Mary Muse, MS, RN, CCHP-RN, CCHP-A, is Nursing Director, Bureau of Health Services, Wisconsin Department of Corrections. This podcast is based on the Preconference Seminar “Nurses’ Scope of Practice and Delegation Authority” that occurred at the 2015 NCCHC Spring Conference on Correctional Health Care in New Orleans, April 11-14, 2015.
The National Commission on Correctional Health Care (NCCHC) recently published a resource document on the scope of practice and delegation authority of correctional nurses based on the input of a taskforce of correctional nurse leaders from around the country. Both scope of practice and delegation have emerged as concerns for nurses working in the criminal justice system. This document can help bring clarity to the issue. In this podcast, Mary provides the following guidance.
Scope of Practice
- The document promotes best practices for maintaining scope of practice and appropriate delegation in nursing services. After all, nurses are the primary health care service provider in the specialty.
- Infrastructure for nursing services may not be available for supporting appropriate practice standards. Correctional nurses might work in small settings without true nursing leadership.
- The document provides the context for application of standard professional principles to the correctional health care environment.
- Often correctional nurses slide into poor practices in trying to help their patient or may be unaware a request is inappropriate for a nurse to do.
- Sick Call is a key area where scope of practice boundaries are breached. For example, nurses may be
- Assess patients and making medical diagnoses rather than nursing diagnoses
- Practicing without collaborating with medical colleagues when they should
- Facilities also have responsibilities for ensuring that structures are in place to support the boundaries of scope of practice for all health care staff. Responsibilities can include
- Staffing patterns
- Job descriptions
- Policies and procedures
- Nurses, though, also have a responsibility to understand their scope of practice based on their state licensure. If a nurse is concerned about an assignment, here are some action steps to take.
- Step back and consider the request. What is being asked?
- Consider how the request or assignment is beyond the scope of licensure
- Write down some objective thoughts about how the scope of practice is being breached in the situation
- Engage in a dialogue with your supervisor about the scope of practice issue
- Come to the discussion with a positive perspective that something can be worked out to meet everyone’s needs
- May want to refer to a document like the NCCHC document
- If additional help or guidance is needed, consider asking for help from the state board of nursing or local nurse leadership
- Although we may perceive that delegation is different in correction, it is not.
- Nurses should not delegate nursing assessment and treatment determination to officers, even for something simple like providing medication for a headache.
- In cases where nurses are not onsite to evaluate a patient, it is best to communicate directly with the patient rather than require the officer to relay information from the patient.
- Here are key components of nurse delegation.
- Know who you are delegating to – their abilities and licensure
- Ensure that what you are delegating is appropriate for that person based on ability and licensure
- The person taking on the delegated function must understand what is being asked of them
- Determine if the person needs supervision in completing the delegated function
- Accountability remains with the nurse delegating the function
Catherine Knox says
This is a very informative podcast especially because of all the practical examples and steps that nurses can take to manage their professional practice. In the discussion about delegation Mary makes several good points about the steps that nurses must take to do this correctly when working with unlicensed staff. Correctional officers can be very important and valuable contributors to a detainee’s health and well being. It is appropriate and acceptable to delegate to correctional personnel. You both make the point that corrections is not different from the rest of the community in terms of the delivery of health care and I agree. I view the corrections population from a community health perspective and from this viewpoint nurses do delegate care to teachers, family and other non licensed care givers. It is not different in the correctional setting. Problems arise though when nurses are not attentive to what tasks can and can not be delegated, the skills and ability of the person being assigned the task and the communication that is necessary to ensure good patient care. So in the example above about the officer not giving Tylenol; it is that the nurse can not delegate to the officer responsibility for the assessment of the patient. I hope that you will consider this refinement to the guidance given above. CMK
Lorry Schoenly says
Excellent points, Catherine. I agree that the bullet point is confusing. I edited it to reflect the underlying principle that, as you rightly state, it is the assessment and determination that must remain in the nurse’s scope.