Section 1300.20 Nursing Delegation by a Registered Professional Nurse

Section 1300.20  Nursing Delegation by a Registered

Professional Nurse

a)

For the purposes of

this Section:

"Community-Based Setting"

means facilities within the community where individuals, groups and populations

may seek or receive assistance and/or care.  These include, but are not limited

to, schools, assisted living facilities, physicians' and APRNs' offices,

clinics, home health, and residences where individuals receive services under

the Home Health, Home Services, and Home Nursing Licensing Act [210 ILCS 55] or

Hospice Program Licensing Act [210 ILCS 60]. Community-based setting does not

include Home Services Agencies and Home Service Placement Agencies.

"Delegation" means

transferring to a specific individual the authority to perform a specific

nursing intervention, in a specific situation.

"Predictability of

outcomes" means that a registered professional nurse or advanced practice

registered nurse has determined that the patient's or individual's clinical

status is stable and expected to improve or the patient's or individual's

deteriorating condition is expected to follow a known or expected course."

"Stability" means a

registered professional nurse or advanced practice registered nurse has

determined that the individual's clinical status and nursing care needs are

consistent.

(Section 50-75(a) of the Act)

b)

A

registered professional nurse may:

1)

Delegate

nursing interventions to other registered professional nurses, licensed

practical nurses, and other unlicensed personnel.

The delegation should be

based on the comprehensive nursing assessment that includes, but is not

limited to:

A)

The

stability and condition of the patient;

B)

The

potential for harm;

C)

The

complexity of the nursing intervention to be delegated;

D)

The

predictability of outcomes; and

E)        The

competency of the person to whom the  nursing intervention is delegated

r unlicensed personnel.

The delegation should be

based on the comprehensive nursing assessment that includes, but is not

limited to:

A)

The

stability and condition of the patient;

B)

The

potential for harm;

C)

The

complexity of the nursing intervention to be delegated;

D)

The

predictability of outcomes; and

E)        The

competency of the person to whom the  nursing intervention is delegated. To

ensure competency, the RN may have to provide instruction to the individual or

evaluate the individual's experience, training and/or education.

2)

Delegate

medication administration to other licensed nurses.

3)

Refuse

to delegate, stop, or rescind a previously authorized delegation.

(Section

5-75(b) of the Act)

c)

In community-based or

in-home care settings, an RN may

:

1)

Delegate

medication administration (limited to oral or subcutaneous dosage and topical

or transdermal application) to unlicensed personnel, if the conditions of

delegations

set forth in subsection (b)

are met

.

2)

Delegate,

guide and evaluate the implementations of nursing interventions as a component of

patient care coordination after completion of the comprehensive patient

assessment based on analysis of the comprehensive nursing assessment data.  Care

coordination may occur in person, by telecommunication, or by electronic

communication

.  (Section 5-75(b) of the Act)

d)         The following actions

are prohibited by this Section:

1)

Mandating

an RN to delegate nurse interventions when the RN has determined that it is not

appropriate to do so.

2)

Delegating

medication administration to unlicensed personnel in any institutional or

long-term facility, including but not limited to those facilities licensed by

the Hospital Licensing Act

[210 ILCS 85]

, the University of Illinois

Hospital Act

[110 ILCS 330]

, State-operated mental health hospitals, or

State-operated developmental centers

determined that it is not

appropriate to do so.

2)

Delegating

medication administration to unlicensed personnel in any institutional or

long-term facility, including but not limited to those facilities licensed by

the Hospital Licensing Act

[210 ILCS 85]

, the University of Illinois

Hospital Act

[110 ILCS 330]

, State-operated mental health hospitals, or

State-operated developmental centers.

3)

Delegating

nursing judgement, the comprehensive patient assessment, development of a plan

of care, and evaluations of care to licensed or unlicensed personnel;

4)

Allowing

a licensed practical nurse or unlicensed personnel to re‑delegate a

nursing intervention that had been delegated to him or her by the RN.

(Section 50-75(b) of the Act)

e)         Practice

in End Stage Renal Dialysis Facilities

1)         For

the purposes of this Section only, an individual working as a dialysis

technician in a Medicare-certified End Stage Renal Dialysis Facility or a

facility regulated under the End Stage Renal Disease Facility Act [210 ILCS 62]

shall be considered a licensed individual for the purposes of delegation only

under Section 50-75 of the Act.  A person working to acquire the experience

necessary to obtain certification under subsection (e)(2) may practice in

accordance with this subsection (e) for a period of no more than 18 months so

long as his or her practice is in compliance with the experience standards set

forth by the entities listed in subsection (e)(2)

al for the purposes of delegation only

under Section 50-75 of the Act.  A person working to acquire the experience

necessary to obtain certification under subsection (e)(2) may practice in

accordance with this subsection (e) for a period of no more than 18 months so

long as his or her practice is in compliance with the experience standards set

forth by the entities listed in subsection (e)(2).

2)         Delegation

under this subsection (e) shall only be allowed if the individual receiving

delegation currently holds, or is in the process of acquiring, the necessary

experience to apply for and achieve one of the following certifications:

A)        Certified

Clinical Hemodialysis Technician (CCHT) by the Nephrology Nursing Certification

Commission (NNCC);

B)        Certified

Hemodialysis Technician (CHT) by the Board of Nephrology Examiners Nursing and

Technology (BONENT);

C)        Certified

in Clinical Nephrology Technology (CCNT) by the National Nephrology

Certification Organization (NNCO).

3)         Delegation

under this subsection (e) shall not include medication administration except

for saline flushes and application of topical anesthetics.  All patient care

provided by a certified dialysis technician practicing under this subsection (e)

shall be under the direct and immediate on-site supervision of a licensed

physician, advanced practice registered nurse, physician assistant or

registered nurse.

4)         Delegation

under this subsection (e) shall also comply with any rules adopted under the

End Stage Renal Disease Facility Act.

5)         Nothing

in this subsection (e) shall be construed to apply to any other facility or

practice setting.  This subsection (e) shall not be construed as granting a

license under the Act and shall not allow individuals receiving delegation

under this subsection (e) to use any title regulated by the Act

ll also comply with any rules adopted under the

End Stage Renal Disease Facility Act.

5)         Nothing

in this subsection (e) shall be construed to apply to any other facility or

practice setting.  This subsection (e) shall not be construed as granting a

license under the Act and shall not allow individuals receiving delegation

under this subsection (e) to use any title regulated by the Act.

f)         The

delegation of medication administration in a community-based setting shall be

rescinded upon the discharge of the patient from the home health, home nursing,

or hospice agency, or when the nurse who delegated the nursing intervention is

no longer providing or coordinating the nursing clinical care.

g)         An RN

who has delegated a nursing intervention does not have to be physically present

while the individual is performing the delegation so long as the RN has

satisfied the conditions of delegation set forth in subsection (b) and is

available to assist in person or by telecommunications.