July 18, 2024
As we previewed in May, the Illinois HomeCare & Hospice Council hosted a Nurse Delegation Seminar in July. Participants heard the story of nurse delegation in Illinois, learned how other states are effectively and safely using nurse delegation in home- and community-based settings, discussed what operationalizing nurse delegation entails, and spent time brainstorming and collaborating with like-minded professionals from across the state. Here is IHHC’s report on the seminar.
After two years of collaborative efforts across the spectrum of home health care providers, IHHC’s work culminated in a nurse delegation seminar hosted on June 4, 2024. The first of its kind in Illinois, this seminar took a practical focus on operationalizing nurse delegation in home- and community-based settings.
In partnership with IHHC, Susan Swart of the American Nurses Association – Illinois presented the history of nurse delegation in Illinois, followed by an update on IHHC’s work from Sheila McMackin of Wellspring Personal Care.
After lunch, Deborah Cateora of CBC Health Education; Robert Vande Merwe of the Idaho Health Care Association; Linda Bifano, DNP, MPA, RN, of Bifano Consulting LLC; and Gretchen Koch, MSN, RN, of the Oregon State Board of Nursing offered their expertise on a panel presentation focused on nurse delegation in other states.
Finally, Maryann Alexander of the National Council of State Boards of Nursing shared the national perspective on nurse delegation in home- and community-based settings.
The seminar concluded with participants engaging in roundtable discussions on three topics: barriers to implementation, other ways delegation can be utilized in this setting, and the different policies and procedures that would need to be in place to make such a program viable.
Barriers
- Staff turnover
- Nurse availability
- Apprehension
- Nurses concerned about workload
- Nurses concerned about impact on their licensures
- Lack of incentive to participate (for example, extra pay or CEUs)
- Delegatees concerned about executing delegated tasks
- No set standards for delegatees
- Undefined processes for supervision
- Includes requirements for supervisory visits for change in patient condition
- Lack of standardized implementation plan
- Policies could change on a facility-by-facility basis
- Client pushback
Other Utilization
- Basic wound care, limited to stage 1-2 routine
- Simple G-tube feedings and flushes, possibly including medication
- Colostomy/ostomy care
- Oxygen treatments
- Subcutaneous injections
- External catheters
Necessary Policies and Procedures
- Fully formed definitions
- Including titles of positions (delegator vs. delegatee)
- Who, what, when, where, and how
- Defined scope of practice (for use in client agreements)
- Training
- Baseline/initial evaluations
- Competency evaluations for all levels of licensure
- Flow of communication
- What competencies have already been evaluated for which CNA
- Patient updates
- What to do if a patient can swallow one day and cannot the next
- Reporting mechanisms
- How to protect the patient/new managers/employees when reporting variances
- Documentation processes
- Frequency of documentation
- Two separate documents: one for delegating a task, one for rescinding a delegated task
- What must be included in the care plan
- Must be specific
- Checklists
- Client agreements in start of care paperwork or service agreement
- TARS/MARS
- Frequency of documentation
- Task appropriateness
- Just because it can be delegated does not always mean that it should
- Client/patient load for both delegators and delegates
- Must be quantified for safety
- Supervisory
- General oversight
- Frequency of check-ins
- Facility expectations of supervisory visits
- Consumer education
- Importance of specificity in what words are used
- Ensuring clients don’t reject delegation off-hand
- Circulating literature to educate on delegation in physician offices (before home health ever touches the client)
Wellspring will continue to report developments in nurse delegation in Illinois. In the meantime, you can read our previous articles on the topic:
How Nurse Delegation Benefits Consumers
Building Support for Nurse Delegation in Illinois
Wellspring CNAs Can Now Administer Medications in the Home
How Nurse Delegation Can Help Home Care Clients and Agencies