Board Policy Statements and Decision Trees

Policy Statements

• AANA-ASA Joint Statement Regarding Propofol Administration (available in Adobe Acrobat .pdf format)
  This ASA/AANA statement was adopted by the Georgia Board of Nursing on May 19, 2005

• Assignment to Unlicensed Assistive Personnel

• Medication Administration

• Patient Abandonment

• Telephonic Nursing
  

Decision Trees 

• RN Assignment Tree

• Scope of Practice (available in Adobe Acrobat .pdf format)

Assignment to Unlicensed Assistive Personnel Policy Statement

There has been a substantial increase in the use of unlicensed assistive personnel (UAP) to provide direct patient care services in the changing health care industry. UAP’s are found performing nursing activities in almost all health care settings.  Because there is a potential that the improper utilization of unlicensed individuals may result in a risk to public safety, the Georgia Board of Nursing has promulgated rules regarding the criteria under which a registered nurse may assign certain tasks to unlicensed assistive personnel.

Other states have promulgated rules to define the parameters within which a licensed nurse may allow an unlicensed individual to provide direct care to patients.  Some states chose to define task lists for UAP’s, often  because the state directly regulates these care providers.  However, by creating task lists for UAP’s, an unofficial scope of practice is created. Also, there is no guarantee that a licensed health care professional is involved in the assessment of the patient to determine if the task can be safely provided by a UAP.  Therefore, the Georgia Board of Nursing has determined that development of lists of activities that may unequivocally be performed by unlicensed individuals does not result in the best protection for the public.

Many states have language in their Nurse Practice Act that specifically provides for “delegation” to unlicensed individuals.  OCGA 43-26-1 Georgia Nurse Practice Act does not provide for delegation of licensed activities to unlicensed individuals.  Based upon well-established administrative case law, RNs may not delegate activities which require professional nursing licensure to unlicensed individuals unless they have specific statutory authority to do so. If the care and activities under the specific circumstances do require the knowledge and skills of a registered nurse, and if a registered nurse permits an unlicensed individual to engage in these activities, it is inappropriate delegation of licensed activities.  This inappropriate delegation has regulatory consequences.  However, Registered professional nurses may delegate professional nursing activities to other licensed individuals where there is statutory authority within their practice act to perform such acts.  (i.e. Licensed Practical Nurses who are under the “direction and supervision” of a Registered Professional Nurse).

The Georgia Board of Nursing has determined that certain tasks can be individually assigned to unlicensed individuals and has generated rules to this end.  The Rules have their statutory basis in O.C.G.A. 43-26-12(a)(3) and O.C.A. 43-26-12(a)(5).  The exemptions for the requirement of licensure as a registered nurse are that:

(a)  No provision in this article shall be construed to require licensure in Georgia as a registered professional nurse in:

(5) The performance of auxiliary services in the care of patients when such care and activities do not require the knowledge and skill required of a person practicing nursing as a registered professional nurse and when such care and activities are performed under orders or direction of a licensed physician, licensed dentist, licensed podiatrist, or person licensed to practice nursing as a registered professional nurse;

Registered nurses have always utilized unlicensed individuals to assist in the provision of nursing care. OCGA 43-26-1 et seq. acknowledged that practice by incorporating certain exemptions from the requirement of professional nursing licensure within the Nurse Practice Act.  OCGA43-26-12 (5) provides an exemption to licensure for the performance of auxiliary services in the care of patients when such care and activities do not require the knowledge and skills required of a person practicing nursing as a registered professional nurse and when such care and activities are performed under orders or direction of a licensed physician, licensed dentist, licensed podiatrist, or person licensed to practice nursing as a registered professional nurse.  Therefore if the care and activities meet all the above criteria for the exemption, it is an unlicensed activity and can be assigned.

The Georgia Board of Nursing has generated rules and a decision making tool to assist registered nurses and nurse employers to make appropriate decisions regarding whether to assign a task to an unlicensed person.  The tool, “RN Assignment Decision Tree” will assist the registered nurse to evaluate patient care tasks on an individual patient basis.  It guides the nurse to assign only those tasks that can be safely performed by trained unlicensed assistive personnel.

Medication Administration Policy Statement

The administration of medication is the process whereby a prescribed medication or a medication ordered under a nurse protocol, O.C.G.A. 43-34-26-1, is given to a patient/client by one of several routes to include but not be limited to, oral, inhalation, topical, rectal, or parenteral.  The registered nurse verifies the medication order and the properly prescribed medication, gives the medication in accordance with current standards of practice and accepted principles and procedures as taught in nursing education.  These include verification that the right medication is being given to the right patient/client in the right dose, by the right route at the right time as well as the assessment of the patient/client following administration of the medication for expected effects and possible untoward side effects.  Administration of medication is a complex nursing responsibility which requires a knowledge of anatomy, physiology, pathophysiology, and pharmacology.  Registered nurses may administer medications prescribed by authorized health care providers which may include protocols as defined in O.C.G.A. 43-34-26.1.

Patient Abandonment Policy Statement

The concerns expressed regarding patient abandonment and mandatory overtime is equally shared by members of the Georgia Board of Nursing. Board staff and Board members alike, are increasingly being confronted by consumers and employers regarding these issues. With today’s health care environment and current nursing shortage, I fear these scenarios will continue to surface.

During the Board’s July meeting, a brief discussion occurred for the need to further dialogue and explore these issues from a regulatory standpoint. Board members reviewed various positions taken by other jurisdictions and a position statement has recently been adopted. During the September 19-21, 2001 Board Meeting, the Georgia Board of Nursing approved the adoption of NCSBN’s resolution that states the following:

“That the National Council of State Boards of Nursing [NCSBN] promotes safe and effective nursing practice in the interest of protecting public health and welfare. Therefore, National Council recognizes the professional responsibility of nurses to accept or decline overtime assignments based on their self-assessment of ability to provide safe care.”

In addition, the Board also approved the following definition for Patient Abandonment to be utilized by the Board staff as the Board’s official position:

“Leaving an assigned patient(s) assignment, for which you have accepted responsibility, prior to the end of an agreed upon work period without appropriately notifying supervisory personnel.”

Patient safety is of utmost importance and a conceptual framework for these workplace issues will springboard further dialogue and potential rules and regulations governing nursing practice in Georgia.

Telephonic Nursing Policy Statement