On March 3, 2015, the New Jersey State Board of Nursing (“Board”) issued a comprehensive set of proposed amendments, repeals and new rules pertaining to Delegation and Certification; Homemaker-Home Health Aides. The changes broaden the authority of registered professional nurses (“RNs”) and permit RNs to train, and then delegate tasks to licensed practical nurses (“LPNs”), certified home health aides (“CHHAs”) and other assistive persons (collectively “assistants”). This certainly seems like a positive step for the Home Health industry and its patients. Nurses will be able to serve a broader patient base by maximizing the talents of more caregivers who are, perhaps, being under-utilized in the current model.
Currently New Jersey limits those tasks which an RN can delegate. Those restrictions were understandable. Delegation of nursing duties is a delicate and complex process. An RN must fully assess and understand a patient’s needs and the potential for complication before feeling secure enough to assign another responsibility for that care. The law change seems to embrace the fact that RNs have always had this key competency, the art of assessment and delegation, but were lacking the necessary assurances that their assistants were able to accept higher levels of responsibility, or that their license would be protected if something were to go wrong. Thus, the new law tightens the screening and training processes employed by HHAs to ensure that the assistants are “equal to the task” of accepting delegation.
It would certainly seem that New Jersey has made changes to benefit the Home Health Industry’s clients. Among those benefits:
- Safe and efficient care is delivered with highly skilled RNs able to devote significant time and attention to those patients in need of specialized care;
- Duplication of services is minimized;
- More care givers are empowered and more patients treated;
- A “team” is established to effectuate goals and problem-solve;
- Care is administered in a more efficient and cost-effective manner.
As with any changes, however, we have to be on the lookout for unintended consequences. There are legal and ethical consequences to delegation. Those nurses who master the art of delegation are still responsible for the care rendered and supervision is key. The RNs must be certain they are delegating to people who are properly trained, understanding of their role, and capable of administering safe nursing care. The delegates must be comfortable with this increased reliance on their skills. Any hiccup in the link between the delegator and the delegate could create patient safety issues. Thus, if any other states are inclined to follow New Jersey’s lead, attention not only to the benefits of delegation, but also to the attendant training and supervision requirements is essential for success.