Legal Implications of Nursing

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The Tennessee Board of Nursing

1000-1-.04 DISCIPLINE OF LICENSEES, UNAUTHORIZED PRACTICE OF PROFESSIONAL NURSING, CIVIL PENALTIES, SCREENING PANELS, SUBPOENAS, ADVISORY RULINGS, DECLARATORY ORDERS, AND ASSESSMENT OF COSTS.

(c) Persons employed in institutions, agencies, or the office of a licensed physician or dentist, assisting in the nursing care of patients where adequate medical or nursing supervision or both is provided. Assisting is defined to mean helping, aiding or cooperating. Adequate supervision is defined to mean overseeing or inspecting with authority. The basic responsibility of the individual nurse who is required to supervise others is to determine which of the nursing needs can be delegated safely to others, and whether the individual to whom the duties are entrusted must be supervised personally. The following are tasks commonly performed by such persons:

1. Answers patients’ signals, provides necessary assistance in conformance with delegated tasks, and notifies the appropriate nurse when the situation so indicates. 2. Assists with the admission, transfer and discharge of patients. 3. Assists with the dressing and undressing of patients.

4. Assists with the patients’ baths.
5. Assists with the measuring of fluid intake and output of patients and the records on appropriate forms.
6. Assists with the collection of urine, stool, and sputum specimens. 7. Assists with the feeding of patients.
8. Assists with the weighing of patients.
9. Assists with the making of patients’ beds.
10. Assists with the application and removal of such protective devices as side rails, footboards, and bed cradles.

11. When a registered nurse undertakes to supervise other nursing tasks requiring greater skill and knowledge by such persons, the following requirements shall apply:

(i) Such persons shall assist with and undertake only those nursing tasks which they are qualified to perform.
(ii) The registered nurse shall supervise such persons. (iii) The registered nurse shall retain professional accountability for nursing care when such persons are performing these activities.

(iv) The registered nurse shall not require assistance with or supervise nursing care activities or responsibilities by such persons contrary to the nurse practice act or rules and regulations to the detriment of patient care. (v) Such persons shall have had proper instruction and supervised practice and shall have demonstrated competency in the procedure or activity. (vi) There is documentation of continued competency by such persons in the performance of the procedure or activity.

(vii) There are written policies and procedures regarding the conditions under which the procedure or activity shall be performed by such persons. (Rules of the TN Board of Nursing, 1994)

Just like we use the five rights of drug administration when administering drugs, we should use the five rights of delegation to ensure we are making the appropriate decision when delegating duties to assistive personnel: The right task- Do the state laws and statutes regulate what can be delegated? Does the task envolve nursing judgment? The right circumstance- Does the assistive personnel have sufficient time to perform the task properly? Do you have time to supervise sufficiently? The right person- Is this person qualified to do this task? Have they had sufficient training to safely complete the task? Should they perform the task on this particular patient? The right direction- Have you given the assistant a clear and concise description of the task, including its objective, any limits, and your expectations? The right supervision- Are you or another licensed experience nurse available to supervise the task? (Sheehan, 2001, 1998)

(3) Responsibility.
(a) Responsibility. Each individual is responsible for personal acts of negligence under the law. Registered nurses are liable if they...
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