Stratford University Week 4 Chapter 6 Non Delegated Nursing Tasks Paper Written Assignment for Week 4 Use the resources listed in week 4 to assist you in

Stratford University Week 4 Chapter 6 Non Delegated Nursing Tasks Paper Written Assignment for Week 4

Use the resources listed in week 4 to assist you in answering these questions-the answers should be used to study for the midterm and final exam.

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The first section has to do with delegation, which we will have covered in discussing ethical provisions 4-6.This is a very important part of how you as a nurse will make decisions about patient care and accountability for that care.Nursing school and licensing questions will require that you understand delegation, so please look at this as a very important subject and read and answer for understanding, not just to answer the questions.

Please explain these in your own words as much as possible.

What is delegation?
What is supervision?
What is the meaning of the term unlicensed person?
What are the 6 criteria that must be addressed by the entity (the organization providing the care) before delegation of nursing tasks can occur.
What are the 5 criteria that must be met before delegation can occur.
What additional criteria are covered by sections C and D
What assessment is required prior to delegation?
What is involved in supervision of delegated tasks?
What nursing tasks cannot be delegated?

Using the Ethical and Legal Issues Power point, answer the following

(There is more information on this power point than we will use in NSG 100.NSG 110 will address legal issues and will not be duplicated here.But legal and ethical issues can be intertwined.Your focus for this class is the questions below.

What is an ethical dilemma?
What are you learning as a student in NSG 100 that you can use to address an ethical dilemma?
Identify the current ethical issues we are currently facing
What are the 4 elements that must be proven in a case of malpractice?
Identify critical ethical and legal patient-oriented issues.

Using the Code of Ethics power point.

List each provision and the sentence that description of each provision
Based on what we have discussed so far in class and your review of the power point, describe one dilemma you think you might encounter in nursing that you would depend on this code to address.(This does not need to be long and involved, but what situation do you think you might have to face as a nurse that you could think back to this class and use what you have learned to address it.) Revised July 1, 2015
The following sections of the Board of Nursing Regulations govern what nursing tasks can be
appropriately delegated by a Registered Nurse to unlicensed persons (which may include CNAs).
18VAC90-20-420. Definitions.
“Delegation” means the authorization by a registered nurse to an unlicensed person to perform selected nursing tasks and
procedures in accordance with this part.
“Supervision” means guidance or direction of a delegated nursing task or procedure by a qualified, registered nurse who
provides periodic observation and evaluation of the performance of the task and who is accessible to the unlicensed
“Unlicensed person” means an appropriately trained individual, regardless of title, who receives compensation, who
functions in a complementary or assistive role to the registered nurse in providing direct patient care or carrying out
common nursing tasks and procedures, and who is responsible and accountable for the performance of such tasks and
procedures. With the exception of certified nurse aides, this shall not include anyone licensed or certified by a health
regulatory board who is practicing within his recognized scope of practice.
18VAC90-20-430. Criteria for delegation.
A. Delegation of nursing tasks and procedures shall only occur in accordance with the plan for delegation adopted by the
entity responsible for client care. The delegation plan shall comply with provisions of this chapter and shall provide:
1. An assessment of the client population to be served;
2. Analysis and identification of nursing care needs and priorities;
3. Establishment of organizational standards to provide for sufficient supervision which assures safe nursing care to meet
the needs of the clients in their specific settings;
4. Communication of the delegation plan to the staff;
5. Identification of the educational and training requirements for unlicensed persons and documentation of their
competencies; and
6. Provision of resources for appropriate delegation in accordance with this part.
B. Delegation shall be made only if all of the following criteria are met:
1. In the judgment of the delegating nurse, the task or procedure can be properly and safely performed by the unlicensed
person and the delegation does not jeopardize the health, safety and welfare of the client.
2. The delegating nurse retains responsibility and accountability for nursing care of the client, including nursing
assessment, planning, evaluation, documentation and supervision.
3. Delegated tasks and procedures are within the knowledge, area of responsibility and skills of the delegating nurse.
4. Delegated tasks and procedures are communicated on a client-specific basis to an unlicensed person with clear, specific
instructions for performance of activities, potential complications, and expected results.
5. The person to whom a nursing task has been delegated is clearly identified to the client as an unlicensed person by a
name tag worn while giving client care and by personal communication by the delegating nurse when necessary.
C. Delegated tasks and procedures shall not be reassigned by unlicensed personnel.
D. Nursing tasks shall only be delegated after an assessment is performed according to the provisions of 18VAC90-20440.
18VAC90-20-440. Assessment required prior to delegation.
Prior to delegation of nursing tasks and procedures, the delegating nurse shall make an assessment of the client and
unlicensed person as follows:
1. The delegating nurse shall assess the clinical status and stability of the client’s condition, shall determine the type,
complexity and frequency of the nursing care needed and shall delegate only those tasks which:
a. Do not require the exercise of independent nursing judgment;
b. Do not require complex observations or critical decisions with respect to the nursing task or procedure;
c. Frequently recur in the routine care of the client or group of clients;
d. Do not require repeated performance of nursing assessments;
e. Utilize a standard procedure in which the tasks or procedures can be performed according to exact, unchanging
directions; and
f. Have predictable results and for which the consequences of performing the task or procedures improperly are minimal
and not life threatening.
Revised July 1, 2015
2. The delegating nurse shall also assess the training, skills and experience of the unlicensed person and shall verify the
competency of the unlicensed person in order to determine which tasks are appropriate for that unlicensed person and the
method of supervision required.
18VAC90-20-450. Supervision of delegated tasks.
A. The delegating nurse shall determine the method and frequency of supervision based on factors which include, but are
not limited to:
1. The stability and condition of the client;
2. The experience and competency of the unlicensed person;
3. The nature of the tasks or procedures being delegated; and
4. The proximity and availability of the registered nurse to the unlicensed person when the nursing tasks will be
B. In the event that the delegating nurse is not available, the delegation shall either be terminated or delegation authority
shall be transferred by the delegating nurse to another registered nurse who shall supervise all nursing tasks delegated to
the unlicensed person, provided the registered nurse meets the requirements of 18VAC90-20-430 B 3.
C. Supervision shall include but not be limited to:
1. Monitoring the performance of delegated tasks;
2. Evaluating the outcome for the client;
3. Ensuring appropriate documentation; and
4. Being accessible for consultation and intervention.
D. Based on an ongoing assessment as described in 18VAC90-20-440, the delegating nurse may determine that delegation
of some or all of the tasks and procedures is no longer appropriate.
18VAC90-20-460. Nursing tasks that shall not be delegated.
A. Nursing tasks that shall not be delegated are those which are inappropriate for a specific, unlicensed person to perform
on a specific patient after an assessment is conducted as provided in 18VAC90-20-440.
B. Nursing tasks that shall not be delegated to any unlicensed person are:
1. Activities involving nursing assessment, problem identification, and outcome evaluation which require independent
nursing judgment;
2. Counseling or teaching except for activities related to promoting independence in personal care and daily living;
3. Coordination and management of care involving collaboration, consultation and referral;
4. Emergency and nonemergency triage;
5. Administration of medications except as specifically permitted by the Virginia Drug Control Act (§54.1-3400 et seq. of
the Code of Virginia); and
6. Circulating duties in an operating room.
Chapter 6
Ethics and Legal Issues
• Apply ethical principles to decision
• Discuss the importance of ethics to the
nursing profession and its professional
• Summarize current ethical issues.
• Define major legal terms.
• Discuss the relevance of legal issues to
nursing practice.
• Explain how malpractice relates to nursing
• Discuss examples of ethical and legal
• Nursing profession has ethical
• Legal issues arise that every nurse must
• Ethics and legal issues involve
– professionalism
– health policy
– reimbursement issues
– the organizations that provide health care.
• Definitions
– Ethics: a standard code or guide to behavior
– Morals: an individual’s code of acceptable behaviors
• Ethical Principles
– Autonomy: focuses on the patient’s right to make
decisions about matters that impact the patient
– Beneficence: relates to doing something good and
carding for the patient
• Ethical Principles
– Justice: is about treating people fairly
– Veracity: is truth
– Other suggested principles:

• Ethical Decision Making
– Ethical dilemma: occurs when a person is
forced to choose between 2 or more
alternatives, none of which is ideal.

• Professional Ethics and Nursing Practice
– Benner et al, 2010
• Nursing education needs to focus more on ethical
• Students need to develop skills to respond ethically to errors
and to make ethical decisions.
• American Nurses Association Code of Ethics
• Reporting Incompetent, Unethical, or Illegal
– Role of the State Board of Nursing
(1 of 2)
• Rationing Care: Who Can Access Care
When Needed
• Healthcare Fraud and Abuse
• Ethics and Research
– Informed consent
– Institutional review boards (IRBs)
– Physical harms
– Psychological harms
– Social and economic harms
(2 of 2)
• Organizational Ethics
– Reimbursement compliance
• Compliance officer
– Whistle-blowing
• False Claims Act
OVERVIEW (1 of 4)
• Licensure
• Nurse practice act
• Critical Terminology
– Assault
– Battery
– Civil law
– Criminal law
– Doctrine of res ipsa loquitur
(2 of 4)
• Critical Terminology
– Emancipation
– Expert witness
– False imprisonment
– Good Samaritan laws
– Malpractice
– Negligence
– Proximate cause
OVERVIEW (3 of 4)
• Critical Terminology
– Respondent superior
– Standards of practice
– Statutory law
– Tort
OVERVIEW (4 of 4)
• Malpractice: Why Should This Concern
– Negligence occurs in nursing and can lead to
a malpractice suit

Nurse has duty to patient
Duty was breached
Breach of duty was cause of harm
Damage or injury to the patient occurred
– Need to prove all elements for successful suit
– Professional liability insurance for nurses
• Confidentiality and Informed Consent
• Advance Directives, Living Wills, Medical Power
of Attorney, and Do-Not-Resuscitate
• Organ Transplantation
• Assisted Suicide
• Social Media and Ethical and Legal Issues: A
New Concern
ANA Code of
What came before
Provisions 1-9
What are Ethics
O 1896-The Nightingale Pledge
O Considered the first code of ethics for
Patterned after the Hippocratic Oath
Focus was on the moral purity of nurses
Written by a nurse educator in honor of
the ethical example displayed by
Florence Nightingale
Often administered at nursing
graduations and pinnings
Florence Nightingale
“I solemnly pledge myself before God and in the
presence of this assembly, to pass my life in
purity and to practice my profession faithfully. I
will abstain from whatever is deleterious and
mischievous, and will not take or knowingly
administer any harmful drug. I will do all in my
power to maintain and elevate the standard of
my profession, and will hold in confidence all
personal matters committed to my keeping and
all family affairs coming to my knowledge in the
practice of my calling. With loyalty will I
endeavor to aid the physician in his work, and
devote myself to the welfare of those
committed to my care.”
O 1926-A Suggested Code
O Elegant, but not specific
O 1926-published in American Journal of
Nursing (AJN)
O Provisionally accepted-but not specific
at practical level
O Never adopted
O 1940- A Tentative Code
O Organized around relationships
O Nurse-to-patient, nurse to profession
O Emphasized nursing as a profession
O 1940-publish in AJN and again asked
for comments from AJN readers
O Never adopted
ANA 1940 Code
“The nurse has a basic concern for
people as human beings, confidence in
the power of personality for good,
respect for religious beliefs of others, and
a philosophy which will sustain and
inspire others as well as herself.”
Ethical Codes
O Many versions proposed
O 1950 version was the first to be officially
O The Code for Professional Nurses
O Enumerated specific provisions
O Professional relationships no longer
overt organizing framework
ANA 1950
“professional nurses do not
permit their names to be used
in connection with
testimonials in the
advertisement of products.”
Speaks for itself
Revised in 1956
“Professional nurses assist in
disseminating scientific knowledge
through any form of public
announcement not intended to endorse
or promote a commercial product or
service. Professional nurses or groups of
nurses who advertise professional
services do so in conformity with the
standards of the nursing profession”
1950 Code
“The nurse must adhere to
standards of personal
ethics which reflect credit
upon the profession.”
1960’s bring changes
O Shift to how to uphold and enforce the
O Developed guidelines for handling alleged
violations of the code
O Dropped professional in title-code applied
to professional and technical nurse
O Dropped reference to private ethics of
O No specific mention of physicians
O Provisions condensed down to 10
1970’s Bring more changes
O 1976-Code of Nurses with Interpretive
O Patient participation in care
O Nurse autonomy
O Nurse as advocate
O Use of client in place of patient
O Nonsexist language
O 2001 Code of Ethics with Interpretive
O Social justice
O Recognition of intrinsic worth of all
O Providing care according to
professional standards
O Just treatment of the nurse
2001ANA Code
“the need for health care is
universal, transcending all
individual differences. The nurse
establishes relationships and
delivers nursing services with
respect for human need and
values, and without prejudice.”
Provision 1
“The nurse practices with
compassion and respect for
the inherent dignity, worth,
and unique attributes of every
Therapeutic use of self
O In every human encounter we convey
one of three messages-which one do
you want to convey?
O Go away, my world would be better
without you
O You are an object, a task to be done,
you mean nothing to me
O You are a person of worth, I care about
Provision 2
O “The nurse’s primary commitment is to
the patient, whether an individual,
family, group, community, or
O This provision intentionally singled out
to demonstrate its significant
importance to the code of nursing
Provision 3
“The nurse promotes,
advocates for, and protects
the rights, health, and safety
of the patient”
Provision 4
“The nurse has authority,
accountability, and responsibility
for nursing practice; makes
decisions; and takes action
consistent with the obligation to
promote health and to provide
optimal care.”
Delegation is
O “….transferring the responsibility
for the performance of an
activity from one person to
another while retaining
accountability for the outcome.”
O ANA 1995
Provision 5
“The nurse owes the same duties
to self as to others, including the
responsibility to promote health
and safety, preserve wholeness of
character and integrity, maintain
competence, and continue
personal and professional growth”
Provision 6
“The nurse, through individual and
collective effort, establishes,
maintains, and improves the
ethical environment of the work
setting and conditions of
employment that are conducive
to safe, quality health care.”
Provision 7
“The nurse, in all roles and settings,
advances the profession through
research and scholarly inquiry,
professional standards
development, and the generation
of both nursing and health policy.”
Provision 8
“The nurse collaborates with
other health professionals and
the public to protect human
rights, promote health
diplomacy, and reduce
health disparities.”
Provision 9
“The profession of nursing,
collectively through its
professional organizations, must
articulate nursing values,
maintain the integrity of the
profession, and integrate
principles of social justice into
nursing and health policy”

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