GENERAL GOVERNMENT CABINET
Board of Nursing
††††† 201 KAR 20:400. Delegation of nursing tasks.
††††† RELATES TO: KRS 311A.170, 314.011, 314.021(2), 314.091(1)
††††† STATUTORY AUTHORITY: KRS 314.131(1)
††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.131(1) authorizes the board to promulgate administrative regulations necessary to implement KRS Chapter 314. KRS 314.091(1)(d) prohibits a person from negligently or willfully acting in a manner inconsistent with the practice of nursing. This administrative regulation establishes requirements that govern the delegation of a nursing task in a safe, effective manner so as to safeguard the health and welfare of the citizens of the Commonwealth.
††††† Section 1. Definitions. (1) "Board" is defined in KRS 314.011(1).
††††† (2) "Client" means a patient, resident or consumer of nursing care.
††††† (3) "Competence" means performing an act in a safe, effective manner.
††††† (4) "Delegatee" means a person to whom a task is delegated.
††††† (5) "Delegation" is defined in KRS 314.011(2).
††††† (6) "Delegator" means the nurse delegating a task to another person.
††††† (7) "Direct supervision" means the continuous, direct, onsite supervision by a registered nurse;
"Nurse" is defined in KRS 314.011(3).
††††† (9) "Nurse Extern" means an employee in a healthcare facility who is also actively enrolled as a student in a board approved prelicensure program of nursing.
††††† (10) "Nursing assistance" is defined in KRS 314.011(13).
"Nursing task" means an act included in the definition of registered nursing
practice, advanced practice registered nursing, or licensed practical nursing practice
pursuant to KRS 314.011(6), (8), or (10).
"Paramedic" is defined in KRS 311A.010.
"Supervision" means the provision of guidance by a qualified nurse for
the accomplishment of a nursing task with periodic observation and evaluation of
the performance of the task including validation that the nursing task has been
performed according to established standards of practice.
"Unlicensed person" means an individual, other than a nurse, the client,
or the client's family, legal guardian, or delegatee, who functions in an assistant
or subordinate role to the nurse.
2. Nurse's Responsibility in Delegation. (1) A registered nurse or a licensed practical
nurse may delegate a task to an unlicensed person in accordance with this section
and Sections 3,[
and] 4, and 5 of this administrative regulation.
††††† (2) A registered nurse may delegate a task to a paramedic employed in a hospital emergency department in accordance with KRS 311A.170 and Sections 3 and 4 of this administrative regulation.
††††† (3) Prior to delegating a nursing task, the nurse shall determine the nursing care needs of the client. The nurse shall retain responsibility and accountability for the nursing care of the client, including nursing assessment, planning, evaluation and assuring documentation.
††††† (4) The nurse, prior to delegation to an unlicensed person, shall have either instructed the unlicensed person in the delegated task or determined that the unlicensed person is competent to perform the nursing task.
††††† (5) A nursing task shall be delegated directly or indirectly. An indirect delegation shall not alter the responsibility of the nurse for appropriately assigning and supervising an unlicensed person.
††††† (6) A nurse who delegates a nursing task in violation of this administrative regulation or participates in the utilization of an unlicensed person in violation of this administrative regulation shall be considered acting in a manner inconsistent with the practice of nursing.
††††† Section 3. Criteria for Delegation. The delegation of a nursing task shall meet the following criteria:
The delegated nursing task shall be a task that a reasonable and prudent nurse would
find is within the scope of sound nursing judgment and practice to delegate;[
The delegated nursing task shall be a task that, in the opinion of the delegating
nurse, can be competently and safely performed by the delegatee without compromising
the client's welfare;[
The nursing task shall not require the delegatee to exercise independent nursing
judgment or intervention; and[
††††† (4) The delegator shall be responsible for assuring that the delegated task is performed in a competent manner by the delegatee.
††††† Section 4. Supervision. (1) The nurse shall provide supervision of a delegated nursing task.
††††† (2) The degree of supervision required shall be determined by the delegator after an evaluation of appropriate factors involved including the following:
††††† (a) The stability and acuity of the client's condition;
††††† (b) The training and competency of the delegatee;
††††† (c) The complexity of the nursing task being delegated; and
††††† (d) The proximity and availability of the delegator to the delegatee when the nursing task is performed.
††††† Section 5. Nurse Extern. (1) The nurse extern may perform nursing tasks as delegated under the direct supervision of a registered nurse in accordance with this section. Those tasks may include the administration of medication or other tasks that have been taught in the nurse externís nursing education program. The nurse extern shall be individually educationally prepared and clinically competent to perform the task. At a minimum, this competency shall be verified by an official letter from the nursing program documenting that the nurse extern has successfully completed the task as a student in the program of nursing. The employer should also independently verify and document the competency of the nurse extern to successfully perform the acts that the nurse extern will perform.
††††† (2) A licensed practical nurse may participate with the registered nurse in providing supervision of a nurse extern enrolled in a practical nurse program of nursing.
††††† (3) The nurse extern may provide nursing assistance that is routinely a part of any nursing assistantís job description.
††††† (4) For a nurse extern enrolled in a practical nurse program of nursing, the administration of medications shall be limited by 201 KAR 20:490.
††††† (5) A nurse extern shall not substitute for licensed nursing staff.
††††† (6) A nurse extern shall not be required to independently assume the role, function or responsibility of licensed personnel.
LEWIS PERKINS, President
††††† APPROVED BY AGENCY: June 15, 2017
††††† FILED WITH LRC: November 15, 2017 at 9 a.m.
††††† PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall be held on December 22, 2017 at 10:00 a.m. (EST) in the office of the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky. Individuals interested in being heard at this hearing shall notify this agency in writing five workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted until end of day (11:59 p.m.) December 31, 2017. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.
††††† CONTACT PERSON: Nathan Goldman, General Counsel, Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222, phone (502) 429-3309, fax (502) 564-4251, email firstname.lastname@example.org
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person: Nathan Goldman
††††† (1) Provide a brief summary of:
††††† (a) What this administrative regulation does: This administrative regulation establishes the standards and requirements for the delegation of nursing tasks to unlicensed persons.
††††† (b) The necessity of this administrative regulation: This administrative regulation is necessary because of KRS 314.011(2).
††††† (c) How this administrative regulation conforms to the content of the authorizing statutes: This administrative regulation conforms to the content of KRS 314.011(2) which requires the Board to promulgate an administrative regulation on delegation.
††††† (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation assists in the effective administration of the statutes by setting delegation standards.
††††† (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
††††† (a) How the amendment will change this existing administrative regulation: The amendment recognizes a category of unlicensed individuals to be known as nurse externs. Nurse externs are nursing students who are employed by a hospital and function as nursing assistants. This administrative regulation sets the requirements for delegation of nursing tasks by a nurse to a nurse extern. The Cabinet for Health and Family Services is amending 902 KAR 20:016 concerning hospitals to recognize nurse externs and refer to this administrative regulation.
††††† (b) The necessity of the amendment to this administrative regulation: The Cabinet for Health and Family Services requested this amendment to work in conjunction with its amendment.
††††† (c) How the amendment conforms to the content of the authorizing statutes: The Board is authorized to make these changes.
††††† (d) How the amendment will assist in the effective administration of the statutes: By setting standards and requirements for nurse externs.
††††† (3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation: hospitals in Kentucky, number unknown; nurse externs, number unknown.
††††† (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
††††† (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
Hospitals may utilize nurse externs consistent with this administrative regulation.
††††† (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There is no additional cost imposed by the amendment.
††††† (c) As a result of compliance, what benefits will accrue to the entities identified in question (3): They will be able to utilize nurse externs as a part of their work force. Nurse externs will gain knowledge and experience that will help them become competent nurses.
††††† (5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
††††† (a) Initially: There is no additional cost.
††††† (b) On a continuing basis: There is no additional cost.
††††† (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: Agency funds.
††††† (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment: No increase is needed.
††††† (8) State whether or not this administrative regulation established any fees or directly or indirectly increased any fees: It does not.
††††† (9) TIERING: Is tiering applied? Tiering was not applied as the changes apply to all equally.
FISCAL NOTE ON STATE OR LOCAL GOVERNMENT
††††† (1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? The Kentucky Board of Nursing.
††††† (2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 314.131.
††††† (3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
††††† (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? None.
††††† (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? None.
††††† (c) How much will it cost to administer this program for the first year? No additional cost.
††††† (d) How much will it cost to administer this program for subsequent years? No additional cost.
††††† Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
††††† Revenues (+/-):
††††† Expenditures (+/-):
††††† Other Explanation: