Board Policy Statements and Decision Trees
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).
Georgia Board of Nursing has determined that certain tasks can be individually
assigned to unlicensed individuals and has generated rules to this end. The
No provision in this article shall be construed to require licensure in
Georgia as a registered professional nurse in:
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.
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
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
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.
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:
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:
an assigned patient(s) assignment, for which you have accepted responsibility,
prior to the end of an agreed upon work period without appropriately notifying
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.
Telenursing involves nursing practice via electronic means such as telephone, satellite, or computer. Examples of telenursing practice may include teaching, consulting, triaging, advising or providing direct services, to name but a few. All of these actions constitute the practice of nursing, even when there is no face-to-face or physical contact with a person or patient. If a job description requires a person to hold a valid nursing license, then the job duties therein involve the practice of nursing. This means a nurse must comply with the Georgia Nurse Practice Act and Board Rules in the exercise of his/her practice of nursing. Rule 410-11-.01 Standards of Registered Professional Nursing Practice, is the primary rule applied to nursing practice in any setting. This rule and additional documents that provide guidance for nurse's on determining their individual scope of practice are located under "Laws, Policies and Rules" of the BON web page at www.sos.ga.gov/sos/plb/rn. Telenursing may also involve practicing nursing across state lines. For example: