Section 380-5-1 - General Regulations Relating to Delegation of Selected Nursing Tasks by Licensed NursesA. The registered professional nurse is responsible for the nature and quality of all nursing care that a patient receives. Assessment of the nursing needs of a patient, the plan of nursing actions, implementation of the plan, and evaluation are essential components of professional nursing practice and are the functions of the registered professional nurse. Although other personnel may be employed to assist the registered professional nurse in the performance of these functions, such personnel cannot be used as a substitute for the registered professional nurse. The services of registered professional nurses may be supplemented and complemented by the services of licensed practical nurses and certified nursing assistants.1. The registered professional nurse in a hospital, nursing facility, skilled care facility, ambulatory care, community health agency, facilities providing assisted housing services licensed under 10-144 CMR Ch. 113, Regulations Governing the Licensing and Functioning of Assisted Housing Programs correction facilities and county jails. shall determine those nursing tasks that may safely be delegated to nursing assistants. No task shall be delegated that is not listed in the Skills Checklist of the PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT TRAINING PROGRAMS, or authorized after additional training by a facility or organization as described in this chapter. When the task is the administration of medications, nothing may be delegated that is not listed in the Skills Checklist of the Standardized Medication Course for Certified Nursing Assistants.2. In assigning selected nursing tasks to certified nursing assistants, the registered professional nurse is responsible for complying with the provisions of this chapter and for exercising the judgment and knowledge ordinarily expected of a registered professional nurse. The nursing employer shall determine that the nursing assistant is listed on the Maine Registry of Certified Nursing Assistants and Direct Care Workers and will ensure that the certified nursing assistant meets the competency requirements of the facility or organization.3. The registered professional nurse also is responsible for supervision of certified nursing assistants to whom delegation is made. The degree of supervision needed shall be determined by the registered professional nurse after an evaluation of all factors involved, including without limitation: a) The right task: the activity falls within the certified assistant's job description and is included as part of the established written policies and procedures of the nursing practice setting;b) The right circumstance: the stability of the condition of the patient;c) The right person: the training and capability of the certified nursing assistant to whom the delegation is being made;d) The right direction and communication: each delegation should be specific to the patient, the registered professions, the certified nursing assistant. The registered professional nurse is expected to communicate specific instructions for the delegated activity to the certified nursing assistant and ascertain that the certified nursing assistant understands what is expected of him/her and agrees to accept the delegation; ande) The right supervision and evaluation: supervision may require direct, continuing presence of the registered professional nurse to observe, guide and direct the nursing assistant; intermittent observation and direction by the registered professional nurse who may only occasionally be physically present; or development of a plan of care, in advance, by the registered professional nurse which will be implemented by the nursing assistant without the physical presence of the registered professional nurse. In the latter situation, the registered professional nurse must be available for supervision, in person, in the event circumstances arise that cause the registered professional nurse to believe such supervision is necessary.B. Home Care Setting. In the home care setting only the registered professional nurse may delegate certain aspects of medication administration to the certified nursing assistant who has not completed the Standardized Medication Course for Certified Nursing Assistants. 1. Delegation by the registered profession nurse may only occur if: a) There is a stable predictable pattern of need;b) There is consent of the patient/family or patient's designee as indicated with a signature on the care plan; andc) The training, capability, and competency of the certified nursing assistants is appropriate to the identified need.2. The registered professional nurse shall ascertain that the certified nursing assistant in the home care setting who has not completed the Standardized Medication Course for Nursing Assistants has documented competencies according to the facility or organization's policies and procedures to perform any of the following skills prior to delegation: oral medications; ear and eye drops; non-narcotic patches; insulin injections for stable diabetics using pre-filled syringes; topical medications; inhalants (hand held manufactured inhalers, and long term nebulizer therapy); vaginal/rectal medications; scheduled Schedule IIs, gastrostomy G-tube feedings and gastrostomy-jejunostomy (G-J) tube feedings (established, stable G-tube and G-J tubes).3. Medication that may not be delegated include PRN medication and those administered via intrathecal, intravenous, intramuscular, subcutaneous (except insulin) routes nor any other invasive methods.C. Additional skills of nursing care are skills of nursing care beyond those listed in the Board APPROVED PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANTS TRAINING PROGRAMS for certified nursing assistants. These additional skills may be performed by certified nursing assistants when taught and assigned in accordance with the organization or facility's established policies and procedures. Certified Nursing Assistants' documented competencies of additional skills are not transferrable from one facility to another, except that facilities within the same organization may share staff with additional skills training as described above in this subsection. Documentation of this additional skills training must be maintained at each organization or facility as indicated by the organization or facility's documented retention policies.D. Certified nursing assistant additional skill(s) eligibility will be determined by the facility or organization's evaluation of readiness to participate. 1. The registered professional nurse will not teach or assign the certified nursing assistant tasks that are categorized as health counseling, teaching independent, specialized nursing knowledge and skill.2. The Certified Nursing Assistant Additional Skills List includes but is not limited to: a) Perform an electrocardiogram (EKG).b) Perform venipuncture for blood collection purposes.c) Perform a straight catheter procedure on an adult patient 18 years or older.d) Provide gastrointestinal-tube (G-tube) and percutaneous gastronomy (PEG) gravity tube feeding only to an established G-Tube, G-J Tube or PEG Tube.e) Assist a patient with eye drops.f) Perform a bladder scan.g) Obtain a swab for surveillance culture.h) Assist with Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BIPAP) for patients with chronic respiratory conditions such as sleep apnea.E. Under the assignment and supervision of a registered professional nurse, pursuant to an established nursing plan of care a licensed practical nurse may delegate to and oversee completion of selected nursing tasks by certified nursing assistants.