Accepting,
Rejecting & Delegating
A Work Assignment: A Guide for Nurses
Legal
Considerations
Nurse
Practice Act (NPA)
The purpose of the NPA is to protect the public by assuring safe
and competent nurses. Only licensed nurses have the legal, formal
authority to practice nursing and to delegate nursing care. The
NPA defines nursing practice and is the legal foundation for the
practice of nursing in Massachusetts. There are clarifying definitions
for the practice of registered nurses and the practice of licensed
practical nurses issued in the form of regulation and promulgated
by the Massachusetts Board of Registration in Nursing. These definitions
are written in broad language that allows for evolving changes
in nursing practice. It is important that each nurse understand
the legal definition of the practice of nursing since it forms
the basis for individual nursing practice in the Commonwealth
of Massachusetts.
When a license is issued, the nurse accepts the
responsibility and accountability to be a safe, competent practitioner.
The nurse must have a clear understanding of his/her own competencies
and communicate them to coworkers and supervisors.
The authority of the NPA is specific
to the practice of the individual nurse. (Mass General Law
(MGL ) and Chapter
112 §74-81C). The NPA authorizes the Board to regulate nursing
practice and education (MGL) but does not extend that authority
to employment practices, staffing patterns, or employer/employee
issues.
Regulations-Code
of Massachusetts Regulations (CMR)
Specifics related to the legal practice of nursing are determined
by the Board of Registration in Nursing (BORN), and communicated
through regulations and advisory rulings. Regulations explain
the law and provide a process for implementation. Regulations
hold the force of law. Nurses must be familiar and comply with
all of the regulations promulgated by the Board. There are several
regulations that are specific to nursing practice and provide
guidance when accepting, rejecting and delegating a work assignment.
Standards
of Practice (244 CMR 2:02 9:02 (Board of Registration in Nursing)
The Standards of Practice describe nursing competence
as:
-
understanding policies and procedures of the
employing institution
-
assuring that delegation of a nursing act to
a licensed or unlicensed person can be done safely
-
remaining knowledgeable about current nursing
procedures
-
obtaining the necessary training before accepting
a nursing responsibility that one does not have the knowledge
to implement.
Delegation
of Nursing Functions
The Massachusetts Board of Nursing regulation governing Delegation
of Nursing Functions (244 CMR: 3.05) gives nurses the authority
to delegate certain nursing activities to unlicensed individuals.
However, the regulations specify that the nurse will determine
the degree of oversight required after an evaluation of appropriate
factors [244 CMR: 3.05(3)] and the activities to be delegated
[244 CMR: 3.05(4)]. The delegating registered nurse shall bear
full and ultimate responsibility for delegation of nursing practice
activities [244 CMR: 3.02] Working beyond competencies or failure
to maintain generally accepted standards of practice places the
nurse at risk for disciplinary action by the Board. The Board
is authorized to take action against nurses who fail to perform
in a manner that ensures safe nursing practice. [MGL Chapter
112, § 61] Behavior and activities that could be the basis
of disciplinary action by the Board include but are not limited
to:
-
Practicing beyond the scope permitted by the
NPA [244 CMR: 9.00]
-
Accepting a work assignment that the nurse
is not competent to perform and/or failing to perform it competently.
-
Failing to exercise oversight over individuals
to whom the nurse has delegated nursing functions [244 CMR:
3.05(3)].
-
Abandoning or neglecting a patient. [244 CMR:
9.03(15)]
-
Failure to report patient abuse; practice of
nursing while impaired by substance abuse; diversion of controlled
substances by licensed nurse. [244 CMR: 9.03(26)]
Following an investigation of a
complaint against a nurse’s practice, the board is empowered
to take action. (see glossary for BORN definition of complaints)
Each disciplinary action is reported to the National Council of
State Boards of Nursing where it is available for review by regulation
to all member boards; such listings are also sent to employers
of nurses in the Commonwealth of Massachusetts.
Advisory
Rulings
The Board issues advisory rulings and opinions to define or clarify
the scope of nursing practice. The Board acts on an individual’s
request and the ruling is specific to the circumstances as described
in the request. Rulings are based on an extensive study of the
situation. Following review of the information that has been gathered,
the Board determines that a specific activity or procedure is
within the scope of practice of the nurse, not within the scope
of practice, or within the designated nurse’s scope if
certain conditions are met. Any rulings that set conditions may
require
specialized training and education, site requirements, and/or
supervision requirements. Nurses should be knowledgeable about
these rulings because they may be helpful in making a decision
about accepting or rejecting a request to perform nursing activities.
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