On March 3, 2015, the New Jersey State Board of Nursing ("Board") issued a comprehensive set of proposed amendments, repeals and new rules pertaining to Delegation and Certification; Homemaker-Home Health Aides.  The changes broaden the authority of registered professional nurses ("RNs") and permit RNs to train, and then delegate tasks to licensed practical nurses ("LPNs"), certified home health aides ("CHHAs") and other assistive persons (collectively "assistants").  This certainly seems like a positive step for the Home Health industry and its patients.  Nurses will be able to serve a broader patient base by maximizing the talents of more caregivers who are, perhaps, being under-utilized in the current model.

Currently New Jersey limits those tasks which an RN can delegate.  Those restrictions were understandable.  Delegation of nursing duties is a delicate and complex process.  An RN must fully assess and understand a patient's needs and the potential for complication before feeling secure enough to assign another responsibility for that care.  The law change seems to embrace the fact that RNs have always had this key competency, the art of assessment and delegation, but were lacking the necessary assurances that their assistants were able to accept higher levels of responsibility, or that their license would be protected if something were to go wrong. Thus, the new law tightens the screening and training processes employed by HHAs to ensure that the assistants are "equal to the task" of accepting delegation.

It would certainly seem that New Jersey has made changes to benefit the Home Health Industry's clients.  Among those benefits:

  • Safe and efficient care is delivered with highly skilled RNs able to devote significant time and attention to those patients in need of specialized care;
  • Duplication of services is minimized;
  • More care givers are empowered and more patients treated;
  • A "team" is established to effectuate goals and problem-solve;
  • Care is administered in a more efficient and cost-effective manner.

As with any changes, however, we have to be on the lookout for unintended consequences.  There are legal and ethical consequences to delegation.  Those nurses who master the art of delegation are still responsible for the care rendered and supervision is key.  The RNs must be certain they are delegating to people who are properly trained, understanding of their role, and capable of administering safe nursing care.  The delegates must be comfortable with this increased reliance on their skills.  Any hiccup in the link between the delegator and the delegate could create patient safety issues.  Thus, if any other states are inclined to follow New Jersey's lead, attention not only to the benefits of delegation, but also to the attendant training and supervision requirements is essential for success.

Back to Health Law Advisor Blog

Search This Blog

Blog Editors

Related Services

Topics

Archives

Jump to Page

Subscribe

Sign up to receive an email notification when new Health Law Advisor posts are published:

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.