TX NJE - Texas Nursing Jurisprudence Delegation to Unlicensed Personnel Questions and Answers — Questions and Answers
Question 1: A registered nurse (RN) in a home health setting is caring for a client with a stable, predictable condition. According to Texas BON Rule 225, which of the following tasks is strictly prohibited from being delegated to an Unlicensed Assistive Person (UAP)?
- Reinforcement of health teaching that was previously provided by the RN.
- Assisting the client with self-administered medications.
- Performing a physical assessment to determine a change in the client's condition. (Correct answer)
- Assisting with tube feedings through a permanently placed gastrostomy tube.
Correct answer: Performing a physical assessment to determine a change in the client's condition.
According to Texas Board of Nursing (BON) Rule 225.13, nursing tasks that require professional nursing judgment, such as physical assessment, formulation of a nursing care plan, and evaluation of the client's response, are prohibited from delegation. Assisting with self-administered medications, reinforcing teaching, and assisting with feedings via a permanent tube are generally delegable under specific conditions for a stable client.
Question 2: An RN working in an acute care hospital delegates the task of obtaining a routine blood glucose level on a stable diabetic patient to a UAP. The RN has already verified the UAP's competency. After the UAP performs the task, who retains ultimate accountability for the patient's overall outcome related to this task?
- The UAP, because they accepted the task and performed it.
- The physician who ordered the blood glucose check.
- The hospital administration, as they are the employer.
- The delegating RN, who is accountable for the delegation process and the client's response. (Correct answer)
Correct answer: The delegating RN, who is accountable for the delegation process and the client's response.
Texas BON Rules 224.5 and 225.5 state that the RN is responsible and accountable for the safe and appropriate delegation of nursing tasks. While the UAP is responsible for performing the task correctly, the delegating RN retains accountability for the entire process, including the decision to delegate, supervision, and the patient's overall outcome.
Question 3: Which of the following scenarios represents an inappropriate delegation of a nursing task by an RN to a UAP in an acute care setting under Texas BON Rule 224?
- Delegating the collection and recording of intake and output on a post-operative patient.
- Delegating the administration of a routine oral pain medication to a patient who just requested it. (Correct answer)
- Delegating the task of ambulating a stable patient to the restroom for the first time after surgery.
- Delegating the task of performing a simple, non-sterile dressing change.
Correct answer: Delegating the administration of a routine oral pain medication to a patient who just requested it.
Texas BON Rule 224.8 explicitly prohibits the delegation of medication administration in acute care settings. The other tasks, such as collecting I/O, ambulating a stable patient, and performing simple non-sterile dressing changes, are generally considered within the scope of delegation provided the client is stable and the UAP is competent.
Question 4: According to the Texas Board of Nursing, the "Five Rights of Delegation" are critical for ensuring patient safety. Which of the following is NOT one of these five rights?
- Right Task
- Right Circumstance
- Right Documentation (Correct answer)
- Right Person
Correct answer: Right Documentation
The Five Rights of Delegation are Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. While proper documentation of the delegated task is a crucial part of the nursing process, "Right Documentation" is not one of the official Five Rights of Delegation.
Question 5: An RN determines the need to delegate a task and provides clear, concise instructions to a UAP, including the expected results and when to report back. This action by the RN fulfills which of the Five Rights of Delegation?
- Right Supervision/Evaluation
- Right Direction/Communication (Correct answer)
- Right Circumstance
- Right Task
Correct answer: Right Direction/Communication
Providing clear, concise, and complete instructions about the task, including objectives, limits, and expectations, directly relates to the Right Direction/Communication. This ensures the UAP understands exactly what to do, how to do it, and what to report, minimizing the chance of error.
Question 6: An RN in a long-term care facility needs to delegate the task of feeding a resident with mild dysphagia. Before delegating this task to a UAP, which of the following is the most critical initial action for the RN to take according to BON Rule 224.6?
- Ensure the UAP has received facility-wide annual training on feeding residents.
- Perform a comprehensive nursing assessment of the client's current health status and stability. (Correct answer)
- Ask the client's family if they are comfortable with a UAP feeding the resident.
- Document the delegation in the facility's administrative logbook.
Correct answer: Perform a comprehensive nursing assessment of the client's current health status and stability.
Texas BON Rule 224.6 requires that before delegating any task, the RN must first conduct a nursing assessment of the client's needs and determine if the client's condition is stable enough for the delegation to occur safely. While UAP training, family comfort, and documentation are important, the foundation of any safe delegation decision is the RN's assessment of the client.
TX NJE - Texas Nursing Jurisprudence Delegation to Unlicensed Personnel Questions and Answers
A registered nurse (RN) in a home health setting is caring for a client with a stable, predictable condition.
According to Texas BON Rule 225, which of the following tasks is strictly prohibited from being delegated to an Unlicensed Assistive Person (UAP)?