The practice of nursing requires specialized judgment and skill and providing care to patients requires a certain level of trust between the nurse and patient. Delegation is an essential nursing skill that Registered Nurses (RNs) use to maximize the nursing care that clients receive. Unfortunately, it is not uncommon for a disagreement to arise between a patient and an RN as to what tasks can and should be properly delegated by the RN to unlicensed individuals.
RNs are bound to the Texas Nursing Practice Act and the BON Rules. Two chapters of the rules regulate nurse delegation:
- Delegation of nursing tasks by RNs to unlicensed personnel for patients with acute conditions or in acute care environments. 22 Tex. Admin. Code §224.
- Delegation of nursing tasks by RNs to unlicensed personnel and tasks not requiring delegation in independent living environments for patients with stable and predictable conditions. Tex. Admin. Code §225.
These two BON rules authorize nurses to delegate certain tasks to unlicensed individuals and the criteria on which assessment and delegation is to be based. Ultimately, the RN is responsible and accountable for safe and appropriate delegation and delegation is utilized at the RN’s discretion.
Conflict Resolution Between a Patient and Registered Nurse in Texas
The Board states that the most effective tool for avoiding disagreements from arising is the “effective education of nurses, clients, and agencies on the value and usefulness assessment and proper delegation.” However, the Board recognizes that not all conflicts between nurses and patients can be avoided.
A number of conflicts that occur between nurses and patients occur while patients are receiving health care serves through programs that are not within the Texas Board of Nursing jurisdiction. Many of these programs are publicly funded and are regulated by different state or federal agencies. The BON cannot mandate dispute resolution procedures to be implemented by these programs, it does, however, encourage the programs which have not implemented dispute resolution procedures to do so.
The BON recognizes there are numerous procedures that are effective in resolving disputes and no one method is not considered better than others. While the BON does not endorse a specific method of dispute resolution, it recommends that program dispute resolution procedures include the following progressive procedures:
- It recommended that clients receive information regarding dispute resolution and/or whether a dispute resolution process is available at all. The clients have a right to be aware of policies and procedures which affect dispute resolution.
- Open and face to face discussions between client and nurse designed to clarify the positions of parties relative to the assessment and delegation. Each party should allow the other to explain the reasons for their position and be allowed to educate the other as to the basis of their opinion.
- Failing a mutually agreed understanding after a frank discussion between the nurse and patient, it may be necessary to request third party intervention with a type of peer mentor or mentors who can understand the divergent positions and regulatory framework of assessment and proper delegation.
- Lastly, a dispute resolution process should allow for the parties to have a right to terminate the nurse/client relationship when attempts at dispute resolution fail.
Ultimately, the nurse should not be required to delegate when he or she sincerely disputes the safety of delegation based on an appropriate assessment. Also, the patient should be allowed to choose another nurse who may be willing to reassess and appropriately delegate under his or her license.
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Nurse License Defense
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