130 Hobbs Ave., Suite B - wyoleg.govwyoleg.gov/arules/2012/rules/ARR17-034.pdf · 2.10 Previously...

130 Hobbs Ave., Suite B • Cheyenne, Wyoming 82002 • Phone: 307-777-7601 • FAX: 307-777-3519 • http://nursing.state.wy.us

Statement of Principal Reasons

Chapter 3 - Scope and Standards of Nursing Practice and CNA Role

Chapter 9 - Delegation and Assignment

The Wyoming State Board of Nursing is proposing Chapter 3: Scope and Standards of Nursing

Practice and CNA Role, and repeal Rules in Chapter 9: Delegation and Assignment. The

amendments update language in Chapter 3 to reflect the suggested language provided by the

National Council of State Boards of Nursing’s model rules and add relevant language from

Chapter 9. Combining the two chapters is necessary for clarity and to keep the common concepts

in the same chapter. The new language reflects modern processes and standards of the nursing

profession. Enclosed is a “crosswalk” identifying the specific amendments and supporting

documentation or direction for each section. Also included in the crosswalk are the reasoned

references and authoritative sources for the changes.

The major changes to Chapter 3 relate to the Board's authority to regulate the scope and practice

of nursing and provide guidance for APRNs, RNs, LPNs and CNAs via the establishment of

acceptable standards of safe nursing tasks. The proposed language also provides the Board with

criteria to evaluate safe and competent nursing tasks and removes redundancy.

The amendments to Chapter 3 also add language from Chapter 9 relating to the Board’s power to

establish acceptable standards of delegation by defining responsibilities among nursing

professionals. The new language provides the Board with criteria to evaluate safe and competent

delegation of nursing tasks and removes redundancy. Chapter 9 will be repealed in its entirety

and the content integrated into Chapter 3, a more appropriate location for its concepts.

By combining Chapter 3 and Chapter 9, the Board can clarify any ambiguity that may occur

from redundancy and provide succinct and comprehensive regulatory framework. This

amendment promotes a common understanding of what constitutes the practice of nursing and

the process of delegation among nursing professionals.

Respectfully submitted,

Cynthia LaBonde MN, RN

Executive Director, WSBN

Matthew H Mead

Governor

Wyoming STATE BOARD OF NURSING

Cynthia LaBonde MN, RN

Executive Director

of 1

Wyoming STATE BOARD OF NURSING

Summary of Comments and Responses to proposed revisions to

Chapter 3: Scope and Standards of Nursing Practice and CNA Role

and repeal of Chapter 9: Delegation and Assignment

Licensing base notified by:

o Notice of Intent published in Casper Star Tribune newspaper May 12,

2017.

o Documentation posted on WSBN website May 12, 2017.

Comment period open from May 12, 2017 to June 30, 2017.

o WSBN received NO comments during the comment period.

Matthew H. Mead

Governor

Cynthia LaBonde, MN RN

Executive Director

130 Hobbs Avenue, Suite B • Cheyenne, Wyoming 82002 • Phone: 307-777-7601 • FAX: 307-777-3519 • http://nursing.state.wy.us

http://nursing.state.wy.us/

Updated 6.3.16 Page 1 of 25

Crosswalk for Chapters 3 & 9

Most of the changes recommended by the Practice and Education Committee for the Administrative Rules and Regulations of the Wyoming State Board of Nursing, Chapters 3 & 9 are based on National

Council of State Boards of Nursing’s (NCSBN) Model Rules (2014). https://www.ncsbn.org/14_Model_Rules_0914.pdf

Chapters 3 & 9 are being combined to simplify language, decrease redundancies and meet recommendations of NCSBN Model Rules

Proposed Chapter 3 Rules Current Chapter 3 & 9 Rules Rationale for Change Comments

BOX 1

CHAPTER 3 Simplifies and updates

language based on

NCSBN

recommendations.

Source2 6.1

1.1 Section 1. Statement of Purpose. These Board Rules are

adopted to implement the Board’s authority to: Section 1. Statement of Purpose. These Board Rules are adopted

to implement the Board's authority to regulate the scope and practice

of nursing and provide guidance for APRN, RN, LPN and the role of

the CNA.

Simplifies language

1.2 (a) Regulate the scope and practice of nursing for

APRN, RN, LPN and the role of the CNA;

Do we need to include

expanded role of LPN

IV, CNA II and MA-C?

1.3 (b) Provide standards of nursing practice that

integrate knowledge, skills, abilities and judgment;

ANA definition of

competency.

Source1 p. 78

CHAPTER 9

1.4 Section 2. Statement of Purpose.

(a) These Board Rules are adopted to implement the

Board’s authority to:

Redundant, combining

chapters

1.5 (c) Establish acceptable standards of safe delegation

of nursing tasks; and

Ch 9, Sect. 2(a)

(i) To establish acceptable standards of safe delegation of

nursing tasks.

Unchanged

https://www.ncsbn.org/14_Model_Rules_0914.pdf



1.6 (d) Provide clear direction and standardization of the

delegation process, from a systems (employer) and client care

perspective.

Recommended language

from NCSBN

Source2

1.7 Ch 9, Sect. 2(a)

(ii) To provide criteria for the Board to evaluate safe and

competent delegation of nursing tasks.

Removed – the

establishment of

standards provide criteria

for evaluation. Language

is redundant.

BOX 2

Note – definitions are not currently included in chs 3 & 9. Definitions are

being moved from Ch 1 when used exclusively in a single chapter.

More terms will need to be added when chapter finalized such as

delegation? Accountability?

2.1 Section 2. Definitions.

2.2 (a) “Assignment” means the routine care activities that

are within the authorized scope of practice or the RN, LPN, or part of

the role of the UAP.

Previously not defined

Source2 p. 6-7

2.3 (b) “Delegatee” means one who is delegated a

nursing responsibility by either an APRN, RN, or LPN, is

competent to perform it, and verbally accepts the responsibility.

A delegatee may be an RN, LPN, or UAP


Source2 p. 7

2.4 (c) “Employer/Nurse Leader” means the person

responsible for the oversight of delegated responsibilities for the

facility.


Source2 p. 9

2.5 “FCSA” means Foreign Credential Services of America corporation

2.6 “Peer Review” means evaluation of scientific, academic, or

professional work by others working in the same field.


Proposed Chapter 3 Rules Current Chapter 3 & 9 Rules Rationale for Change Comments 2.7 (d) “Licensed Nurse” means those holding an active

Wyoming license as an APRN, RN, or LPN.

2.8 (e) “Predictable” means behaving or occurring in a

way that is expected.

2.9 (f) “Scope and Standard”

2.10 (g) “UAP” means unlicensed assistive personnel

trained to function in a supportive role, regardless of title, to

whom a nursing responsibility may be delegated. This includes

but is not limited to CNAs, patient care technicians, CMAs,

certified medication aides, and home health aides.


Source2 p. 7

2.11 (h) “WCSA”

2.12 (i) “WPA”

BOX 3

3.1 Section 3. Scope and Standards of Nursing Practice for

the APRN.

Unchanged – ch 3

3.2 (a) APRN Scope and Standards.

Unchanged – ch 3

3.3 (i) The APRN is subject at all times to the standards

and scope of practice established by national professional

organizations and/or accrediting agencies representing the

various core, role and population focus areas for APRNs, and

the NPA.

Unchanged – ch 3

3.4 (ii) The Board recognizes APRN core, role and

population focus areas described in the scope of practice

statements for APRNs issued by national professional

Unchanged – ch 3



organizations and/or accrediting agencies.

3.5 (iii) Role and population focus of the APRN shall be

declared, and the role and population focus to be utilized shall

be the title(s) granted by nationally recognized professional

organization(s) and/or accrediting agency(ies) or the title(s) of

the role and population focus of nursing practice in which the

APRN has received postgraduate education preparation.

Unchanged – ch 3

3.6 (iv) In order to practice in one of the four roles and in

a defined population, the APRN shall be recognized by the

Board in that particular role with a population focus of advanced

practice nursing.

Unchanged – ch 3

3.7 (b) Prescriptive Authority. Unchanged – ch 3

3.8 (i) The Board may authorize an APRN to prescribe,

order, procure, administer, dispense and furnish over the

counter, legend and controlled substances pursuant to applicable

state and federal laws and within the APRN’s role and

population focus.

Ch 3, Sect. 2(b)

(i) The Board may authorize an APRN to prescribe

medications and devices, within the recognized scope of APRN’s role

and population focus, and in accordance with all applicable state and

federal laws including, but not limited to, the WPA, WCSA, the

FCSA, and their applicable Rules and Regulations.

Reflects language and

recommendations from

NCSBN Model Rules.

Source3 11.5.1

Do WPA, WCSA, etc

all need to be listed?

What about DEA?

3.9 (ii) Authorized prescriptions by an APRN shall: Ch 3, Sect. 2(b)(iii)

Wording unchanged ch

3– relocated for better

comprehension

3.10 (A) Comply with all current and applicable

state and federal laws; and

3.11 (B) Be signed by the APRN with the initials

"APRN" or the initials of the nationally recognized role and

population focus.



3.12 (iii) APRNs may receive, sign for, record and

distribute samples to clients. Distribution of drug samples shall

be in accordance with state law and DEA laws, regulations and

guidelines.



NCSBN Model Rules.

Source3 11.5.2

3.13 (iv) The Board shall transmit to the Board of

Pharmacy a list of all APRNs who have prescriptive authority.

The list shall include:

Ch 3, Sect. 2(b)(ii)

Unchanged – ch 3

3.14 (A) The name of the authorized APRN; Ch 3, Sect. 2(b)(ii)(A-C

Unchanged – ch 3

3.15 (B) The RN license number, role and

population focus of the APRN recognized by the Board; and

Unchanged – ch 3 Does this need to be

changed to APRN

number?

3.16 (C) The effective date of prescriptive

authority authorization.

Unchanged – ch 3

3.17 (v) The Board will notify the Board of Pharmacy

within two working days after termination of or change in the

prescriptive authority of an APRN.

Ch 3, Sect. 2(b)(vi)

Wording unchanged ch

3– relocated for better

comprehension

3.18 (c)

3.19 (i)

3.20 (ii)

3.21 (iii)

3.22 (A)



3.23 (B)

3.24 (C) Ch 3, Sect. 2(b)

(iv) Prescriptive authorization will be terminated if the

APRN has:

(A) Prescribed outside the scope of recognized

APRN's role and population focus or for other than therapeutic

purposes;

3.25 (D)

3.26 Ch 3, Sect. 2(b)

(iv) Prescriptive authorization will be terminated if the

APRN has:

(A) Not maintained current recognition as an

APRN;

(C) Not completed four hundred (400) hours of

practice as an APRN within the past two (2) years;

(D) Not documented fifteen (15) contact hours of

pharmacology within the past two (2) years; or

(E) Violated the standards of practice, Board Rules,

or the NPA.

Removed – information

redundant from Ch 2 /8

3.27 (d) Applicability. Ch 3, Sect. 2(c)

Unchanged – ch 3

3.28 (i) The provisions of this chapter are only applicable

to an APRN who is recognized as an APRN, whose

authorization to perform advanced and specialized acts of

nursing practice, advanced nursing and medical diagnosis, and

the administration and prescription of therapeutic and corrective



measures comes from educational preparation, national

certification, and recognition to practice in compliance with

Board Rules.

3.29 (ii) Nothing in this chapter prohibits the usual and

customary practice of an APRN in the State from directly

administering prescribed controlled substances under derived

authority. In addition, the direct administration, or the ordering

of controlled substances preoperatively, intraoperatively or

postoperatively, by an APRN (certified registered nurse

anesthetist) does not involve prescribing within the meaning of

21 CFR 1308.02(f) or the Board Rules. These rules do not

require any changes in the current practice and procedures of

APRN who are certified registered nurse anesthetists or the

institutional and individual practitioners with whom they may

practice.

Ch 3, Sect. 2(c)

Unchanged – ch 3

3.30 Ch 3, Sect. 2(c)

(iii) Nothing in this chapter prohibits the usual and

customary practice of APRNs in the State from providing/dispensing

drugs in accordance with applicable state and federal laws.

Removed – redundant

to authority granted in

Ch 3, Sect. 2(b)

3.31 (iii) Nothing in this section limits or enhances the

usual and customary practice of a RN or LPN in the State.

Ch 3, Sect. 2(c)(iv)

Unchanged – ch 3

BOX 4 4.1 Section 4. Standards of Nursing Practice for

the RN and LPN.

Standards of practice are

the same for both the RN

and LPN. Combining

removes redundancy.

4.2 (a) Accountability. The RN/LPN shall:

4.3 (i) Practice within the legal boundaries for nursing

through the scope of practice authorized in the Nurse Practice

Ch 3, Sect. 3(a)

(i) Have knowledge of the statutes and regulations



NCSBN Model Rules.



Act (NPA) and rules governing nursing; governing nursing;

(ii) Practice within the legal boundaries for nursing

through the scope of practice authorized in the NPA and the Board

Rules;

Ch 3, Sect. 4(b)

(i) Have knowledge of the statutes and regulations

governing nursing;

Source3 3.1.1/3.2.1

Removes redundancy by

combining RN/LPN

standards

4.4 (ii) Demonstrate honesty and integrity in nursing

practice;



NCSBN Model Rules.

Source3 3.1.1/3.2.1


combining RN/LPN

standards

4.5 (iii) Base nursing decisions on nursing knowledge

and skills, the needs of clients and nursing standards;

Ch 3, Sect. 3(a)

(iv) Base professional decisions on nursing knowledge and

skills, the needs of clients and the expectations delineated in

professional standards;

Ch 3, Sect. 4(a)(ii)

(E) Base nursing decisions on nursing knowledge,

skills, and needs of clients.

4.6 (iv) Accept responsibility for judgments, individual

nursing actions, competence, decisions and behavior in the

course of nursing practice;

Ch 3, Sect. 4(b)

(ii) Accept individual responsibility and accountability for

nursing actions and competency;

4.7 (v) Seek clarification of orders when needed;

4.8 (vi) Maintain competence through ongoing learning

and application of knowledge in nursing practice;

Ch 3, Sect. 3(a)

(v) Maintain continued competence through ongoing

learning and application of knowledge to nursing practice;



Ch 3, Sect. 4(b)

(xi) Maintain continued competency through ongoing

learning and application of knowledge to nursing practice;

4.9 (vii) Participate in the evaluation of nursing practice

through quality and safety activities including peer review;

Ch 3, Sect. 3(a)

(vii) Participate in the evaluation of nursing practice

through quality and safety activities including peer review;

Ch 3, Sect. 4(b)

(v) Participate in the evaluation of nursing practice

through quality and safety activities;


combining RN/LPN

standards

4.10 (viii) Take preventive measures to protect the client,

others, and self;

Ch 3, Sect. 3(a)

(iii) Take preventive measures to protect the client, others,

and self.

Ch 3, Sect. 4(c)

(ii) Take preventive measures to protect client, others, and

self;

Unchanged – Ch 3

4.11 (ix) Participate in the development of continued

competency in the performance of nursing care activities for

nursing personnel and students; and

Ch 3, Sect. 4(b)

(xii) Participate in the development of continued

competency in the performance of nursing care activities for nursing

personnel and students; and

4.13 (x) Report violations of the NPA or Rules by self or

other licensees. Report unsafe conditions for practice to

Ch 3, Sect. 3(a)

(vi) Report unfit or incompetent nursing practice to



NCSBN Model Rules.



recognized legal authorities. recognized legal authorities;

Ch 3, Sect. 4(b)

(vi) Report unfit or incompetent nursing practice to the

board. Report unsafe conditions for practice to recognized legal

authorities;

Source3 3.1.1/3.2.1


combining RN/LPN

standards

4.14 (b) Client Advocacy. The RN/LPN have

responsibility to advocate for the client and shall:

4.15 (i) Conduct practice without discrimination on the

basis of age, race, religion, sex, life style, national origin,

medical diagnosis, or handicap;

Ch 3, Sect. 3(a)

(x) Conduct practice without discrimination on the basis of

age, race, religion, sex, life style, national origin, medical diagnosis,

or handicap.

Ch 3, Sect. 4(b)

(vii) Conduct practice without discrimination on the basis of

age, race, religion, sex, life-style, national origin, or disability;


combining RN/LPN

standards

4.16 (ii) Respect the dignity and rights of clients and their

significant others, regardless of social or economic status,

personal attributes, or nature of health problems;

Ch 3, Sect. 4(b)

(viii) Respect the dignity and rights of clients and their

significant others, regardless of social or economic status, personal

attributes, or nature of health problems;


combining RN/LPN

standards

4.17 (iii) Maintain client confidentiality unless obligated

by law to disclose the information;

Ch 3, Sect. 3(a)

(ix) Maintain client confidentiality unless obligated by law

to disclose the information; and

Ch 3, Sect. 4(b)

(ix) Protect confidential information, unless obligated by


combining RN/LPN

standards



law to disclose the information;

4.18 (iv) Maintain appropriate professional boundaries,

including sexual boundaries;

Ch 3, Sect. 3(a)

(viii) Maintain appropriate professional boundaries,

including sexual boundaries;

Ch 3, Sect. 4(b)

(x) Maintain boundaries, including sexual boundaries;

4.19 (v) Promote a safe and therapeutic environment by: Reflects language and


NCSBN Model Rules.

Source3 3.2.4

4.20 (A) Appropriate monitoring and surveillance

of the care environment;

4.21 (B) Identifying unsafe care situations; and

4.22 (C) Correcting problems or referring

problems to appropriate management level when needed.

5.1 Section 5. Scope of Nursing Practice for

the RN.

5.2 (a) RN Standard. The RN has the responsibility to

organize, manage, and supervise the practice of nursing.



NCSBN Model Rules.

Source3 3.2.4

5.3 (b) RN Scope of Practice. The RN shall:

5.4 (i) Retain professional accountability for nursing

care;

Ch 3, Sect. 3(a) Unchanged – ch 3



5.5 Ch 9, Sect. 2(a)

(i) The RN takes responsibility and accountability for the

provision of nursing practice.

Removed – redundant

information Ch 9

5.6 (ii) Participate as a member of the interdisciplinary

healthcare team;

Ch 3, Sect. 3

(b) The RN shall participate of an interdisciplinary

healthcare team and organize, manage, and supervise the practice of

nursing.

Language from Ch 3 -

part of section moved to

standard

5.7 (iii) Implement the nursing process: Ch 3, Sect. 3(d)

Unchanged – Ch 3

5.8 (A) Conduct a comprehensive nursing

assessment;

Ch 3, Sect. 3(d)

(i) Conduct a comprehensive health assessment that is an

extensive data collection (initial and ongoing) regarding individuals,

families, groups, and communities; and

(ii) Collect objective and subjective data from

observations, examinations, interviews, and written records in an

accurate and timely manner.



NCSBN Model Rules.

Source3 3.2.2

5.9 (B) Plan nursing care and nursing

interventions consistent with the client’s overall health care

plan;

5.10 (C) Utilize decision-making, critical thinking

and clinical judgment to make independent nursing decisions

and nursing diagnoses;



NCSBN Model Rules.

Source3 3.2.2

5.11 (D) Implement treatment and therapy,

including medication administration and delegated medical and

independent nursing functions; and



5.12 (E) Evaluate the client’s response to nursing

care and other therapy.

5.13 (iv) Identify changes in client’s health status and

comprehend clinical implications of client’s signs, symptoms

and changes as part of expected and unexpected client course or

emergent situations;

5.14 (v) Document nursing care;

5.15 (vi) Communicate and consult with other health team

members;

5.16 (vii) Provide comprehensive nursing and health care

education in which the RN:

5.17 (B) Assesses and analyzes educational needs

of learners;

5.18 (C) Plans educational programs based on

learning needs and teaching-learning principles;

5.19 (D) Ensures implementation of an educational

plan either directly or by delegating selected aspects of the

education to other qualified persons; and

5.20 (E) Evaluates the education to meet the

identified goals.

5.21 (viii) Provide delegation to the RN, LPN and UAP.

Match client needs with personnel qualifications, available

resources and appropriate supervision using delegation

guidelines in this chapter, sections nine (9) through eleven (11).



NCSBN Model Rules.

Source3 3.2.4

BOX 5



6.1 Section 6. Scope of Nursing Practice for the LPN.

6.2 (a) LPN Standards.

6.3 (i) Practice under the supervision of an RN, APRN,

licensed physician or other authorized licensed independent

health care provider.

Ch 3, Sect. 4(a)(iii)

(A) Provide care for clients under the direction of a

licensed physician, dentist, APRN, or RN.



NCSBN Model Rules.

Source3 3.1.2

6.4 (ii) Participate in nursing care, health maintenance,

patient teaching, counseling, collaborative planning and

rehabilitation, to the extent of his/her generic and continuing

education and experience.

Ch 3, Sect. 4(b)

(iii) Accept client care assignments from the licensed

physician, APRN, dentist, or RN only for which they are

educationally prepared and adequately trained;



NCSBN Model Rules.

Source3 3.1.2

6.5 (iii) Initiate appropriate standard emergency

procedures established by the institution until a licensed

physician, dentist, APRN or RN is available.

Ch 3, Sect. 4(a)(iii)(B) Unchanged – Ch 3

6.6 (iv) Contribute to the formulation, interpretation,

implementation, and evaluation of the objectives and policies

relating to practical nursing practice within the employment

setting.

Ch 3, Sect. 4(a)(i) Unchanged – Ch 3

6.7 (b) LPN Scope of Practice. The LPN shall:

6.8 (i) Conduct a focused nursing assessment, which is

an appraisal of the client’s health status and needs that

contributes to ongoing data collection;

Ch 3, Sect. 4(a)

(i) Contribute to the nursing assessment by collecting,

reporting, and recording objective and subjective data in an accurate

and timely manner. Data collection includes observations about the

condition or change in condition of the client.



NCSBN Model Rules.

Source3 3.1.2



6.9 (ii) Recognize patient characteristics that may affect

the patient’s health status;



NCSBN Model Rules.

Source3 3.1.2

6.10 (iii) Contribute to the plan of care by:

(A) Gathering, observing, recording, and

communicating patient responses to nursing interventions; and

(B) Modifying the plan of care in

collaboration with a registered nurse based on an analysis of

patient responses.

Ch 3, Sect. 4(a)

(ii) Participate in the development and modification of the

plan of care by:

(A) Provide data;

(B) Contribute to the identification of priorities;

(C) Contribute to setting realistic and measurable

goals;

(D) Assist in the identification of measures to

maintain comfort, support human functions and responses, maintain

an environment conducive to well-being, and provide health teaching

and counseling; and

6.11 (iv) Function as a member of the health care team,

contributing to the implementation of an integrated patient-

centered health care plan;

Ch 3, Sect. 4(c)

(i) Participate in nursing management;

6.12 (v) Implement nursing interventions and prescribed

medical regimens in a timely and safe manner;

Ch 3, Sect. 4(b)(xiii) Unchanged – Ch 3

6.13 (vi) Collaborate and communicate relevant and timely

patient information with patients and other health team members

to ensure quality and continuity of care;



NCSBN Model Rules.

Source3 3.1.2

6.14 (vii) Document nursing care;

6.15 (viii) Teach and counsel clients and families in Ch 3, Sect. 4(c)(iii) Unchanged – Ch 3



accordance with the nursing care plan; and

6.16 (ix) Provide delegation to the LPN and UAP. Match

client needs with personnel qualifications, available resources

and appropriate supervision using delegation guidelines in this

chapter, sections nine (9) through eleven (11).



NCSBN Model Rules.

Source3 3.2.4

BOX 6

7.1 Section 7. Role of CNA.

7.2 (a) Standard. The CNA, regardless of title or care

setting shall be under the direction of an APRN, RN, or LPN.

Ch 3, Sect. 6(a) Unchanged – Ch 3

7.3 Ch 9, Sect. 4

(b) CNA may complement the APRN, RN, or LPN in the

performance of nursing functions but shall not substitute for the

APRN, RN, or LPN.

Removed - outdated and

inaccurate language. It is

not within the CNA role

to substitute for the

licensed nurse.

7.4 (b) CNA Role. After appropriate client assessment

and delegation by the an APRN, RN, or LPN, the CNA shall

utilize knowledge of client’s rights, legal and ethical concepts,

communication skills, safety, and infection control while

performing the following:

(i) Basic Nursing Skills;

(ii) Personal Care Skills;

(iii) Basic Restorative Skills Assistance;

(iv) Mental Health and Psychosocial Skills;

(v) Communication Skills; and

(vi) Nursing Team Member Skills of the CNA.

Ch 3, Sect. 6(b)

Unchanged – Ch 3

BOX 7



8.1 Section 8. Expanded Role for LPN IV, MA-C and CNA.

With successful completion of a Board-approved curriculum,

the LPN or CNA may obtain certification which expands the

LPN scope of practice or CNA role.

Ch 3, Sect. 5 Unchanged – Ch 3

BOX 8 9.1 Section 9. Standards of Delegation.

9.2 (a) All decisions related to delegation and

assignment shall be based on the fundamental principles of

protection of the health, safety and welfare of the public.

Ch 9, Sect. 2(a)

(a) All decisions related to delegation and assignments are

based on the fundamental principles of protection of the health, safety

and welfare of the public.

No significant change

9.3 (b) The delegating APRN, RN, or LPN must

delegate only those tasks which are within his/her area of

responsibility and scope of practice;

Ch 9, Sect. 4(e)

(i) The delegating APRN, RN, or LPN must delegate only

those tasks which:

(A) Are within his/her area of responsibility and

scope of practice;

No significant change

9.4 (c) Delegation shall be at the discretion of the

licensed nurse, with consideration of the particular situation.

Ch 9, Sect. 2(a)

(ii) The RN directs care and determines the appropriate

utilization of any CNA involved in providing direct client care.

(iv) The decision of whether or not to delegate or assign is

based upon the RN’s judgment concerning the condition of the

patient, the competence of members of the nursing team and the

degree of supervision that will be required of the RN if a task is

delegated.



NCSBN National

Delegation Guidelines

Source2 p. 10

9.5 (d) The RN may delegate components of assessment

and care but shall retain responsibility for the nursing process

itself.

Ch 9, Sect. 2(a)

(iii) The RN may delegate components of care but does not

delegate the nursing process itself. The functions of assessment,

planning, evaluation and nursing judgment are pervasive to nursing

Simplified current

language to remove

redundancies.



practice and cannot be delegated

Ch 9, Sect. 3

(b) Certain nursing functions require nursing knowledge,

judgment, and skill and may not be delegated.

Ch 9, Sect.6

Section 6. Basic Nursing Functions, Tasks, and Skills that

May Not be Delegated.

(a) The nursing process requires nursing knowledge,

judgment, and skill and may not be delegated. The nursing process

includes, but is not limited to:

(i) Assessment;

(ii) Development of the nursing diagnosis;

(iii) Establishment of the nursing care goal;

(iv) Development of the nursing care plan; and

(v) Evaluation of the client’s progress, or lack of progress,

toward goal achievement.

9.6 (e) The licensed nurse shall maintain accountability

for the client, while the delegatee shall be responsible for the

designated activity, skill, or procedure. The employer has

responsibility for delegation policies and procedures that guide

the delegation process.

Ch 9, Sect. 3

(a) The delegating RN or LPN retains accountability for:

(i) Nursing care when delegating nursing tasks or

interventions to ensure client safety;

(ii) The decision to delegate;



NCSBN National


Source2 p. 10



(iii) Verifying the delegate’s competency to perform the

tasks;

(iv) Providing direction or supervision;

(v) The performance of the delegated task;

(vi) Evaluating the effectiveness of the delegated nursing

task or interventions performed under direction or supervision.

(Also covered in Section 9 Responsibilities of Delegation and

Assignment)

9.7 (f) It shall be considered assignment rather than

delegation if the particular activity or task is already within the

legally recognized scope of practice or role of the individual.

Ch 9, Sect. 4(e)

(iii) Delegation is unnecessary if the particular activity or

task is already within the legally recognized scope of practice or role

of the individual who is to perform the activity or task;

Change to positive

wording and includes

language of assignment

as suggested by NCSBN.

Source2

9.8 Ch 9, Sect. 2(a)

(vi) The RN individualizes communication regarding

delegation to the CNA and client situation. The communication

should be clear, concise, correct and complete. The RN verifies

comprehension with the CNA and that the CNA accepts the

delegation and the responsibility that accompanies it.

Deleted – describes the

process for delegation.

Moved to Advisory

Opinion

9.9 Ch 9, Sect. 2(a)

(vii) Communication must be a two-way process. CNA

must have the opportunity to ask questions and/or for clarification of

expectations.



Moved to Advisory

Opinion

9.10 Ch 9, Sect. 2(a)

(viii) The RN uses critical thinking and professional



Moved to Advisory

Opinion



judgment when following the Five Rights of Delegation:

(A) Right task;

(B) Right circumstances;

(C) Right person;

(D) Right directions and communication; and

(E) Right supervision and evaluation.

9.11 (g) Transfer of responsibility of care between

licensed nurses shall be considered a handoff of care rather than

delegation.

Clarification of the

delegation process.

Source2 p. 9

10.1 Section 10. Responsibilities of Delegation and

Assignment. The employer, individual licensed nurse, and

delegatee each shall have specific responsibilities within the

delegation and assignment process.



NCSBN National


Source2 p. 9

10.2 (a) Employer Responsibilities. The employer shall: Reflects language and


NCSBN National


Source2 p. 9

10.3 (i) Identify a nurse leader responsible for oversight

of delegated responsibilities for the facility;

Ch 9, Sect. 2

(b) Chief nursing officers are accountable for establishing

systems to assess, monitor, verify and communicate ongoing

competence requirements in areas related to delegation.

10.4 (ii) Develop policies for delegation; and

10.5 (iii) Assess, monitor and verify competency of staff.

10.6 (b) Licensed Nurse Responsibilities. The licensed

nurse shall:



10.7 (i) Direct care and determine appropriate assignment

and delegation in client care;

Ch 9, Sect. 2(a)

(ii) The RN directs care and determines the appropriate

utilization of any CNA involved in providing direct client care.

Simplifying language

10.8 (ii) Assign or delegate to another, those nursing

measures the individual has the education, legal authority and

demonstrated competency to perform safely including:

Ch 9, Sect. 2(a)

(v) The RN delegates only those tasks for which she or he

believes the other health care worker has the knowledge and skill to

perform, taking into consideration training, cultural competence,

experience and facility/agency policies and procedures.



NCSBN Model Rules and

National Delegation

Guidelines

Source3 3.2.4 (a-b)

Source2 p. 9-10

10.9 (A) The APRN or RN may assign or delegate

nursing care to the RN, LPN or UAP;

10.10 (B) The LPN may assign or delegate nursing

care to the LPN or UAP;

10.11 (iii) Provide direction, guidance, and evaluation for

assignment or delegation;

Ch 9, Sect. 5

Section 5. Degree of Direction or Supervision.

(l) The degree of required direction or supervision for the CNA

shall comply with the following criteria:

(i) Direction or supervision means a licensed nurse

providing appropriate guidance in the accomplishment of a nursing

task, including but not limited to:

(A) Periodic observation and evaluation of the

performance of the task; and

(B) Validation that the task has been performed

according to established standards of practice.

10.12 (iv) Be readily available in person, by

telecommunication, text or other alternative method of

communication; and

Ch 9, Sect. 5(a)

(iii) The delegating APRN, RN, or LPN or another

qualified nurse shall be readily available either in person or by

Simplifying language.

Updating to support

current technology.



telecommunication.

10.13 (v) Maintain accountability for any assigned or

delegated nursing measures.



NCSBN Model Rules

Source3 3.2.4 (i)

10.14 (c) Delegatee Responsibilities. The delegatee shall: Reflects language and


NCSBN National


Source2 p. 11

10.15 (i) Accept only assignments and delegated

responsibilities for which they have adequate training and

education;

10.16 (ii) Maintain competency for the assigned or

delegated responsibility;

10.17 (iii) Communicate questions and follow-up to the

licensed nurse making the assignment or delegation; and

10.18 (iv) Be accountable for carrying out the delegated or

assigned responsibility or contact the assigning/delegating nurse.

11.1 Section 11. Criteria for Delegation and

Assignment. The following criteria shall determine what

nursing tasks, functions or activities may be delegated or

assigned:

Ch 9, Sect. 4

(a) The licensed nurse delegates tasks based on the needs

and condition of the client, potential for harm, stability of the client’s

condition, complexity of the task, predictability of the outcomes,

ability of the staff to whom the task is delegated, and the context of

other client needs.

Ch 9, Sect. 5(a)

(ii) Delegation will ensue after an evaluation of factors

including but not limited to the:



NCSBN Model Rules.

Source3 10.3.1-2

11.2 (i) Legal authority, knowledge, and skills of the

delegatee;

11.3 (ii) Verification of the clinical competence of the

delegatee by the employing agency;

11.4 (iii) Stability of the client’s condition that involves

predictability, absence of risk or complications, and rate of



change; and (A) Stability of the client;

(B) Training and capability of the delegate;

(C) Nature of the nursing task being delegated; and

(D) Proximity and availability of the delegator to

the delegate.

11.5 (iv) Variables in the clinical setting including, but not

limited to:

11.6 (A) The accessible resources and established

policies that lend support to the type of nursing tasks, functions ,

and activities being delegated;

11.7 (B) The complexity and frequency of care

needed by a given client population;

11.8 (C) The proximity of the client to staff;

11.9 (D) The number and qualifications of staff;

and

11.10 (E) The accessibility of the licensed nurse.

11.11 Ch 9, Sect. 4

(c) Delegation shall be task-specific, client-specific, and

CNA specific.

(d) The CNA role evolves from the performance of

delegated nursing related tasks and services regardless of an

individual's title or care setting.

(e) Delegation shall be directed by a APRN, RN, or LPN.


is redundant.

11.12 Ch 9, Sect. 4(e)

(i) The delegating APRN, RN, or LPN must delegate only

those tasks which:


is redundant.



(B) A reasonable, prudent APRN, RN, or LPN

would find, within his/her sound nursing judgment, appropriate to

delegate;

(C) In the opinion of the APRN, RN, or LPN, shall

be properly and safely performed by the CNA without jeopardizing

the client's welfare;

(D) Does not require the CNA to exercise nursing

judgment, complex observations or nursing assessments, critical

decision making or interventions except in an emergency situation;

and

(E) Are client specific, task specific, and CNA

specific and outcomes are predictable.

11.13 Ch 9, Sect. 4(e)

(ii) When delegating a nursing task, the APRN, RN, or

LPN shall:

(A) Make an initial assessment of the client's

nursing care needs before delegating the task;

(B) Verify the CNA’s competence to perform any

nursing task prior to delegation;

(C) Verify appropriate continuing education for

each CNA for each task to be performed;

(D) Communicate with CNA allowing the

opportunity to ask questions, provide feedback, or clarification;

(E) Inform the client of the decision to delegate;

Reflects the process of

delegation, which

provides suggestions on

how to apply the rules.

This information is

covered in the Advisory

Opinion.



(F) Provide appropriate direction or supervision;

(G) Remain accountable for the delegated tasks;

(H) Evaluate client outcomes and make adjustments

accordingly; and

Make clear to the CNA that the delegated task cannot be re-delegated. 11.14 Ch 9, Sect. 4(e)(iii)

(A) An element of assignment exists in all

delegation; however, for the purpose of these rules, assignment means

that an individual designates another to be responsible for specific

clients or selected nursing functions for specifically identified clients;

(B) Both “assignment” and “delegation” decisions

must be made by the licensed nurse on the basis of the skill levels of

the care givers, the care needs of clients, and other considerations.

Deleted – redundant

information. Both terms

are in definitions.

1American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice. Silver Springs, MD: American Nurses Association.

2 National Council of State Boards of Nursing (NCSBN). (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-12.

3National Council of State Boards of Nursing (NCSBN). (2012). NCSBN Model Rules. Retrieved from: https://www.ncsbn.org/14_Model_Rules_0914.pdf

https://www.ncsbn.org/14_Model_Rules_0914.pdf

3-1

CHAPTER 3

SCOPE AND STANDARDS OF NURSING PRACTICE AND CNA ROLE.

Section 1. Statement of Purpose. These Board Rules are adopted to implement the

Board’s authority to:

(a) Regulate the scope and practice of nursing for APRN, RN, LPN, and the role of

the CNA;

(b) Provide standards of nursing practice that integrate knowledge, skills, abilities,

and judgment;

(c) Establish acceptable standards of safe delegation of nursing tasks; and

(d) Provide clear direction and standardization of the delegation process, from a

systems (employer) and client care perspective.

Section 2. Definitions.

(a) “Delegatee” means the person who is delegated a nursing responsibility by either

and APRN, RN, or LPN, is competent to perform it, and verbally accepts the responsibility. A

delegate may be either an RN, LPN or UAP.

(b) “Delegation” means the transition of a performance of an activity, skill or

procedure by a licensed nurse to a Delegatee. Pervasive functions of clinical reasoning, nursing

judgment, or critical decision making cannot be delegated.

(c) “Employer/Nurse Leader” means the person responsible for the oversight of

delegated responsibilities for the facility.

(d) “Licensed Nurse” mean those persons holding an active Wyoming license as an

APRN, RN, or LPN.

(e) “UAP” means unlicensed assistive personnel trained to function in a supportive

role, regardless of title, to which a nursing responsibility may be delegated. This includes, but is

not limited to CNAs, patient care technicians, certified medication aides, and home health aides.

Section 3. Scope and Standards of Nursing Practice for the APRN.

(a) Scope and Standards for APRN:

(i) The APRN is subject at all times to the standards and scope of practice

established by national professional organizations and/or accrediting agencies representing the

various core, role and population focus areas for APRNs, and the NPA.

3-2

(ii) The Board recognizes APRN core, role and population focus areas

described in the scope of practice statements for APRNs issued by national professional


(iii) Role and population focus of the APRN shall be declared upon application

for licensure, and the role and population focus to be utilized shall be the title(s) granted by

nationally recognized professional organization(s) and/or accrediting agency(ies) or the title(s) of

the role and population focus of nursing practice in which the APRN has received postgraduate

education preparation.

(iv) In order to practice in one of the four roles and in a defined population, the

APRN shall be recognized by the Board in that particular role with a population focus of

advanced practice nursing.

(b) Prescriptive Authority:

(i) The Board may authorize an APRN to prescribe, order, procure,

administer, dispense and furnish over the counter, legend and controlled substances pursuant to

applicable state and federal laws and within the APRN’s role and population focus.

(ii) Authorized prescriptions by an APRN shall:

(A) Comply with all current applicable state and federal laws; and

(B) Be signed by the APRN with the initials “APRN” or the initials of

the nationally recognized role and population focus.

(iii) APRNs may receive, sign for, record, and distribute samples to clients.

Distribution of drug samples shall be in accordance with state law and Drug Enforcement

Agency laws, regulations, and guidelines.

(iv) The Board shall transmit to the Board of Pharmacy a list of all APRNs

who have prescriptive authority. The list shall include:

(A) The name of the authorized APRN;

(B) The RN license number, role and population focus of the APRN

recognized by the Board; and

(C) The effective date of prescriptive authority authorization.

(v) The Board will notify the Board of Pharmacy within two working days

after termination of or change in the prescriptive authority of an APRN.

(c) Applicability:

3-3

(i) The provisions of this chapter are only applicable to an APRN who is

recognized as an APRN, who is authorized to perform advanced and specialized acts of nursing

practice, advanced nursing and medical diagnosis, and the administration and prescription of

therapeutic and corrective measures comes from educational preparation, national certification,

and recognition to practice in compliance with Board Rules.

(ii) Nothing in this chapter prohibits the usual and customary practice of an

APRN in the State from directly administering prescribed controlled substances under derived

authority. In addition, the direct administration, or the ordering of controlled substances

preoperatively, intraoperatively or postoperatively, by an APRN (certified registered nurse

anesthetist) does not involve prescribing within the meaning of 21 CFR 1308.02(f) or the Board

Rules. These rules do not require any changes in the current practice and procedures of APRN,

who are certified registered nurse anesthetists or the institutional and individual practitioners

with whom they may practice.

(iii) Nothing in this section limits or enhances the usual and customary practice

of an RN or LPN in the State.

Section 4. Scope of Nursing Practice for the RN and the LPN.

(a) Accountability. The RN/LPN shall:

(i) Practice within the legal boundaries for nursing through the scope of

practice authorized in the Nurse Practice Act (NPA) and the Board Rules;

(ii) Demonstrate honesty, integrity and ethical behaviors in nursing practice;

(iii) Base nursing decisions on nursing knowledge, evidence-based practice,

skills, standards, and the needs of the clients;

(iv) Accept responsibility for judgments, individual nursing actions,

competence, decisions and behavior in the course of nursing practice;

(v) Seek clarification of orders or direction when needed;

(vi) Maintain competence through ongoing learning and application of

knowledge in nursing practice;

(vii) Participate in the evaluation of nursing practice through quality and safety

activities, including peer review;

(viii) Take preventative measures to protect the client, others, and self;

(ix) Participate in the development of continued competency in the

performance of nursing care activities for nursing personnel and students; and

3-4

(x) Report violations of the Nurse Practice Act or Rules by self or other

licensees. Report unsafe conditions for practice to recognized legal authorities.

(b) Client Advocacy. The RN/LPN have the responsibility for the client and shall:

(i) Conduct practice without discrimination on the basis of age, race, religion,

sex, life style, national origin, culture, medical diagnosis, or disability;

(ii) Respect the dignity and rights of clients and their significant others,

regardless of social or economic status, personal attributes, culture or nature of health problems;

(iii) Maintain client confidentiality unless obligated by law to disclose the

information;

(iv) Maintain appropriate professional boundaries, including sexual

boundaries;

(v) Promote a safe and therapeutic environment by;

(A) Monitoring and surveillance of the care environment;

(B) Identifying unsafe care situations; and

(C) Correcting problems or referring problems to appropriate

management level when needed.

Section 5. Scope and Standards of Nursing Practice for the RN.

(a) RN Standard. The RN has the responsibility to organize, manage, and supervise

the practice of nursing.

(b) RN Scope of Practice. The RN shall:

(i) Retain professional accountability for nursing care;

(ii) Participate as a member of the inter disciplinary healthcare team;

(iii) Implement the nursing process:

(A) Conduct a comprehensive assessment;

(B) Plan nursing care and nursing interventions consistent with the

client’s overall health care plan;

(C) Utilize decision-making, critical thinking and clinical judgment to

3-5

make independent nursing decisions and nursing diagnosis;

(D) Implement treatment and therapy, including medication

administration and delegated medical and independent nursing functions; and

(E) Evaluate the client’s response to nursing care and other therapy.

(iv) Identify changes in the client’s health status and comprehend clinical

implications of the client’s signs, symptoms and changes as part of expected or unexpected client

course and emergent situations;

(v) Document nursing care;

(vi) Communicate and consult with other health team members;

(vii) Provide comprehensive nursing and health care education in which the

RN:

(A) Assesses and analyzes educational needs of learners;

(B) Plans educational programs based on learning needs and teaching-

learning principles;

(C) Ensures implementation of an educational plan either directly or by

delegating selected aspects of the education to other qualified persons; and

(D) Evaluates the education to meet the identified goals.

(viii) Provide delegation to the RN, LPN, and UAP. Match the client needs with

personnel qualifications, available resources and appropriate supervision using delegation

guidelines in this Chapter, Sections nine (9) through eleven (11).

Section 6. Scope and Standards of Nursing Practice for the LPN.

(a) LPN Standard.

(i) Practice under the supervision of an APRN, RN, licensed physician, or

other authorized licensed independent health care provider.

(ii) Participate in nursing care, health maintenance, patient teaching,

counseling, collaborative planning and rehabilitation, to the extent of his/her generic and

continuing education and experience.

(iii) Initiate appropriate standard emergency procedures established by the

institution until an APRN, RN, licensed physician, or dentist is available.

3-6

(iv) Contribute to the formulation, interpretation, implementation and

evaluation of the objectives and policies relating to practical nursing practice within the

employment setting.

(b) LPN Scope of Practice. The LPN shall:

(i) Conduct a focused nursing assessment, which is an appraisal of the

client’s health status and needs that contributes to ongoing data collection;

(ii) Recognize patient characteristics that may affect the patient’s health

status;

(iii) Contribute to the plan of care by:

(A) Gathering, observing, recording, and communicating patient

responses to nursing interventions; and

(B) Contributing to the plan of care in collaboration with a RN based

on an analysis of patient responses.

(iv) Function as a member of the health care team, contributing to the

implementation of an integrated patient-centered health care plan;

(v) Implement nursing interventions and prescribed medical regimes in a

timely and safe manner;

(vi) Collaborate and communicate relevant and timely patient information with

patients and other health team members to ensure quality and continuity of care;

(vii) Document nursing care;

(viii) Teach and counsel clients and families in accordance with the nursing care

plan; and

(ix) Provide delegation to the UAP. Match client needs with personnel

qualification, available resources and appropriate supervision using delegation guidelines in this

Chapter, Sections nine (9) through eleven (11).

Section 7. Role of the CNA

(a) Standard. The CNA, regardless of title or care setting, shall be under the direction

of an APRN, RN, or LPN.

(b) CNA Role. After appropriate client assessment and delegation by the APRN, RN

or LPN, the CNA shall utilize knowledge of client’s rights, legal and ethical concepts,

communications skills, and safety and infection control practices while performing the

3-7

following:

(i) Basic nursing skills;

(ii) Personal care skills;

(iii) Basic restorative skills;

(iv) Mental health and psychological support;

(v) Communication skills; and

(vi) Nursing team member technical skills of the CNA.

Section 8. Expanded Role for the LPN IV, MA-C and CNA II. With successful

completion of a Board-approved program, the LPN or CNA may obtain certification which

expands the LPN scope of practice or CNA role.

Section 9. Standards of Delegation

(a) All decisions related to delegation and assignment shall be based on the

fundamental principles of protection of the health, safety, welfare of the public and doctrine of

client rights.

(b) The licensed nurse must delegate only those tasks that are within his/her area of

responsibility and scope of practice.

(c) Delegation shall be at the discretion of the licensed nurse, with consideration of

the particular situation.

(d) The RN may delegate components of assessment and care tasks, but shall retain

responsibility for the nursing process itself.

(e) The licensed nurse shall maintain accountability for the client, while the

Delegatee shall be responsible for the designated activity, skill, task, or intervention. The

employer has responsibility for delegation policies and procedures that guide the delegation

process.

(f) It shall be considered assignment rather than delegation if the particular activity or

task is already within the legally recognized scope of practice or role of the individual Delegatee.

(g) Transfer of responsibility of care between licensed nurses shall be considered a

handoff of care rather than delegation.

Section 10. Responsibilities of Delegation and Assignment. The employer,

individual licensed nurse, and Delegatee each shall have specific responsibilities within the

3-8

delegation assignment process.

(a) Employer Responsibilities. The Employer shall:

(i) Identify a nurse leader responsible for oversight of delegated

responsibilities for the facility;

(ii) Develop policies for delegation; and

(iii) Assess, monitor, and verify competency of staff.

(b) Licensed Nurse Responsibilities. The licensed nurse shall:

(i) Direct care and determine appropriate assignment and delegation in client

care;

(ii) Assign or delegate to another, those nursing skills the individual has the

education, legal authority, and demonstrated competency to perform safely including:

(A) The APRN or RN may assign or delegate nursing care to the RN,

LPN, or UAP; and

(B) The LPN may assign or delegate nursing care to the LPN or UAP;

(iii) Provide direction, guidance, and evaluation for assignment or delegation;

(iv) Be readily available in person, by telecommunication, text or other

alternative method of communication; and

(v) Maintain accountability for any assigned or delegated nursing measures.

(c) Delegatee Responsibilities. The Delegatee shall:

(i) Accept only assignments and delegated responsibilities for which they

have adequate training, skills, and education;

(ii) Maintain competency for the assigned or delegated responsibility;

(iii) Communicate questions and concerns to the licensed nurse creating the

assignment or delegation; and

(iv) Be accountable for carrying out the delegated or assigned responsibility or

contact the assigning/delegating nurse.

Section 11. Criteria for Delegation and Assignment. The following criteria shall

determine what nursing tasks, functions, or activities may be delegated or assigned:

3-9

(a) Legal authority, knowledge, skills, and scope of practice of the Delegatee;

(b) Verification of the clinical competence of the Delegatee by the employing

agency;

(c) Stability of the client’s condition that involves predictability, absence of risk or

complications, and rate of change; and

(d) Variables in the clinical setting including, but not limited to:

(i) The accessible resources and established policies that lend support to the

type of nursing tasks, functions, and activities being delegated;

(ii) The complexity and frequency of care by a given client population;

(iii) The proximity of the client to staff;

(iv) The number and qualifications of staff; and

(v) The accessibility of a licensed nurse.

9-1

CHAPTER 9

DELEGATION AND ASSIGNMENT

These rules have been repealed.

3-1

CHAPTER 3

SCOPE AND STANDARDS OF NURSING PRACTICE AND CNA ROLE

Section 1. Statement of Purpose. These Board Rules are adopted to implement the

Board's authority to: regulate the scope and practice of nursing and provide guidance for APRN,

RN, LPN and the role of the CNA.

(a) Regulate the scope and practice of nursing for the APRN, RN, LPN, and the role

of the CNA.

(b) Provide standards of nursing practice that integrate knowledge, skills, abilities

and judgment;

(c) Establish acceptable standards of safe delegation of nursing tasks; and

(d) Provide clear direction and standardization of the delegation process, from a

systems (employer) and client care perspective.

Section 2. Definitions

(a) “Delegatee” means the person who is delegated a nursing responsibility by either

and APRN, RN, or LPN, is competent to perform it, and verbally accepts the responsibility. A

delegate may be either an RN, LPN or UAP.

(b) “Delegation” means the transition of a performance of an activity, skill or

procedure by a licensed nurse to a Delegatee. Pervasive functions of clinical reasoning, nursing

judgment, or critical decision making cannot be delegated.

(c) “Employer/Nurse Leader” means the person responsible for the oversight of

delegated responsibilities for the facility.

(d) “Licensed Nurse” mean those persons holding an active Wyoming license as an

APRN, RN, or LPN.

(e) “UAP” means unlicensed assistive personnel trained to function in a supportive

role, regardless of title, to which a nursing responsibility may be delegated. This includes, but is

not limited to CNAs, patient care technicians, certified medication aides, and home health aides.

Section 23. Scope and Standards of Nursing Practice for the APRN.

(a) Scope and Standards for APRN:

(i) The APRN is subject at all times to the standards and scope of practice

established by national professional organizations and/or accrediting agencies representing the

various core, role and population focus areas for APRNs, and the NPA.

3-2

(ii) The Board recognizes APRN core, role and population focus areas

described in the scope of practice statements for APRNs issued by national professional


(iii) Role and population focus of the APRN shall be declared, and the role and

population focus to be utilized shall be the title(s) granted by nationally recognized professional

organization(s) and/or accrediting agency(ies) or the title(s) of the role and population focus of

nursing practice in which the APRN has received postgraduate education preparation.

(iv) In order to practice in one of the four roles and in a defined population, the

APRN shall be recognized by the Board in that particular role with a population focus of

advanced practice nursing.

(b) Prescriptive Authority:

(i) The Board may authorize an APRN to prescribe medications and devices,

within the recognized scope of APRN’s role and population focus, and in accordance with all

applicable state and federal laws including, but not limited to, the WPA, WCSA, the FCSA, and

their applicable Rules and Regulations. The Board may authorize an APRN to prescribe, order,

procure, administer, dispense and furnish over the counter, legend and controlled substances,

pursuant to applicable state and federal laws and within the APRN’s role and population focus.

(ii) The Board shall transmit to the Board of Pharmacy a list of all APRNs






(iii) (ii) Authorized prescriptions by an APRN shall:

(A) Comply with all current and applicable state and federal laws; and

(B) Be signed by the APRN with the initials “APRN” or the initials of

the nationally recognized role and population focus.

(iii) APRNs may receive, sign for, record, and distribute samples to clients.

Distribution of drug samples shall be in accordance with state law and Drug Enforcement

Agency laws, regulations, and guidelines.

(iv) The Board shall transmit to the Board of Pharmacy a list of all APRNs


3-3





(iv) Prescriptive authorization will be terminated if the APRN has:

(A) Not maintained current recognition as an APRN;

(B) Prescribed outside the scope of recognized APRN's role and

population focus or for other than therapeutic purposes;

(C) Not completed four hundred (400) hours of practice as an APRN

within the past two (2) years;

(D) Not documented fifteen (15) contact hours of pharmacology within

the past two (2) years; or

(E) Violated the standards of practice, Board Rules, or the NPA.

(v) APRN’s prescriptive authority shall be renewed biennially.

(vi)(v) The Board will notify the Board of Pharmacy within two working days

after termination of or change in the prescriptive authority of an APRN.

(c) Applicability:

(i) The provisions of this chapter are only applicable to an APRN who is

recognized as an APRN, whose authorization who is authorized to perform advanced and

specialized acts of nursing practice, advanced nursing and medical diagnosis, and the

administration and prescription of therapeutic and corrective measures comes from educational

preparation, national certification, and recognition to practice in compliance with Board Rules.

(ii) Nothing in this chapter prohibits the usual and customary practice of an

APRN in the State from directly administering prescribed controlled substances under derived

authority. In addition, the direct administration, or the ordering of controlled substances

preoperatively, intraoperatively or postoperatively, by an APRN (certified registered nurse

anesthetist) does not involve prescribing within the meaning of 21 CFR 1308.02(f) or the Board

Rules. These rules do not require any changes in the current practice and procedures of APRN

who are certified registered nurse anesthetists or the institutional and individual practitioners

with whom they may practice.

(iii) Nothing in this chapter prohibits the usual and customary practice of

APRNs in the State from providing/dispensing drugs in accordance with applicable state and

3-4

federal laws.

(iv)(iii) Nothing in this section limits or enhances the usual and customary

practice of an RN or LPN in the State.

Section 34. Scope and Standards of Nursing Practice for the RN and the LPN.

(a) Accountability. The RN/LPN shall: retain professional accountability for nursing

care:

(i) Have knowledge of the statutes and regulations governing nursing;

(ii)(i) Practice within the legal boundaries for nursing through the scope of

practice authorized in the Nurse Practice Act (NPA) and the Board Rules;

(iii) Take preventive measures to protect the client, others, and self;

(ii) Demonstrate honesty, integrity, and ethical behaviors in nursing practice;

(iv)(iii) Base professional nursing decisions on nursing knowledge and skills, the

needs of clients and the expectations delineated in professional standards, skills, evidence-based

standards and the needs of the clients;

(iv) Accept responsibility for judgments, individual nursing actions,

competence, decisions and behavior in the course of nursing practice;

(v) Seek clarification of orders or directions when needed;

(v)(vi) Maintain continued competence through ongoing learning and application

of knowledge in nursing practice;

(vi) Report unfit or incompetent nursing practice to recognized legal

authorities;

(vii) Participate in the evaluation of nursing practice through quality and safety

activities including peer review;

(viii) Maintain appropriate professional boundaries, including sexual

boundaries;

(ix) Maintain client confidentiality unless obligated by law to disclose the

information; and

(x) Conduct practice without discrimination on the basis of age, race, religion,

sex, life style, national origin, medical diagnosis, or handicap.

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(viii) Take preventative measures to protect the client, others, and self;

(ix) Participate in the development of continued competency in the

performance of nursing care activities for nursing personel and students; and

(x) Report violations of the NPA or Rules by self or other licensees. Report

unsafe condition for practice to recognized legal authorities.

(b) Client Advocacy. The RN/LPN have responsibility to advocate for the client and

shall:

(i) Conduct practice without discrimination on the basis of age, race, religion,

sex, life style, national origin, culture, medical diagnosis, or disability;

(ii) Respect the dignity and rights of clients and their significant others,

regardless of social or economic status, personal attributes, culture or nature of health problems;

(iii) Maintain client confidentiality unless obligated by law to disclose the

information;

(iv) Maintain appropriate professional boundaries, including sexual

boundaries;

(v) Promote a safe and therapeutic environment by:

(A) Monitoring and surveillance of the care environment;

(B) Identifying unsafe care situations; and

(C) Correcting problems or referring problems to appropriate

management level when needs.

(b) The RN shall participate of an interdisciplinary healthcare team and organize,

manage, and supervise the practice of nursing.

(c) The RN shall advocate for the client.

(d) The RN shall implement the nursing process:

(i) Conduct a comprehensive health assessment that is an extensive data

collection (initial and ongoing) regarding individuals, families, groups, and communities; and

(ii) Plan nursing care and nursing interventions consistent with the client’s

overall health care plan;

Section 5. Scope and Standards of Nursing Practice for the RN.

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(a) RN. Standard. The RN has the responsibility to organize, manage, and supervise

the practice of nursing.

(b) RN Scope of Practice. The RN shall:

(i) Retain professional accountability for nursing care;

(ii) Participate as a member of the inter disciplinary healthcare team

(iii) Implement the nursing process:

(A) Concdcut a comprehensive assessment;

(B) Plan nursing care and nursing interventions consistent with the

client’s overall health care plan;

(C) Utilize decision-making, critical thinking and clinical judgment to

make independent nursing decisions and nursing diagnosis;

(D) Implement treatment and therapy, including medication

administration and delegated medical and independent nursing functions; and

(E) Evaluate the client’s response to nursing care and other therapy.

(iv) Identify changes in clients health status and comprehend clinical

implications of client’s sign, symptoms and changes as part of expected or unexpected client

course and emergent situations;

(v) Document nursing care;

(vi) Communicate and consult with other health team members;

(vii) Provide comprehensive nursing and health care education in shich the RN:

(A) Assesses and anlayzes educational needs of learners;

(B) Plans educational programs based on learning needs and teaching-

learning principles;

(C) Ensures implementation of an educational plan either directly or by

delegating selected aspects of the education to other qualified personsl; and

(D) Evaluates the education to meet the identified goals.

(viii) Provide delegation to the RN, LPN, and UAP. Match the client needs with


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guidelines in this chapter, Sections nine (9) through eleven (11).

Section 46. Scope and Standards of Nursing Practice for the LPN.

(a) LPN Standards. related to the LPN's contribution to the nursing process. The LPN

shall:

(i) Practice under the supervision of an APRN, RN, licensed physician, or

other authorized licensed independent health care provider.

(ii) Participate in nursing care, health maintenance, patient teaching,

counseling, collaborative planning and rehabilitation, to the extent of his/her generic and

continuing education and experience.

(iii) Initiate appropriate standard emergency procedures established by the

institution until a licensed physician, dentist, APRN, or RN is available.

(iv) Contribute to the formulation, interpretation, implementation and


employment setting.

(i) Contribute to the nursing assessment by collecting, reporting, and

recording objective and subjective data in an accurate and timely manner. Data collection

includes observations about the condition or change in condition of the client.

(ii) Participate in the development and modification of the plan of care by:

(A) Provide data;

(B) Contribute to the identification of priorities;

(C) Contribute to setting realistic and measurable goals;

(D) Assist in the identification of measures to maintain comfort,

support human functions and responses, maintain an environment conducive to well-being, and

provide health teaching and counseling; and

(A) Base nursing decisions on nursing knowledge, skills, and needs of

clients.

(iii) Participate in the implementation of the plan of care by:

(A) Provide care for clients under the direction of a licensed physician,

dentist, APRN, or RN.

(B) Initiate appropriate standard emergency procedures established by the

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institution until a licensed physician, dentist, APRN or RN is available.

(b) Accountability. LPN Scope of Practice.The LPN shall:

(i) Conduct a focused nursing assessment, which is an appraisal of th client’s

health status and needs that contributes to ongoing data collection;

(ii) Recognize patient characteristics that may affect the patient’s health

status;

(iii) Contribute to the plan of care by;

(A) Gathering, observing, recording, and communicating patient

responses to nursing interventions; and

(B) Contributing to the plan of care in collaboration with a registered

nurse based on an analysis of patient reponses.

(iv) Function as a member of the health care team, contributing to the

implementation of an integrated patient-centered health care plan;

(v) Impement nursing interventions and prescribed medical regimens in a

timely and safe manner;

(ii) Collaborate and communicate relevant and timely patient information with

patients and other health team members to ensure quality and continuity of care;

(iii) Document nursing care;

(iv) Teach and counsel clients and families in accordance with the nursing care

plan; and

(v) Provide delegation to the LPN and UAP. Match client needs with


guidelines in this chapter and, sections nine (9) through eleven (11).

(i) Have knowledge of the statutes and regulations governing nursing;

(ii) Accept individual responsibility and accountability for nursing actions and

competency;

(iii) Accept client care assignments from the licensed physician, APRN,

dentist, or RN only for which they are educationally prepared and adequately trained;

(iv) Contribute to the formulation, interpretation, implementation, and


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employment setting;

(v) Participate in the evaluation of nursing practice through quality and safety

activities;

(vi) Report unfit or incompetent nursing practice to the board. Report unsafe

conditions for practice to recognized legal authorities;

(vii) Conduct practice without discrimination on the basis of age, race, religion,

sex, life-style, national origin, or disability;

(viii) Respect the dignity and rights of clients and their significant others,

regardless of social or economic status, personal attributes, or nature of health problems;

(ix) Protect confidential information, unless obligated by law to disclose the

information;

(x) Maintain boundaries, including sexual boundaries;

(xi) Maintain continued competency through ongoing learning and application

of knowledge to nursing practice;

(xii) Participate in the development of continued competency in the

performance of nursing care activities for nursing personnel and students; and

(xiii) Implement appropriate aspects of client care in a timely manner.

(c) Implementation. The LPN shall:

(i) Participate in nursing management;

(ii) Take preventive measures to protect client, others, and self; and

(iii) Teach and counsel clients and families in accordance with the nursing care

plan.

Section 5. Expanded Role for LPN IV, MA-C and CNA II. With successful

completion of a Board-approved curriculum, the LPN or CNA may obtain certification which

expands the LPN scope of practice or CNA role

Section 67. Role of CNA.

(a) Standard. A The CNA, regardless of title or care setting, shall be under the

direction of an APRN, RN, or LPN;

(b) CNA Role. After appropriate client assessment and delegation by the an APRN,

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RN, or LPN, the CNA shall utilize knowledge of client’s rights, legal and ethical concepts,

communication skills, safety, and infection control practices while performing the following:

(i) Basic Nnursing Sskills;

(ii) Personal Ccare Sskills;

(iii) Basic Rrestorative Sskills Assistance;

(iv) Mental Hhealth and Ppsychosocial Sskills;

(v) Communication Sskills; and

(vi) Nursing Tteam Mmember Ttechnical Sskills of the CNA.

Section 8. Expanded Role for LPN IV, MA-C and CNA II. With successful

completion of a Board-approved curriculum, the LPN or CNA may obtain certification which

expands the LPN scope of practice or CNA role.

Section 9. Standards of Delegation

(a) All decision related to delegation and assignment shall be based on the

fundamental principles of protection of the health, safety, welfare of the public and doctrine of

client rights.

(b) The delegating APRN, RN, or LPN must delegate only those tasks which are

within his/her area of responsibility and scope of practice.

(c) Delegation shall be at the discretion of the licensed nurse, with consideration of

the particular situation.

(d) The RN may delegate components of assessment and care tasks, but shall retain

responsibility for the nursing process itself.

(e) The licensed nurse shall maintain accountability for the client, while the

Delegatee shall be responsible for the designated activity, skill, task, or intervention. The

employer has responsibility for delegation policies and procedures that guide the delegation

process.

(f) It shall be considered assignment rather than delegation if the particular activity or

task is already within the legally recognized scope of practice or role of the individual Delegatee.

(g) Transfer of responsibility of care between licensed nurses shall be considered a

handoff of care rather than delegation.

Section 10. Responsibilities of Delegation and Assignment. The employer,

individual licensed nurse, and Delegatee each shall have specific responsibilities within the

delegation assignment process.

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(a) Employer Responsibilities. The Employer shall:

(i) Identify a nurse leader responsible for oversight of delegated

responsibilities for the facility;

(ii) Develop policies for delegation; and

(iii) Assess, monitor and verify competency of staff.

(b) Licensed Nurse Responsibilities. The licensed nurse shall:

(i) Direct care and determine appropriate assignment and delegation in client

care;

(ii) Assign or delegate to another, those nursing skills the individual has the

education, legal authority, and demonstrated competency to perform safely including:

(A) The APRN or RN may assign or delegate nursing care to the RN,

LPN, or UAP;

(B) The LPN may assign or delegate nursing care to the LPN or UAP;

(iii) Provide direction, guidance, and evaluation for assignment or delegation;

(iv) Be readily available in person, by telecommunication, text or other

alternative method of communication; and

(v) Maintain accountability for any assigned or delegated nursing measures.

(c) Delegatee Responsibilities. The Delegatee shall:

(i) Accept only assignments and delegated responsibilities for which they

have adequate training, skills, and education;

(ii) Maintain competency for the assigned or delegated responsibility;

(iii) Communicate questions and concerns to the licensed nurse creating the

assignment or delegation; and

(iv) Be accountable for carrying out the delegated or assigned responsibility or

contact the assigning/delegating nurse.

Section 11. Criteria for Delegation and Assignment. The following criteria shall

determine what nursing tasks, functions, or activities may be delegated or assigned:

(a) Legal authority, knowledge, skills, and scope of practice of the Delegatee;

(b) Verification of the clinical competence of the Delegatee by the employing

agency;

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(c) Stability of the client’s condition that involves predictability, absence of risk or

complications, and rate of change; and

(d) Variables in the clinical setting including, but not limited to:

(i) The accessible resources and established policies that lend support to the

type of nursing tasks, functions, and activities being delegated;

(ii) The complexity and frequency of care by a given client population;

(iii) The proximity of the client to staff;

(iv) The number and qualifications of staff; and

(v) The accessibility of a licensed nurse.

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CHAPTER 9

DELEGATION AND ASSIGNMENT

These rules have been repealed.

Section 1. Statement of Purpose.

(a) These Board Rules are adopted to implement the Board’s authority to:

(i) To establish acceptable standards of safe delegation of nursing tasks.

(ii) To provide criteria for the Board to evaluate safe and competent delegation of

nursing tasks.

Section 2. Principles of Delegation.

(a) All decisions related to delegation and assignments are based on the fundamental

principles of protection of the health, safety and welfare of the public.

(i) The RN takes responsibility and accountability for the provision of nursing

practice.

(ii) The RN directs care and determines the appropriate utilization of any CNA

involved in providing direct client care.

(iii) The RN may delegate components of care but does not delegate the nursing

process itself. The functions of assessment, planning, evaluation and nursing judgment are

pervasive to nursing practice and cannot be delegated.

(iv) The decision of whether or not to delegate or assign is based upon the RN’s

judgment concerning the condition of the patient, the competence of members of the nursing

team and the degree of supervision that will be required of the RN if a task is delegated.

(v) The RN delegates only those tasks for which she or he believes the other health

care worker has the knowledge and skill to perform, taking into consideration training, cultural

competence, experience and facility/agency policies and procedures.

(vi) The RN individualizes communication regarding delegation to the CNA and

client situation. The communication should be clear, concise, correct and complete. The RN

verifies comprehension with the CNA and that the CNA accepts the delegation and the

responsibility that accompanies it.

(vii) Communication must be a two-way process. CNA must have the opportunity to

ask questions and/or for clarification of expectations.

(viii) The RN uses critical thinking and professional judgment when following the Five

Rights of Delegation:

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(A) Right task;

(B) Right circumstances;

(C) Right person;

(D) Right directions and communication; and

(E) Right supervision and evaluation.

(b) Chief nursing officers are accountable for establishing systems to assess, monitor,

verify and communicate ongoing competence requirements in areas related to delegation.

Section 3. Accountability.

(a) The delegating RN or LPN retains accountability for:

(i) Nursing care when delegating nursing tasks or interventions to ensure client

safety;

(ii) The decision to delegate;

(iii) Verifying the delegate’s competency to perform the tasks;

(iv) Providing direction or supervision;

(v) The performance of the delegated task;

(vi) Evaluating the effectiveness of the delegated nursing task or interventions

performed under direction or supervision.

(b) Certain nursing functions require nursing knowledge, judgment, and skill and may

not be delegated.

Section 4. Standard for Delegation of Basic Nursing Tasks and Skills.

(a) The licensed nurse delegates tasks based on the needs and condition of the client,

potential for harm, stability of the client’s condition, complexity of the task, predictability of the

outcomes, ability of the staff to whom the task is delegated, and the context of other client needs.

(b) CNA may complement the APRN, RN, or LPN in the performance of nursing

functions but shall not substitute for the APRN, RN, or LPN.

(c) Delegation shall be task-specific, client-specific, and CNA specific.

(d) The CNA role evolves from the performance of delegated nursing related tasks

and services regardless of an individual's title or care setting.

(e) Delegation shall be directed by a APRN, RN, or LPN.

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(i) The delegating APRN, RN, or LPN must delegate only those tasks which:

(A) Are within his/her area of responsibility and scope of practice;

(B) A reasonable, prudent APRN, RN, or LPN would find, within his/her

sound nursing judgment, appropriate to delegate;

(C) In the opinion of the APRN, RN, or LPN, shall be properly and safely

performed by the CNA without jeopardizing the client's welfare;

(D) Does not require the CNA to exercise nursing judgment, complex

observations or nursing assessments, critical decision making or interventions except in an

emergency situation; and

(E) Are client specific, task specific, and CNA specific and outcomes are

predictable.

(ii) When delegating a nursing task, the APRN, RN, or LPN shall:

(A) Make an initial assessment of the client's nursing care needs before

delegating the task;

(B) Verify the CNA’s competence to perform any nursing task prior to

delegation;

(C) Verify appropriate continuing education for each CNA for each task to be

performed;

(D) Communicate with CNA allowing the opportunity to ask questions,

provide feedback, or clarification;

(E) Inform the client of the decision to delegate;

(F) Provide appropriate direction or supervision;

(G) Remain accountable for the delegated tasks;

(H) Evaluate client outcomes and make adjustments accordingly; and

(I) Make clear to the CNA that the delegated task cannot be re-delegated.

(iii) Delegation is unnecessary if the particular activity or task is already within the

legally recognized scope of practice or role of the individual who is to perform the activity or

task;

(A) An element of assignment exists in all delegation; however, for the

purpose of these rules, assignment means that an individual designates another to be responsible

for specific clients or selected nursing functions for specifically identified clients;

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(B) Both “assignment” and “delegation” decisions must be made by the

licensed nurse on the basis of the skill levels of the care givers, the care needs of clients, and

other considerations.

Section 5. Degree of Direction or Supervision.

(a) The degree of required direction or supervision for the CNA shall comply with

the following criteria:

(i) Direction or supervision means a licensed nurse providing appropriate guidance in

the accomplishment of a nursing task, including but not limited to:

(A) Periodic observation and evaluation of the performance of the task; and

(B) Validation that the task has been performed according to established

standards of practice.

(ii) Delegation will ensue after an evaluation of factors including but not limited to

the:

(A) Stability of the client;

(B) Training and capability of the delegate;

(C) Nature of the nursing task being delegated; and

(D) Proximity and availability of the delegator to the delegate.

(iii) The delegating APRN, RN, or LPN or another qualified nurse shall be readily

available either in person or by telecommunication.

Section 6. Basic Nursing Functions, Tasks, and Skills that May Not be Delegated.

(a) The nursing process requires nursing knowledge, judgment, and skill and may not

be delegated. The nursing process includes, but is not limited to:

(i) Assessment;

(ii) Development of the nursing diagnosis;

(iii) Establishment of the nursing care goal;

(iv) Development of the nursing care plan; and

(v) Evaluation of the patient’s progress, or lack of progress, toward goal achievement.

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