.14 Delegation of Nursing Functions.

A. The following nursing functions require nursing knowledge, judgment, and skill and may not be delegated:

(1) The nursing assessment including, but not limited to, the admission, shift, transfer, or discharge assessment;

(2) Development of the nursing diagnosis;

(3) The establishment of the nursing care goal;

(4) Development of the nursing care plan;

(5) Evaluation of the patient's progress, or lack of progress, toward goal achievement; and

(6) Any nursing task which requires nursing knowledge, judgment, and skill.

B. The nurse may delegate treatments of a routine nature if:

(1) The licensed nursing staff of the specific dialysis setting has identified the function as being routinely performed;

(2) The specific treatments are performed at a high frequency necessary to retain competency;

(3) The treatment has an inherently low risk to the patient, as determined by weighing the following factors:

(a) Type of equipment utilized to perform the function;

(b) Nurse staffing ratio that allows for close supervision;

(c) Basic educational preparation of the certified dialysis technician performing the delegated function; and

(d) Knowledge and skill set of the nurse delegating and supervising the delegated function; and

(4) There is a quality assurance mechanism in place to ensure the function is performed safely and patient outcomes meet accepted professional nursing standards, including, but not limited to:

(a) An ongoing formalized documented performance appraisal mechanism designed to ensure that the certified dialysis technician’s revalidation of continued competency is a component of the quality assurance mechanism; and

(b) Patient outcomes meeting accepted professional standards, as reflected by:

(i) Infection rates;

(ii) Rates of adverse events;

(iii) Error rates; and

(iv) Patient satisfaction surveys.

C. The nurse may delegate the obtaining of specific information to a certified dialysis technician.

D. When implementing the interdisciplinary plan of care, the nurse may delegate a nursing task to a certified dialysis technician when the delegation of that task does not jeopardize the patient's welfare.

E. Administration of medication is a nursing function. As such, the nurse retains full responsibility for medication administration.

F. The following activities related to medication administration may not be delegated except as provided in Regulation .11A(1) of this chapter:

(1) Calculation of any medication dose;

(2) Administration of medications by injection route;

(3) Administration of medications by way of a tube inserted in a cavity of the body; and

(4) Administration of medication by intravenous route.

G. Delegation of Medication Administration.

(1) The administration of medication may be delegated to certified dialysis technicians only in structured settings.

(2) A nurse may delegate the administration of only the medications set forth in Regulation .11A(1) of this chapter to a certified dialysis technician.