between the role of the RN and the advanced practice nurse as well as to identify if the Virginia NPA identifies the role of an infection prevention nurse specialist.

It is no secret that communication is key when providing direct patient care in a skilled nursing facility. However, there is a noticeable lapse in the communication between the care team when providing care to the individual or groups of individuals. Two main parts of any care team are the registered nurse and the certified nursing assistant, as these are the two people whom have the most direct and impactful roles with residents in a skilled facility. The Registered Nurse and the Certified Nursing Assistant play similar roles in providing patient care, but have different roles in its entirety. The role of the Registered Nurse (RN) is defined as having the competency and skill to provide direct and indirect health care to individuals, their families, and communities around them. Services are also provided designed to give out medications, to promote comfort or healing, promote healing, and to also provide the dignity of their patients and patient’s families (American College of Rheumatology, 2015).

The National Council of State Boards in Nursing defines delegation as “transferring to a competent individual the authority to perform a selected nursing task in a selected situation” (National Council of State Boards of Nursing, Resources section, 4). When delegating, the registered nurse (RN) assigns nursing tasks to unlicensed assistive personnel (UAP) while still remaining accountable for the patient and the task that was assigned. Delegating is a management strategy that is used to provide more efficient care to patients. Authorizing other individuals to take on nursing responsibilities allows the nurse to complete other tasks that need tended to. However, delegation is done at the nurses’

It is important to know that the task a nurse performs is within the scope of practice. So that a nurse can perform his/her task in a permitted way safely.

This article discusses about the process of nursing delegation. For the process of nursing delegation, it must have strong communication, empowered staff, and organizational support. The guidelines identify 5 rights of delegation, which include right task, right circumstances, right person, right direction & communication, and right supervision & evaluation. When a delegator, such as a nurse, delegates, they will remain responsible for the tasks that were delegated. Delegation of an action/task is done based on the patient’s safety and their quality of care. Following the process enables a nurse to appropriately delegate to benefit the care of the patient.

Delegation in nursing practice will be discussed in this essay. Delegation will be clearly and concisely defined and described as following:

The Nurse Practice Act of Illinois State is 225 ILCS 65. IL offers an APN to diagnose, interpret labs and order diagnostic tests. APNs is able to provide counseling and education for prevention of illness and promotion of health. They can provide palliative and end of life care, and can supervise and delegate to task to LPNs and RNs. APNs have prescriptive authority if they have a written collaborative agreement with a physician and are limited to 30 days (IGA, 2014). In order to practice as an APN in IL one must have a current unrestricted RN license, have a masters degree approved by the State Board of Nursing in the specialty of choice and a national certification. State Board of nursing is the regulatory authority of IL APN practice, and they accept certification from ANCC or AANP or certification from specialty agencies. APNs in IL requires 50 hours of continuing education in a 2-year license renewal period. IL is one of the States that offers versatile certification opportunities for APN in addition to advocating for the full practice authority of APNs. A systemic review done by Kuethe (2013) finds it is better for an NP to manage chronic diseases such as asthma and diabetes for their better control and healthcare cost reduction as physicians do not have enough time to provide comprehensive care (p. 5).

Scope of practice is defined as the actions, tasks, procedures, etc that are permitted by law for a specific profession. The scope of practice in nursing "outlines restrictions to what the law permits, based on education, training and experience qualifications" (Anderson, 2013). The Boards of Nursing in the United States, for example the California Board of Registered Nursing, where I practice, has defined the scope of nursing practice in the California Nursing Practice Act.

The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligations to provide optimum patient care. (Bosek & Savage, 2007, p. 59) The nursing student realized that she wasn’t an expert in pharmacokinetics and requested the help of a pharmacist to provide quality care for her patient. (Bosek & Savage, 2007, p. 59) Delegation is a huge responsibility and should never be taken lightly. The duty of the nurse is to ensure the patient receives quality care. This means delegating responsibilities to others to ensure that care is met. If a nurse feels she is unsure of a certain area of care, that nurse is obligated to find the precise person who can provide that care. The author’s daughter (Bella) was in the hospital for a reoccurring MRSA infection. When the nurse walked in the door they were asked a question regarding infectious disease protocols and how best to handle the situation. Instead of giving an answer they thought might be correct, the nurse requested that an infectious disease doctor be called in to answer all questions concerning the patient.

One common mistakes exhibited by professionals in the field is delegation of duties by persons. Nurses should be wary of delegating duties to health care assistant because nurses should be aware of the abilities of the person with whom he or she is delegating duties. This is to minimize any chance of poor service delivery. Poor patient attendance by a person tasked with the duty at the time of delivery will extend the liability to the nurse delegating duties.

It is up to the nurse/delegator to determine the delegatee’s knowledge, skills, abilities, and any training that will ensure that the task will be handled appropriately and safely. If it is necessary the nurse/delegator must provide instruction and direction to the delegatee. The nurse/delegator or another qualified nurse must be available to supervise the delegate and delegated task. The level of supervision needed will be determined by the training, capability, and willingness of the delegate to perform the task. A delegate may not delegate to another person or expand the delegated task without the permission of the nurse/delegator. Once the delegated task is completed the nurse must evaluate the delegated task, patient’s health status, determination if the goals are being met and if the delegation of the task may be continued (UT Admin Code R156-31b. Nurse Practice Act Rule, 2013). In section R156-31b-704 the rules for the recognized scope of practice of an RN are outlined. It states that the RN, RN managers, and RN administrators should practice

The Nursing Practice Act (NPA) is the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs. The Practice Act is located in the California Business and Professions Code starting with Section 2700. Regulations that specify the implementation of the law appear in the California Code of Regulations ("Board Of Nursing", n.d.). What is the NPA? How does it affect nurses? What are the requirements for getting a nursing license from the Board of Nursing? All of these are important questions for someone to ponder when considering joining the nursing

effectiveness (Cioffi & Ferguson, 2009). Therefore, it is important to ensure that nurses who assume leader roles have the skills to manage and delegate tasks as required. There must be clearly defined roles and responsibilities for each team member that take into account the levels of expertise among the members. It can be troublesome when team members do not carry their share of the work. When this occurs, other team members take on an additional work burden to address the shortfalls in patient care. If the team leader is unable to provide clarity and direction for the team, the model will not be effective.

We hear nurse’s talk about how rewarding their profession is but what they seldom talk about is how it can be very challenging as well. There seems to be many issues existing in the nursing profession. One of the most affective issues in nursing is the decreasing number of staff nurses. With inadequate staffing, nurses are demanded to have more responsibilities thus causing more stress on the nurse. This increase in responsibility causes nurses to neglect many aspects of their patients’ care. Patient care is suffering from the shortage of nurses as there is an increase in adverse patient outcomes due to the shortage. Also, there is evidence that there is a positive relationship between the number of staff and the effectiveness of their teamwork. The more staff available the more likely nurses will work together as a team. A new act is being implemented to help with the nursing shortage. This act is called the National Nursing Shortage Reform and Patient Advocacy Act. The purpose of this paper is to discuss the issue of nursing shortage and how the National Nursing Shortage Reform and Patient Advocacy Act is an example of evidence-based practice.