Delegation means the transfer of responsibility for the performance of a selected nursing task from a licensed nurse authorized to perform the task to an individual who does not otherwise have the authority to perform the task.
Delegating nurse means the nurse who delegates a nursing task or assumes responsibility for individuals who are receiving delegated nursing care.
Nursing tasks are those activities that constitute the practice of nursing as a licensed nurse and may include, but are not limited to, assistance with activities of daily living that are performed to maintain or improve the patient’s well-being, when the patient is unable to perform that activity for him or herself.
Unlicensed person means an individual, not currently licensed by the board as a registered nurse or licensed practical nurse, or an individual who does not hold a current valid certificate to practice as a dialysis technician or administer medications as a medication aide.
General Information about Delegation (4723-13-02 and -03)
[The following is taken from Chapter 4723-13 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-13.]
A nursing task may be delegated to an unlicensed person only by a licensed nurse who shall delegate in accordance with this Chapter 4723-13. No person to whom a nursing task is delegated shall delegate the nursing task to any other person. An unlicensed person is not allowed to perform a delegated nursing task on any individual other than the individual specified by the delegating nurse.
An unlicensed person may assist an individual who can safely self-direct his or her own care, including helping the individual with self-administration of medications in a facility where the substantial purpose of the setting is other than the provision of healthcare.
An unlicensed person assisting with self-administration of medications may do only the following:
- Remind an individual when to take the medication and observe to ensure that the individual follows the directions on the container.
- Assist an individual in the self-administration of medication by taking the medication in its container from the area where it is stored and handing the container with the medication in it to the individual. If the individual is physically unable to open the container, the unlicensed person may open the container for the individual.
- Assist upon request by or with the consent of, a physically impaired but mentally alert individual, in removing oral or topical medication from the container and in taking or applying the medication. If an individual is physically unable to place a dose of medicine in the individual's mouth without spilling or dropping it, an unlicensed person may place the dose in another container and place that container to the mouth of the individual.
Assisting an individual with self-administration does not mean that an unlicensed person can administer medication to an individual, whether orally, by injection, or by any other route.
Nothing in Chapter 4723-13-10 shall prohibit an unlicensed person from administering medication under the following circumstances:
- The giving of oral or the applying of topical medication in accordance with sections 5123.41 to 5123.47 of the Revised Code and in accordance with rules 5123:2-6-01 to 5123:2-6-07 of the Administrative Code;
- When medication is administered by an individual employed by a board of education, or a school charted by the state board of education, who has been designated according to section 3313.713 of the Revised Code to administer to a student a drug prescribed by an authorized prescriber; or
- In accordance with any other law or rule that authorizes an unlicensed person to administer medications.
Criteria and Standards for Delegating to an Unlicensed Person (4723-13-05)
A registered nurse may delegate a nursing task to an unlicensed person if all the conditions for delegation set forth in this chapter are met. A licensed practical nurse may delegate to an unlicensed person only at the direction of the registered nurse and if all the conditions for delegation set forth in this chapter are met. An advanced practice registered nurse may delegate the administration of medication to an unlicensed person in accordance with the requirements set forth in division (C) of section 4723.48 of the Revised Code and section 4723.489 of the Revised Code.
Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:
- Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier; and
- Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas. (4723-13-05)
Prior to delegating a nursing task to an unlicensed person, the delegating nurse shall determine each of the following:
- That the nursing task is within the scope of practice of the delegating nurse as set forth in section 4723.01 of the Revised Code.
- That the nursing task is within the knowledge, skill, and ability of the nurse delegating the nursing task;
- That the nursing task is within the training, ability, and skill of the unlicensed person who will be performing the delegated nursing task;
- That appropriate resources and support are available for the performance of the task and management of the outcome; and
- That adequate and appropriate supervision by a licensed nurse of the performance of the nursing task is available in accordance with rule 4732-13-07 of the Administrative Code.
- That: The nursing task requires no judgment based on nursing knowledge and expertise on the part of the unlicensed person performing the task;
- The results of the nursing task are reasonably predictable;
- The nursing task can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task;
- The performance of the nursing task does not require that complex observations or critical decisions be made with respect to the nursing task;
- The nursing task does not require repeated performance of nursing assessments; and
- The consequences of performing the nursing task improperly are minimal and not life-threatening.
Prior to delegating a nursing task, the delegating nurse shall:
- The individual on whom the nursing task may be performed; and
- A specific time frame during which the delegated nursing task may be performed.
Complete an evaluation of the conditions that relate to the delegation of the nursing task to be performed, including:
- An evaluation of the individual who needs nursing care;
- The types of nursing care the individual requires;
- The complexity and frequency of the nursing care needed;
- The stability of the individual who needs nursing care; and
- A review of the evaluations performed by other licensed health care professionals.
The delegating nurse shall be accountable for the decision to delegate nursing tasks to an unlicensed person. If a licensed nurse determines that an unlicensed person is not correctly performing a delegated nursing task, the licensed nurse shall immediately intervene.
Minimum Curriculum Requirements for Teaching a Nursing Task (4723-13-06)
A licensed nurse shall include all of the following when teaching an unlicensed person to perform a nursing task:
- Presentation of information on infection control and universal precautions;
- Presentation of information and directions on the concepts underlying the nursing task;
- Presentation of information and direction on how to correctly perform the specific nursing task according to current standards of practice following step-by-step directions readily available to the unlicensed person;
- Demonstration of the nursing task; and
- Observation and documentation of a satisfactory return demonstration by the unlicensed person of the nursing task.
[The above effective as of 12/19/2016]
APRNs Delegating Medication Administration
Prescribe-Delegate Authority SB 110, passed by the 131st General Assembly, authorizes CTP holders to delegate non-controlled drug administration under specified circumstances to unlicensed persons (OBN, 2018c). Effective October 15, 2015, APRNs holding prescriptive authority are authorized to delegate medication administration as specified in Sections 4723.48(C) and 4723.489, Ohio Revised Code (ORC). In doing so, APRNs must comply with standards of safe practice, including delegation. The new authorization supersedes rule language currently found in Chapter 4723-13, OAC, with respect to APRN prescribers, which previously limited the types of medication that could be delegated to an unlicensed person (OBN, 2018c).
A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner may delegate to a person not otherwise authorized to administer drugs the authority to administer to a specified patient a drug (unless the drug is a controlled substance or is listed in the formulary established in rules adopted under section 4723.50 of the Revised Code). The delegation shall be in accordance with division (B) of this section and standards and procedures established in rules adopted under division (O) of section 4723.07 of the Revised Code.
Prior to delegating the authority, the nurse shall do both of the following:
- Assess the patient and determine that the drug is appropriate for the patient;
- Determine that the person to whom the authority will be delegated has met the conditions specified in division (D) of section 4723.489 of the Revised Code.
[The above effective as of 4/6/2017]
Effective April 6, 2017, HB 216 eliminated the certificate of authority (COA) and the Certificate to Prescribe (CTP) and replaced them with an APRN license that designates APRNs as CRNAs, CNPs, CNSs, or CNMs. The bill made additional changes to Chapter 4723 of the Ohio Revised Code (ORC), also known as the Nurse Practice Act, as well as other related ORC Sections.
Source: OBN, 2018e.
Delegated Authority to Administer Drugs (4723.489)
A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met:
- The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a license issued under section 4723.42 of the Revised Code.
- The drug is not listed in the formulary established in rules adopted under section 4723.50 of the Revised Code, is not a controlled substance, and is not to be administered intravenously.
- The drug is to be administered at a location other than a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department or a freestanding emergency department; or an ambulatory surgical facility, as defined in section 3702.30 of the Revised Code.
- The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely.
- The person's employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section.
- The advanced practice registered nurse is physically present at the location where the drug is administered.
[The above effective as of 4/6/2017]