WAY BACK WHEN we walked uphill both ways in the snow to nursing school, we were taught team nursing. I did my clinical in a county teaching hospital on a medical floor staffed with RNs, LPNs, CNAs, and lots of medical interns and residents. It fascinated me how knowledgeable and assertive the nurses were. I dreamt that one day I too would be giving information to doctors. The RNs cared for their patients with the help and collaboration of the other members of their team, which consisted of LPNs and CNAs, radiology techs, respiratory techs, and other unlicensed assistive personnel. Their synchronicity in delivering patient care was a wonder to behold.

After a year as an RN in this setting, I began nursing at a private psychiatric hospital where once again we were involved in team nursing. This time my team consisted of mental health workers I, II, and IIIs, and an LPN who gave medications to the entire floor of 27 adolescent psychiatric patients. Although I was a relatively new nurse, I was hired as a supervising RN and I was accountable to nursing administration, medical staff, and of course, most importantly, the patients for all that transpired on my unit during my three, 12-hour shifts per week. All that I had learned in nursing school was put to the test in the supervision and delegation of the care provided to our patients. In this setting, it was crucial that we as staff were of one accord, the proverbial “surrogate parents” who could and would not be split.

In 1993, I moved to Nevada. I spent the first two years finishing my masters in nursing and working as the Director of Clinical Services at a well-known residential center for adolescents and children. Again, we strove to provide a culture of collaboration, utilizing each staff member-licensed and unlicensed-based on his or her scope of practice, skill level, competence, and expertise.

I began working for the NSBN in November, 1996. My first experience with Board meetings was during the Board’s attempt to pass regulations regarding delegation. I was surprised there was such controversy over a concept I believed was so basic to nursing. What we learned from this experience was that Nevada nurses needed education on what our current regulations said regarding delegation. The Board’s executive director at that time, Kathy Apple, and some of us staff traveled across the state giving presentations wherever we were invited. In my communications with Nevada nurses in 2004, I’ve found we still are not only ill informed, but also fearful of the concept of “delegation.”

Earlier this year, the American Nurses Association (ANA) asked for input to a draft of their Principles of Delegation. I responded with,

“Thank you for addressing this controversial issue in such a well-thought out and understandable document.”

ANA’s draft defined “delegation” as:

The transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome. Example: The nurse, in delegating an activity to an unlicensed individual, transfers the responsibility for the performance of the activity but retains professional accountability for the overall care.

The Nevada Administrative Code defines delegation as:

NAC 632.047 “Delegation” defined. (NRS 632.120) “Delegation” means entrusting the performance of a delegable nursing duty to a person who is qualified and competent to perform the duty.

ANA did a better job of defining “delegation.” (I learned in high school English class that you don’t use the word you’re defining with another form of that word.)

Not only did they give us an excellent definition, but they gave some noteworthy recommendations for nurses who were interested in utilizing delegation in their practice.

I was ecstatic! In its draft, ANA had provided an outline for me to follow in giving Nevada nurses simple, understandable information about what has been a very controversial topic.

ANA’s first recommendation involved getting answers from your state nursing board. I decided, I can help. I was given the opportunity during a panel presentation at the Nevada Nurses Association workshop in Carson City. ANA suggested nurses get the following questions answered by their nursing board.

Don’t stop reading now. Find your Nurse Practice Act or go to the Board’s website and bring up NAC Chapter 632, the Board’s rules and regulations for nursing practice. The questions are answered for you, but you have to find the why and wherefore in our law, the Nurse Practice Act.

QUESTION #1

Does it permit delegation?

YES. NAC 632.222 Delegation and supervision of nursing care. 1. A registered nurse may delegate nursing care to other nurses and supervise other personnel in the provision of care if those persons are qualified to provide that care.

QUESTION #2

What is the definition of delegation in your state?

NAC 632.047 “Delegation” defined. “Delegation” means entrusting the performance of a delegable nursing duty to a person who is qualified and competent to perform the duty.