News & Events

President’s Column: Be very afraid: The BORN wants to change regs on delegation of nursing tasks

Proposal opens door to allow unlicensed staff to administer meds

From the Massachusetts Nurse Newsletter
February/March 2012 Edition

President’s Column
By Donna Kelly-Williams

Earlier this month, the MNA received a draft report from a “Collaborative Task Force” of the Board of Registration in Nursing, which was established in 2010 to make “evidenced-based recommendations to guide the practice of RNs and LPNs relative to delegation and training.” In the report, the BORN states that this process was initiated in response to the filing of specific pieces of legislation that have called for a process to allow licensed nurses to delegate medication administration to unlicensed personnel in two settings: home care and long-term care.

Specifically, the report states that its primary focus is the issue of the provision of nursing tasks and activities delegated by the nurse to unlicensed personnel in settings (home care) where the nurse does not retain accountability for the care provided by the unlicensed personnel. The example given is the patient who is being cared for by a home health aide, neighbor or friend on a long-term basis, where the care provided is needed to maintain stability and independence at home. This may be an elderly patient living alone who needs assistance with daily colostomy care, or help with administration of medications for a chronic condition.

The MNA/NNU understands this dilemma, and believes that this is an issue that needs to be addressed with an advisory ruling for this specific situation. And we are willing to engage in a process involving frontline home care nurses and other stakeholders to develop that ruling.

Unfortunately, as part of this process, the BORN, through the task force, is proposing sweeping changes to the language in the Nurse Practice Act that rewrite the entire section of the law dealing with ALL aspects of nursing delegation for all settings.

Worse still, the draft language for the new section of the law on delegation is ambiguous at best and we believe it can undo important protections in the law that prevent the delegation of nursing tasks, specifically medication administration, in a number of settings, including long-term care and acute care. While this may not be the intention of the task force, the written words in the law live on for decades and can be manipulated by unscrupulous employers, placing both nurses and patients in jeopardy.

While the BORN states in its report that the MNA was invited to participate in this process, we have NO RECORD of anyone receiving such an invitation. In addition, I, along with other MNA staff, have been attending BORN meetings and other meetings with members of this task force for months, and this effort was never mentioned or discussed until recently when this report was about to be unveiled.

In moving forward with this process, the BORN has opened up its report for public comment, which the MNA has submitted. The MNA’s response includes the following points:

  • As stated above, we believe the narrow issue of allowing the delegation (including training and monitoring) of certain tasks to unlicensed personnel in specific home care situations is an issue that needs to be addressed through two carefully developed advisory rulings. One ruling should address nurse delegation to unlicensed personnel in settings where the care is “incidental” (BORN’s term for situations where the unlicensed person is not employed by an agency and/or is coming into the home on an irregular basis); and the other advisory should address the home care situation where licensed nurses and unlicensed personnel are employed and under the supervision of an agency. These are two different situations which currently need to be addressed and which call for different recommendations.
  • The board must not touch the regulations containing delegation language currently in place. It has worked in the settings for which it applies and any tampering with this language could have serious negative unintended consequences.
  • We have requested a meeting between members of the MNA board and staff with the BORN to discuss our concerns in detail, since we were never formally invited to participate in a process that impacts the staff nurses we represent.
  • In developing the advisory ruling on the home care delegation issue, as has been done by the BORN in the past, we believe the BORN should hold a series of regional hearings across the state where home care and other frontline nurses can discuss the proposed changes and offer input so that the advisory that is developed reflects the real-world concerns of nurses and patients.

You can be assured that we will keep you informed of further developments and will alert you to any opportunities we create for you to lend your voice to this vitally important process. Visit the MNA Web site at to view the full text of the MNA’s letter to the BORN.