Chapter 4723-13 Delegation of Nursing Tasks

4723-13-01 Definitions.

For the purposes of this chapter, the following definitions shall apply:

(A) "Board" means the Ohio board of nursing.

(B) "Delegation" means the transfer of responsibility for the performance of a selected nursing task from a licensed nurse authorized to perform the task to an individual who does not otherwise have the authority to perform the task.

(C) "Delegating nurse" means the nurse who delegates a nursing task or assumes responsibility for individuals who are receiving delegated nursing care.

(D) "Dialysis technician" means an individual who holds a current valid certificate issued under Chapter 4723. of the Revised Code that authorizes the provision of dialysis care.

(E) "Direction" means communicating a plan of care to a licensed practical nurse. Direction by a registered nurse is not meant to imply the registered nurse is supervising the licensed practical nurse in the employment context.

(F) "Licensed nurse" means a registered nurse or a licensed practical nurse licensed to practice nursing in Ohio.

(G) "Medication aide" means an individual who holds a current valid certificate issued under Chapter 4723. of the Revised Code that authorizes the individual to administer medications in nursing homes or residential care facilities

(H) "DODD" means the Ohio department of developmental disabilities.

(I) "Nursing tasks" means those activities that constitute the practice of nursing as a licensed nurse and may include, but are not limited to, assistance with activities of daily living that are performed to maintain or improve the client's well-being, when the client is unable to perform that activity for him or herself.

(J) " Unlicensed person" means an individual, not currently licensed by the board as a registered nurse or licensed practical nurse, or an individual who does not hold a current valid certificate to practice as a dialysis technician or administer medications as a medication aide.

Effective: 02/01/2012
R.C. 119.032 review dates: 10/13/2011 and 10/15/2016
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.07
Prior Effective Dates: 12/01/1995, 02/01/2002, 02/01/2003, 02/01/2004, 02/01/2007

4723-13-02 General information.

(A) A nursing task may be delegated to an unlicensed person only by a licensed nurse who shall delegate in accordance with this chapter.

(B) Nothing in this chapter shall be construed to prevent any person registered, certified, licensed, or otherwise legally authorized in this state under any law from engaging in the practice for which such person is registered, certified, licensed, or authorized.

"Otherwise legally authorized" may include, but is not limited to, authorization for medication administration pursuant to section 3313.713 of the Revised Code, DODD personnel authorized to perform tasks or activities pursuant to sections 5123.41 to 5123.47 of the Revised Code, and individuals authorized to administer medications or perform tasks pursuant to Title 47 of the Revised Code.

(C) Nothing in this chapter shall prohibit an unlicensed person from assisting an individual who can safely self direct his or her own care, including , helping the individual with self-administration of medications in a facility where the substantial purpose of the setting is other than the provision of health care. An unlicensed person assisting with self-administration of medications may do only the following:

(1) Remind an individual when to take the medication and observe to ensure that the individual follows the directions on the container;

(2) Assist an individual in the self-administration of medication by taking the medication in its container from the area where it is stored and handing the container with the medication in it to the individual. If the individual is physically unable to open the container, the unlicensed person may open the container for the individual;

(3) Assist upon request by or with the consent of, a physically impaired but mentally alert individual, in removing oral or topical medication from the container and in taking or applying the medication. If an individual is physically unable to place a dose of medicine in the individual's mouth without spilling or dropping it, an unlicensed person may place the dose in another container and place that container to the mouth of the individual ; or

(4) Assisting an individual with self-administration does not mean that an unlicensed person can administer medication to an individual, whether orally, by injection, or by any other route.

(D) Nothing in this chapter shall prohibit an unlicensed person from administering medication under the following circumstances:

(1) The giving of oral or the applying of topical medication in accordance with sections 5123.41 to 5123.47 of the Revised Code and in accordance with rules 5123:2-6-01 to 5123:2-6-07 of the Administrative Code;

(2) When medication is administered by an individual employed by a board of education, or a school charted by the state board of education, who has been designated according to section 3313.713 of the Revised Code to administer to a student a drug prescribed by an authorized prescriber; or

(3) In accordance with any other law or rule that authorizes an unlicensed person to administer medications.

Effective: 02/01/2012
R.C. 119.032 review dates: 10/13/2011 and 10/15/2016
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.03
Prior Effective Dates: 12/01/1995, 02/01/2000, 02/01/2002, 02/01/2003, 02/01/2004, 02/01/2007

4723-13-03 Prohibitions.

(A) No person to whom a nursing task is delegated shall delegate the nursing task to any other person.

(B) An unlicensed person who performs a nursing task and does not comply with all the provisions as set forth in this chapter, and who is not otherwise excepted from licensure pursuant to section 4723.32 of the Revised Code, or otherwise legally authorized, shall be engaging in the unauthorized practice of nursing, which is prohibited by section 4723.03 of the Revised Code.

(C) Nothing in this chapter shall be construed to allow an unlicensed person to perform a delegated nursing task on any individual other than the individual specified by the delegating nurse.

R.C. 119.032 review dates: 10/13/2011 and 10/13/2016
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.03 , 4723.07
Prior Effective Dates: 12/01/1995, 04/01/1997, 04/01/1998, 02/01/2000, 02/01/2002, 02/01/2007

4723-13-04 Conditions for delegation of medication administration. [Rescinded].

Rescinded eff 2-1-07

4723-13-05 Criteria and standards for a licensed nurse delegating to an unlicensed person.

(A) A registered nurse may delegate a nursing task to an unlicensed person if all the conditions for delegation set forth in this chapter are met.

(B) A licensed practical nurse may delegate to an unlicensed person only at the direction of the registered nurse and if all the conditions for delegation set forth in this chapter are met.

(C) Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:

(1) Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and

(2) Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas.

(D) Prior to delegating a nursing task to an unlicensed person, the delegating nurse shall determine each of the following:

(1) That the nursing task is within the scope of practice of the delegating nurse as set forth in section 4723.01 of the Revised Code.

(2) That the nursing task is within the knowledge, skill, and ability of the nurse delegating the nursing task;

(3) That the nursing task is within the training, ability, and skill of the unlicensed person who will be performing the delegated nursing task;

(4) That appropriate resources and support are available for the performance of the task and management of the outcome; and

(5) That adequate and appropriate supervision by a licensed nurse of the performance of the nursing task is available in accordance with rule 4732-13-07 of the Administrative Code.

(6) That:

(a) The nursing task requires no judgment based on nursing knowledge and expertise on the part of the unlicensed person performing the task;

(b) The results of the nursing task are reasonably predictable;

(c) The nursing task can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task;

(d) The performance of the nursing task does not require that complex observations or critical decisions be made with respect to the nursing task;

(e) The nursing task does not require repeated performance of nursing assessments; and

(f) The consequences of performing the nursing task improperly are minimal and not life-threatening.

(E) Prior to delegating a nursing task, the delegating nurse shall:

(1) Identify:

(a) The individual on whom the nursing task may be performed; and

(b) A specific time frame during which the delegated nursing task may be performed.

(2) Complete an evaluation of the conditions that relate to the delegation of the nursing task to be performed, including:

(a) An evaluation of the individual who needs nursing care;

(b) The types of nursing care the individual requires;

(c) The complexity and frequency of the nursing care needed;

(d) The stability of the individual who needs nursing care; and

(e) A review of the evaluations performed by other licensed health care professionals.

(F) The delegating nurse shall be accountable for the decision to delegate nursing tasks to an unlicensed person.

(G) If a licensed nurse determines that an unlicensed person is not correctly performing a delegated nursing task, the licensed nurse shall immediately intervene.

R.C. 119.032 review dates: 10/13/2011 and 10/13/2016
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.03 , 4723.07
Prior Effective Dates: 12/01/1995, 02/01/2002, 02/01/2007, 02/01/2010

4723-13-06 Minimum curriculum requirements for teaching a nursing task.

A licensed nurse shall include all of the following when teaching an unlicensed person to perform a nursing task:

(A) Presentation of information on infection control and universal precautions;

(B) Presentation of information and directions on the concepts underlying the nursing task;

(C) Presentation of information and direction on how to correctly perform the specific nursing task according to current standards of practice following step-by-step directions readily available to the unlicensed person;

(D) Demonstration of the nursing task; and

(E) Observation and documentation of a satisfactory return demonstration by the unlicensed person of the nursing task.

R.C. 119.032 review dates: 10/13/2011 and 10/13/2016
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.03 , 4723.07
Prior Effective Dates: 12/01/1995, 02/01/2002, 02/01/2007

4723-13-07 Supervision of the performance of a nursing task performed by an unlicensed person.

(A) When a licensed nurse delegates a nursing task to an unlicensed person in accordance with this chapter, supervision of the performance of the nursing task by the unlicensed person shall be provided by the delegating nurse. For purposes of this rule, supervision includes initial and ongoing direction, procedural guidance, and evaluation, and may include direct observation of the performance of the nursing task. The delegating nurse shall evaluate the performance by the unlicensed person of the delegated nursing task, the need for further instruction, and the need to withdraw the delegation.

(B) If the substantial purpose of the setting, institution, or agency where a delegated nursing task is being performed is the provision of health care services, the supervision provided by the delegating nurse shall be on-site direct supervision.

(C) If the substantial purpose of the setting, institution, or agency where a delegated nursing task is being performed is other than the provision of health care services, the supervision provided by the delegating nurse may be on-site direct supervision, or indirect supervision provided by the delegating nurse who is always accessible through some form of telecommunication. Prior to the delegation of any nursing task in a setting, institution, or agency where the substantial purpose of the setting, institution, or agency is other than the provision of health care, a registered nurse shall conduct an assessment . The assessment and the following factors shall be used by the delegating nurse to determine the supervision required by the delegating nurse.

(1) The number of individuals who require nursing care and the health status of the individuals;

(2) The types and number of nursing tasks that will be delegated;

(3) The continuity, dependability, and reliability of the unlicensed person who will be performing the delegated nursing task;

(4) If the delegating nurse is assuming responsibility for more than one setting, the distance between settings, the accessibility of each setting, and any unusual problems that may be encountered in reaching each setting; and

(5) The availability of emergency aid should the nurse be too far from the setting to arrive at the setting in a timely manner.

R.C. 119.032 review dates: 10/13/2011 and 10/13/2016
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.03 , 4723.07
Prior Effective Dates: 12/01/1995, 02/01/2002, 02/01/2007