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Nurse Delegation to LNAs


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Title: Nurse Delegation to LNAs

Nurse Delegation to LNAs Unlicensed Personnel in
the Ambulatory Care Settings
  • Margaret Walker, Ed.D., RN
  • NH Board of Nursing

What are we seeing as trends in the ambulatory
  • Increased responsibility questions have been
    coming to the board.
  • Unlicensed and nursing assistant staff are
    providing a scope of practice that is more
    intense which, challenges the educational
    experience of personnel.

What do we need to keep in mind?
  • The delegation rules in Nur 400
  • These rules allow nurse delegation of nursing
    tasks to individuals for care to individuals who
    are stable.

Where do I find Nur 400?
  • Go to Nurse Practice Act
  • Open Administrative Rules Chapters 100-800.
  • Note The NH Legislature gives approval for these
    rules that govern our practice through
    legislative process.

What does the Delegation rule say?
  • The licensed nurse can delegate tasks to LNAs and
    unlicensed persons provided the patient does not
    have an acute problem rendering them unstable.
  • The nurse must make sure the delegatee has the
    competencies to perform the task.
  • The nurse is ultimately responsible and
    accountable for delegated tasks.

What if the nurse is simply teaching a task and
  • The nurse can teach and must make it clear that
    she/he is not delegating but simply teaching the

Where can I find board clinical practice answers
already processes?
  • The quick link section on the boards home page
    connects you to the nursing practice page. This
    page contains board opinions for the last several
    years. Older decisions are located in archived
    newsletters located in the Applications, Forms,
    and Publications section of the website.

Recent board advisories related to the expanding
roles of licensee
  • Go to the website and click on Nursing
  • There is a section where the board has provided
    practice opinions at its board meeting. The
    questions are posted for 30 days or longer for
    public comments.

What is the process for board advisories?
  • Individuals with questions go to the Nursing
    Practice section of the website and use the
    Decision Tree to determine if the task is part
    of their practice.
  • If, after completing the decision tree and
    researching the question it is still not
    clear…the person can ask the board.

Completing a Clinical Practice Inquiry Form
  • The form is located on the Nursing Practice page
    of the website.
  • Please complete all sections and make sure you
    provide as much information as possible to allow
    full board understanding of your question.
  • Also provide information regarding your research
    of the question.

What next?
  • There are several avenues/options you can take
  • Attend the OPEN FORUM of the board meeting to
    present your question and/or
  • Mail or email (
    your form and watch for the board minutes and
    Nursing Practice page for the final results.

Board action on advisory questions…how does it
  • The board receives the board packet in advance of
    the meeting for review and research
  • The board may answer the question at the meeting
  • Refer the question to the Practice and Education
    Committee for additional research.

Practice and Education Committee
  • This committee is an important part of the board
  • After careful study and deliberation of the
    question, the committee develops and presents a
    recommendation to the next board meeting.
  • The questions are becoming numerous!!

What is the definition of stable patient
  • The concept of predictable outcomes is
  • Stability is defined as the expectation of the
    individual patients level of predictable
  • Delegation can occur with individuals who are
    stable and have predictable outcomes of care.

What if my patient has serious health issues but
we know about their condition?
  • If the condition of the patient is known and
    consistently occurs, it is considered a
    predictable outcome for that patient.
  • If the patient suddenly has a condition they have
    never experienced and is not part of the care
    plan, we have an unpredictable outcome.

The constantly changing health care delivery
  • This is a work environment that is impacted by
    new technologies
  • Health care systems are continually changing to
    improve patient outcomes
  • Financial/economic issues have created an
    environment that changes to adapt to
    reimbursement, costs, and effective care.

Prediction for the Future
  • The board is aware that we need to adapt to the
    changing healthcare needs and at the same
  • Maintain optimal patient care.
  • Maintain patient safety.
  • Assure quality care systems.

So, how do I keep up on all of these changes?
  • Review the boards website on a regular basis.
  • Continue to learn new skills.
  • Continue to maintain a good knowledge base and
    keep up with changes in the healthcare options
    for patients.
  • Ask questions to make sure you are working within
    your scope of practice.

Thank you
  • Margarets email
  • Norma Blake
  • Board staff member for LNAs is Mary Lou Moreen RN