1. Legal Aspects of Delegating
Within a Team Model of Care
Coleen R. Elmers, RN, MSN
Leadership Educator
Baptist Health System

2. Delegation & Supervision:
Understanding the RN’s
Responsibilities

3. Delegation Guidance
 Board of Nurse Examiners (BNE)
Rule 217 (9/2004)
 BHS Scope of Practice LD-NA-10
www.bne.state.tx.us

4. BNE-Interpretive Guidelines for
LVN Scope of Practice (9/2004)
 Rule 217.11 Sets minimum standard of
nursing practice
 Supervision: LVN functions “under the
supervision” of an RN
 Comprehensive RN assessment
 LVN scope of practice cannot be
expanded to RN level without formal
program of study/licensure

5. RN As Coordinator of Care
 Makes assignments to licensed staff
(LVN’s/RN’s,)
 Delegates tasks to unlicensed staff
in accordance with BNE rules
 Requires continuous supervision of
LVN (direct/indirect)

6. Principles of Delegation
 Staff Competence
 Complexity of Activity
 Job Description/Scope of Practice
 Continuity of Care
 Degree of Judgment

7. RN Responsibilities When
Delegating Tasks
 Assess competency of staff member to
perform delegated task
 Provide supervision based on staff members
experience level/clients needs
 Ensure task delegated is within staff
members scope of practice

8. RN Responsibilities As a Resource
 Receive report on all patients in the team
 Perform focused assessment (based on
diagnosis) on patients assigned to LVN
 Establishes daily goals and interventions
(Plan of Care) on the PCR
 Has knowledge of the medical plan of care,
and the relevant goals of other disciplines

9. Making Assignments*
 Patient needs must  Review staff
be considered in competencies
making assignments  Agency nurses or
 Using an acuity scale nurses floating to
can even out work unit must provide
load same level of care
*May require switching patient care assignments

10. Routine Patients
 Can the LVN assess his/her own
patients? Yes
 Does the RN have to co-sign the LVNs
assessment? No
 What does the RN document and
where?
RN must develop the plan of care and document
the patient’s progress on the Nursing Plan of Care
document or in the nurses notes. The RN must
review and sign the graphics for that shift.

11. Who Is Legally Responsible?
 If an RN assigns a task or a patient to an
LVN, and the LVN does something wrong,
who is legally responsible for any negative
outcome?

12. LVN Responsibilities
 Ensure RN is aware of changes in condition
 Ensure RN is aware of response to interventions
 Attend classes/complete competencies required
to maximize your role in patient care
 After attending IV therapy class and completing
competency may give IV push meds that are not
 Vasoactive: causing changes in heart rate, or
BP (this includes drugs like Lasix, that have a
vasodilative effect and may cause extreme
drops in BP)
 Narcotic
 Chemotherapy

13. Advancing LVN Practice
 After completion of learning activity and
competency, LVNs may give
 IV push Lasix (furosemide)
 IV push Demerol (meperidine)
 IV push Morphine
 IV push Dilaudid (hydromorphone)

14. Delegating Within Team
Model of Care Exercise
 Using delegation scenario provided
identify:
 Legal responsibilities
 Measures to avoid legal pitfalls
 How 6 Rights of Delegation can help