5415 DELEGATION AND ASSIGNMENT

5415.1 A registered nurse shall be fully responsible for the provision of nursing services including implementation of a plan of care. A registered nurse may delegate or assign nursing interventions or tasks only in accordance with this section, and shall be responsible and accountable for the performance and outcome of any delegated or assigned task.5415.2 A registered nurse may delegate or assign nursing interventions or tasks to be performed by a licensed practical nurse (LPN), nursing assistive personnel (NAP), or unlicensed assistive personnel (UAP). Each delegation or assignment shall be in a manner that does not conflict with the Act or other District laws, this chapter, or federal laws and regulations that affect the practice of nursing in the District.5415.3 To properly delegate a nursing intervention or task to a delegatee:- (a) The registered nurse shall have performed a full assessment of the patient's, client's, or consumer's needs and determined the required nursing interventions or tasks;

- (b) The registered nurse shall have determined that:

- (1) The delegatee possesses sufficient skills, training, and competence to successfully and safely perform the delegated interventions or tasks;

- (2) The interventions or tasks to be delegated are of the type that frequently recur in the daily care of the patient, client, or customer and are usually performed according to established sequence of steps with predictable results and minimal potential risks;

- (3) The successful performance of the intervention or task does not require ongoing assessment, interpretation, or decision-making beyond the completion of the task or intervention at hand;

- (4) The organization or agency has policies, procedures, or protocol in place for the delegation; and

- (c) The registered nurse shall be available to provide supervision to the delegatee, which shall include:

- (1) Providing instructions to the delegatee;

(2) Monitoring the performance of the delegated nursing intervention(s);

(3) Verifying that the delegated nursing intervention(s) has been implemented; and

(4) Evaluating the client's response and the outcome of the delegated nursing intervention(s).

5415.4 A registered nurse shall not delegate an intervention or task unless the registered nurse is themself competent to perform it, and the intervention or task is within scope of practice for registered nursing in accordance with § 5414.

5415.5 Prior to delegation, the nurse administrator or administrator of nursing services in any setting where nursing services are provided shall establish policies and procedures for delegation in nursing practice. The policies and procedures shall include a mechanism for:

(a) Identifying those individuals, by position title and job description, to whom nursing interventions may be delegated or assigned based on education, training, and competency measurements;

(b) Documenting the competence level of the LPN, NAP, or UAP;

(c) Specifying the level and type of supervision required for each delegatee; and

(d) Periodically evaluating the delegation process.

5415.6 If the delegating registered nurse determines that an LPN, NAP, or UAP cannot safely perform the nursing intervention, the delegating registered nurse shall not delegate the nursing intervention to the LPN, NAP, or UAP.

5415.7 The delegating registered nurse shall delegate in a manner that protects the health, safety, and welfare of the client and others. The nursing tasks delegated shall be:

(a) Within the area of responsibility of the nurse delegating the task;

(b) The type that can be properly and safely performed by the delegatee without jeopardizing the client's welfare; and

(c) Based on the assessment of a reasonable and prudent nurse, within the scope of sound nursing judgment.

5415.8 The delegating registered nurse shall determine the required degree of supervision

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after an evaluation of appropriate factors including:

(a) The stability of the client's condition;

(b) The willingness and ability of the client to be involved in the management of his or her care;

(c) The training, experience, and competency of the delegatee implementing the nursing intervention; and

(d) The nature of the nursing intervention.

5415.9 The following registered nursing responsibilities shall not be delegated:

(a) The initial nursing assessment of the client;

(b) The ongoing comprehensive nursing assessment of the client;

(c) Development of the nursing diagnoses;

(d) Establishment of the nursing care goals;

(e) Evaluation of the client's progress or lack of progress toward goal achievement;

(f) Client counseling and family education, except as it relates to promoting independence in personal care and activities of daily living (ADLs);

(g) Coordination and management of care including triage, collaborating, consulting, and referring;

(h) Providing advice to a client or family member; or

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

5415.10 A registered nurse shall comply with the regulations governing the delegation to and scope of NAP in accordance with chapters 61, 93, 94, 95, 96, 97 of this title and any other rules or regulations governing NAP.

5415.11 To properly assign a nursing care task, a registered nurse shall:

(a) Ensure that the task or intervention to be assigned is clearly within the basic training and lawful scope of the person assigned;

(b) Ensure that the person assigned possesses the requisite skills and competence; and

(c) Supervise, monitor, and evaluate the performance of assigned tasks or interventions.

SOURCE: Final Rulemaking published at 51 DCR 8613 (September 3, 2004); as amended by Final Rulemaking published at 69 DCR 010990 (September 2, 2022).