1. The Nevada Nurse Practice Act and Delegation
Chris Sansom, MSN, RN
Director of Operations
Nevada State Board of Nursing 1

2. The Nevada Nurse Practice Act
Nevada Revised Statutes – NRS 632
 Bill passed by the Assembly and Senate and signed into law by the Governor
Nevada Administrative Code – NAC 632
 Adopted by the Board of Nursing to carry out the
intent of the law
Practice Decisions
Scope of Practice 2

3. Roles and Responsibilities
Registered Nurse
 Independent, dependent and interdependent
functions
Licensed Practical Nurse (LPN)
 At the direction of RN, APN, licensed physician, licensed physician assistant, or licensed podiatric physician 3

4. Roles and Responsibilities
Certified Nursing Assistant (CNA)
 At the direction and under supervision of RN or LPN
Unlicensed Assistive Personnel (UAP) 

5. - Florence Nightingale
But in both [hospitals and private houses], let whoever is in charge keep this simple question in her head, (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?
- Florence Nightingale

6. Delegation NAC 632.047 Delegation defined.
“Delegation” means entrusting the performance of a delegable nursing duty to a person who is qualified and competent to perform the duty.” 6

7. What does it mean?
Nurses possess the knowledge, skill and ability to coordinate and supervise the delivery of nursing care, which includes the assignment of nursing tasks to others.
Nursing Process: assess, diagnose, outcomes, plan, implement, evaluate.

8. ANA’s Definition
The transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.
Example: The nurse, in delegating an activity to an unlicensed individual, transfers the responsibility for the performance of the activity but retains professional accountability for the overall care.
Responsibility – Allocated and accepted 8

9. The Nurse Practice Act (NPA)
NAC (2) An RN shall demonstrate competence in:
(f) Delegating appropriate duties to other persons;
(g) Supervising a person to whom the RN has delegated nursing duties;
(h) Maintaining accountability in the delegation of care

10. NPA Continued NAC 632.222 (1) RN may delegate nursing care to other
personnel and supervise other personnel in the
provision of that care if those persons are
qualified to provide that care.
(2) RN shall perform or supervise any act necessary to ensure the quality and sufficiency of delegated care provided to a patient.

11. NPA Continued
NAC
(3) Before delegating the RN shall determine:
(a) Amount of direction
(b) Complexity of care
(c) Educational preparation and competency
(d) Policy and procedures
(4) The RN who delegates nursing care or duties is responsible for the care.

12. Still confused? Case study:
Right task – is it safe, predictable outcome
Right circumstance – client condition/setting,
complexity
Right person – within their scope of practice,
education/competence
Right direction/communication – clear,
concise
Right supervision – follow-up 12

13. Not Delegable Nursing judgment except to another RN Nursing assessment
Evaluation of patient outcomes based on interventions
Any act not within the persons scope of practice
Any act that another reasonable and prudent nurse would not delegate

14. RN – Delegation Regulations
NAC RN duties
NAC Medications and treatment
NAC Supervision
NAC Unauthorized acts prohibited
NAC Assignment to UAPs
NAC Exemptions from required licensing or certification

15. LPN – Delegation Regulations
NAC Limitations; Supervision; Delegation
NAC Procedures delegable to LPNs
NAC Procedures not delegable to LPNs 15

16. Nurse Apprentices NAC 632.063 Nursing student
NAC Performance of tasks
NAC Prohibited acts 16

17. Unlicensed Assistive Personnel
NAC (2-4)(8) – Employment as school nurse; Qualified person 17

18. Medication Aides-Certified (MA-C)
RN delegates medication administration to the MA-C
Long term care facilities only
May not give: enteral or parenteral, NG or G-tube, controlled substances
May not take/transcribe orders, calculate dosages, destroy meds, perform treatments, assess, evaluate errors, conduct patient teaching

19. Responsibility of the nurse
Patient advocacy
Maintain accountability
Choose to delegate (assign) or not to delegate (assign)
Know the skill level of the healthcare team to provide safe and competent care to your patients
Evaluate outcomes 19

20. Unprofessional Conduct
The following acts related to delegation are considered unprofessional conduct by the Board and are grounds for disciplinary action.
NAC (6-8), (15), (19), (24)
(27-28), (30), (31), (33), (34), (39) 20

21. Handouts Delegation Decision-making Tree,
National Council of State Boards of Nursing
Scope of Practice Decision Tree
Nevada State Board of Nursing 21

22. References American Nurses Association www.nursingworld.org
Draft Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP), 2012
National Council of State Boards of Nursing
Working with Others: A Position Paper, 2005
Delegating Effectively Video (on their website and on YouTube.com)
Nevada State Board of Nursing

23. QUESTIONS?