Delegation and Supervision
Who is responsible and accountable for delegation of nursing tasks?Only a licensed nurse can delegate.
In accordance with
KRS 314.021(2), nurses are held responsible and accountable for their decisions regarding the supervision and delegation of nursing acts to unlicensed personnel who provide nursing assistance, based upon the nurse's educational preparation and current clinical competence in nursing.
How do I determine what nursing tasks may be delegated?
When aspects of nursing care need to be delegated beyond the traditional role, nurses may delegate some nursing acts to Unlicensed Assistive Personnel (UAP). UAP who provide assistance to nurses may contribute to the implementation of the plan of nursing care when the delegation of the task does not jeopardize the client welfare. Tasks may be delegated only after a nursing assessment is made and, in the nurse’s judgment, it is decided that delegation of the task is appropriate.
Guidance Related to Delegation
Delegation of Nursing Tasks is discussed in 201 KAR 20:400;
Advisory Opinion Statement (AOS) #15 Supervision and Delegation of Nursing Tasks to Unlicensed Personnel, found in the Document Library; and
The Decision Tree for Delegation to UAP (Unlicensed Assistive Personnel), found in the Document Library.
Guidance Related to Supervision
Supervision is defined as “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.” See 201 KAR 20:400.
Determining the Degree of Supervision
Factors to be determined by the delegator include:
- The stability and acuity of the patient;
- The training and competency of the delegatee;
- The complexity of the nursing task being delegated; and
- The proximity and availability of the delegating nurse to the delegate when the nursing task is performed.
Degree of Supervision of the LPN:
- Determined by the LPN’s supervisor; and
- Is based on a patient’s condition, as determined by the LPN’s supervisor.
A supervisor may provide supervision without being physically present in the immediate vicinity of the LPN, when:
- A patient’s condition is stable;
- Predictable, and Rapid change is not anticipated; but
- The supervisor must be readily available.
A supervisor must be physically present in the immediate vicinity of the LPN and immediately available to intervene in care, when:
- A patient’s condition is or becomes unstable.
- A patient is receiving blood, blood components, or plasma volume expanders.
- A patient is receiving peritoneal dialysis or hemodialysis.
Guidance Related to LPN Practice
The Advisory Opinion Statement (AOS) #27 Components of Licensed Practical Nursing Practice may be found in the
Document Library
Scope of Practice Related to Cosmetic and Dermatological Procedures
Can a nurse engage in the practice of cosmetology and esthetics?Aesthetic, cosmetic, and dermatological procedures may be performed by a nurse as a part of a medically prescribed plan of care for treatment of various dermatological conditions.
The Kentucky statutes applicable to cosmetologists, and estheticians licenses are not applicable to nursing practice. They are regulated under
KRS Chapter 317A.
No person shall engage in the practice of cosmetology, esthetic practices, or nail technology for other than cosmetic purposes nor shall any person engage in the practice of cosmetology, esthetic practices, or nail technology for the treatment of physical or mental ailments. This chapter does not apply to . . . Persons authorized by the law of this state to practice . . . nursing . . . who perform incidental practices of cosmetology, esthetic practices, and nail technology in the normal course of the practice of their profession.
See
KRS 317A.020.
However, you may wish to acquaint yourself with the practice standards followed by non-nurse estheticians, as there is likely overlap in terms of accepted professional practices in the provision of esthetic services.
Advisory Opinion Statement (AOS)In the
Document Library, you can find additional information in
AOS #35 Cosmetic and Dermatological Procedures by Nurses, to assist nurses who wish to engage in the safe practice of nursing.
Scope of Practice of LPNs and RNs in the Performance of Cosmetic and Dermatological ProceduresLPNs and RNs are able to implement interventions and administer medications and treatments as prescribed and supervised by a physician, physician assistant, dentist, or APRN. These healthcare providers are able to delegate tasks to the RN or LPN.
The LPN or RN may follow standing orders/protocol after the healthcare provider has established a treatment plan.
In the
Document Library, you can learn about standing orders and protocols in
AOS #14: Roles of Nurses in the Implementation of Patient Care Orders: Use of Protocols, Standing Orders, and Routine Orders.
Best Practices APRNs Interested in Providing Cosmetic and Dermatological ProceduresIn the
Document Library, you can find additional information
AOS #35 Cosmetic and Dermatological Procedures by Nurses, which lists a set of recommended best practices for APRNs who are interested in providing cosmetic and dermatological procedures in a responsible, safe, and effective manner.
Nurses - Neurotoxins and Derm FillersIt is not within the scope of practice for an LPN or RN to independently practice, order products, prescribe treatments, or perform medical aesthetic procedures such as Botox© or Derm fillers.
APRNsAPRNs should consult the APRN Scope of Practice and Decision Making Model as well as
AOS #35, both are found in the
Document Library, to determine if it is within their scope of practice to assess, diagnosis, administer, prescribe treatments, and order products.
Offsite
Neurotoxins (e.g. Botox©)No statute, regulation, or published decision precludes an APRN from lawfully taking a multi-dose vial of Neurotoxin to a patient’s home, a hair salon, or any other place where the conditions are sufficiently sanitary for the administration of Neurotoxins.
However, the assessment, diagnosis, prescription and administration of Neurotoxins must be within the APRN’s scope of practice as measured pursuant to the
APRN Scope of Practice Decision Making Model, which can be found in the
Document Library. For more information, please see the webpage at the following link,
Advanced Practice Registered Nurses (APRNs) Dispensing Drug Samples - Kentucky Board of Nursing.
APRNs as Medical Director for a Med SpaAn APRN who meets the requisite educational and experiential requirements may own a med spa and function as the medical director. One of the responsibilities of a medical director is to stay informed regarding developments in both law and practice.
An APRN medical director of a med spa in a clinical setting, without a physician or pharmacist on staff, may order and stock nonscheduled legend drugs, including neurotoxins or dermal filler medications, for the specific purpose of direct administration. However, an APRN may not dispense nonscheduled legend drugs, except as provided in
KRS 314.011(17).
However, if the facility has a physician or pharmacist on staff, the applicability of the physician or pharmacist broadens the scope of what may lawfully occur at the facility.
In the
Document Library, you can find the
APRN Scope of Practice Decision Making Model, which can assist in determining whether you are qualified to serve as the medical director of a med spa.
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