BP BHEAD INT H

AN ACT Relating to delegating nursing care in schools; amending RCW 18.79.260; and adding new sections to chapter 28A.210 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature recognizes that nurses have been successfully delegating nursing care tasks to family members and auxiliary staff for many years. The opportunity to delegate to registered and certified nursing assistants and other credentialed health personnel is essential to enhance the viability and quality of care in the common schools of this state. It is not the intent of the legislature to require all employees in the settings outlined in section 3 of this act to be credentialed health personnel. Only those employees who carry out delegated nursing tasks as delineated in this section are required to be registered or certified nurse assistants or credentialed health personnel.

(1) School nurses shall have the option to delegate to certified and registered nursing assistants, or other credentialed health personnel the following tasks: Oral and topical medications and ointments; nose, ear, and eye drops and ointments; dressing changes and catheterization using only clean technique; suppositories; enemas; colostomy care; and gastrostomy feedings in established, wound-healed gastrostomies.

(2) The following procedures shall not be delegated: Sterile procedures; crossing the barrier of the skin; and management, manipulation, or care for intravenous devices, intravenous lines, or infusion of intravenous substances.

(3) Delegation should only occur for patients with a "stable and predictable" condition. In addition to this section and sections 3 through 7 of this act, nurse delegation in common schools is subject to the provisions of applicable provisions of law.

Sec. 2. RCW 18.79.260 and 1994 sp.s. c 9 s 426 are each amended to read as follows:

A registered nurse under his or her license may perform for compensation nursing care, as that term is usually understood, of the ill, injured, or infirm, and in the course thereof, she or he may do the following things that shall not be done by a person not so licensed, except as provided in RCW 18.79.270:

(1) At or under the general direction of a licensed physician and surgeon, dentist, osteopathic physician and surgeon, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner acting within the scope of his or her license, administer medications, treatments, tests, and inoculations, whether or not the severing or penetrating of tissues is involved and whether or not a degree of independent judgment and skill is required except as provided in sections 3 through 7 of this act;

(2) Delegate to other persons engaged in nursing, the functions outlined in subsection (1) of this section;

(3) Delegate to certified and registered nursing assistants and other health personnel credentialed under chapter 18.130 RCW the functions outlined in sections 1 and 3 through 7 of this act;

(4) Instruct nurses in technical subjects pertaining to nursing;

((~~(4)~~)) (5) Hold herself or himself out to the public or designate herself or himself as a registered nurse.

NEW SECTION. Sec. 3. (1) The Washington state nursing care quality assurance commission shall define "stable and predictable" conditions.

(2) The Washington state nursing care quality assurance commission shall develop a model informed consent form for nurses to use to provide consumers, delegatees, and the delegating nurse information regarding the delegation process, the rights of refusal by the delegatee and the consumer and/or the parents or guardian, and agreement by all parties of the delegation of the nursing task.

(3) The Washington state nursing care quality assurance commission shall develop delegation protocols that shall be available to schools by July 1, 1996, that include the following requirements:

(a) Thorough patient assessment by the school nurse before consideration of delegation;

(b) The school nurse obtaining written consent signed by the consumer, delegatee, and registered nurse agreeing to the provision of delegated nursing tasks;

(d) The school nurse evaluating the ability of the delegatee to perform the delegated nursing task in the absence of direct nurse supervision;

(e) The school nurse determining any appropriate additional training requirements the delegatee must complete before tasks being delegated;

(f) The school nurse teaching the delegatee the specific delegated nursing task for each patient. The teaching requirements may vary depending upon the degree of complexity of the delegated task;

(g) The school nurse informing the delegatee that the delegated nursing task is specific to a consumer and is not transferable;

(h) The school nurse initially observing the delegatee performing the delegated task;

(i) The school nurse providing written instructions to the delegatee on delegated nursing tasks;

(j) The school nurse assuring the delegatee is aware of changes in patient status requiring reassessment by the school nurse; and

(k) The school nurse providing documentation and a written plan for nursing supervision and reevaluation of nursing tasks.

NEW SECTION. Sec. 4. No one may coerce a school nurse into compromising client safety by requiring the school nurse to delegate if the school nurse determines it is inappropriate to do so. The school nurse shall have total discretion and final decision making in determining the appropriateness of delegation.

(1) The school nurse, delegatee, and consumer must sign an informed consent form regarding the delegation process, rights of refusal, and agreement to delegation of nursing tasks.

(2) School nurses shall not be subject to any employer reprisal or commission disciplinary action for refusing to delegate tasks or refusing to provide the required training for delegation if the school nurse determines delegation may compromise client safety.

(3) The delegatee shall have the right to refuse the assignment of a delegated task and the consumer and/or the parent or guardian shall have the right to refuse the delegation of nursing tasks.

(4) Delegatees shall not be subject to any employer reprisal or commission disciplinary action for refusing to accept delegation of a nursing task.

NEW SECTION. Sec. 5. (1) The school nurse and delegatee shall be held accountable for their own actions in the delegation process.

(2) School nurses acting within the protocols of their delegation authority are immune from suit in any action, civil or criminal, performed in the course of their delegation duties.

(3) Delegatees are immune from suit in any civil or criminal action, when following written delegation instructions from school nurses, and performed in the course of their duties.

NEW SECTION. Sec. 6. Public and private schools are subject to nurse delegation protocols under RCW 18.79.260, WAC 246-839-010, and sections 4 through 7 of this act, excluding those tasks under RCW 28A.210.260 and 28A.210.270.

NEW SECTION. Sec. 7. The department of health in consultation with the nursing care quality assurance commission, office of the superintendent of public instruction, and other interested parties shall submit a report on nurse delegation in public schools to the legislative health committees by December 1997. The office of the superintendent of public instruction shall also implement communication strategies to assure that students, and/or parents or guardians, and providers have a complete understanding of the delegation process and the implications of current or revised statutes and rules. The commission shall provide data on incidence of harm to the public due to the delegation of nursing tasks, reports of school nurses being coerced to delegate, and coercion of delegatees to accept delegated nursing tasks.

NEW SECTION. Sec. 8. Sections 1 and 3 through 7 of this act are each added to chapter 28A.210 RCW.