What Texas law says about delegated tasks
Registered nurses still hold the reins
Under Texas law, the kinds of activities a registered nurse can delegate are based on the clients’ willingness and ability to participate in their own care. (For more information about applying the delegation rules, see story, p. 31.)
Here are some specific nursing tasks that Texas law allows RNs to delegate to unlicensed personnel:
• noninvasive and nonsterile documentation treatments unless otherwise prohibited by §218.10 of this title;
• the collecting, reporting, and documentation of date including, but not limited to:
vital signs, height, weight, intake and output, clinitest, and hemitest results;
changes from baseline data established by the RN;
environmental situations;
client or family comments relating to the client’s care;
behaviors related to the plan of care;
• ambulation, positioning, and turning;
• transportation of the client within a facility;
• personal hygiene and elimination, including vaginal irrigations and cleansing enemas;
• feeding, cutting up food, or placing meal trays;
• socialization activities;
• activities of daily living;
• reinforcement of health teaching planned and/or provided by the registered nurse.
The law also allows RNs to delegate activities of daily living required for maintenance of the client’s status. Delegable tasks include:
• medication administration in accordance with §218.8(2);
• assistance with feeding, including tube feeding through permanently placed tubes;
• assistance with elimination, including intermittent catheterization;
• assistance with other activities necessary to maintain the independence of the client such as maintenance of skin integrity and mobility.
In contrast, some nursing tasks that may not be delegated, according to the rules are as follows:
• physical, psychological, and social assessments that require professional nursing judgment, intervention, referral, or follow-up;
• formulation of the plan of nursing care and evaluation of the client’s response to the care rendered;
• specific tasks involved in the implementation of the plan of care that require professional nursing judgment or intervention;
• the responsibility and accountability for client health teaching and health counseling that promotes client education and involves the client’s significant other in accomplishing health goals;
• administration of medications, including intravenous fluids, except as permitted by §218.8 of this title (relating to administration of medications).
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