Nursing services, including Nurse Health Case Management, Delegation Services, and Consultation, play a vital role in providing personalized care and support. Ensuring compliance with health and safety standards is essential for individuals to achieve their goals and contribute positively to society. The RN Case Manager & Delegating Nurse (RN CM/DN) oversees healthcare management and delegates nursing tasks as permitted by relevant legislation, ensuring access to comprehensive care for all individuals served by EHS Inc.
Scope of Service:
Within a developmental disabilities organization sanctioned by the Maryland Developmental Disability Administration (DDA), a registered nurse (RN) assumes various roles and duties. As an integral part of a multidisciplinary healthcare team, the RN acts as both a healthcare case manager and a delegating nurse for individuals under their care. Collaboration with other team members, including CCS, family members, local physicians, and agency administrators, ensures the preservation of each individual’s health and safety. The healthcare team, comprising the RN Case Manager/Delegating Nurse (RN CM/DN), licensed practical nurses (LPNs), and Unlicensed Assistive Personnel (UAPs) like Certified Medication Technicians (CMTs) and Certified Nursing Assistants (CNAs), operates within the organization. Compliance with the Maryland Nurse Practice Act’s regulations on nursing function delegation, outlined in COMAR 10.27.11, is imperative for Developmental Disabilities (DD) nurses, with the RN CM/DN potentially serving as an MTTP Trainer.
Nursing Functions
Registered nurses are obliged to do tasks that call on their knowledge, discretion, and abilities while providing nursing services to individuals inside the agency without delegating them. Among these services are :
- The nursing assessment includes, but is not limited to, the admission, shift, transfer, or discharge assessment.
- The establishment of the nursing care goal
- Development of the nursing diagnosis
- Development of the nursing care plan
- Evaluation of the client’s progress, or lack of progress, toward goal achievement
- Any other nursing task which requires nursing knowledge, judgment, and skill.
The agency in accordance with the requirement of the DDA and COMAR 10.27.11.05 may delegate treatments of a routine nature if:
- The licensed nursing staff of the specific unit of care has identified the function as being routinely performed.
- The specific treatments are performed at a high frequency necessary to retain competency.
- The treatment has an inherently low risk to the client, as determined by weighing the following factors:
- Type of equipment utilized to perform the function.
- Nurse staffing ratio that allows for close supervision
- Basic educational preparation of the unlicensed individual or certified nursing assistant performing the delegated function.
- Knowledge and skill set of the nurse delegating and supervising the delegated function.
- There is a quality assurance mechanism in place to assure the function is performed safely, and client outcomes meet accepted professional nursing standards including, but not limited to:
- An ongoing formalized documented performance appraisal mechanism designed to assure that unlicensed individual or certified nursing assistant’s revalidation or continued competency is a component of the quality assurance mechanism.
- Client outcomes meet accepted professional standards, as reflected by:
- Infection rates
- Rates of adverse events
- Error rates
- Patient satisfaction surveys.
A registered nurse is authorized to assign the gathering of certain information to an unlicensed individual or certified nursing assistant. Additionally, the nurse can delegate a nursing task to an unlicensed individual or certified nursing assistant only after conducting a thorough client assessment and ensuring that the task delegation does not compromise the client’s well-being. Similarly, a registered nurse may extend the responsibility of executing a nursing task to an unlicensed individual under specific circumstances if:
- Acceptance of the delegated nursing task does not become a routine part of the unlicensed individual’s job duties; or
- An unlicensed individual merely aids with activities of daily living unless the client’s needs are such that adverse health consequences are predictable.
Medication administration falls within the realm of nursing responsibilities, thereby placing the nurse solely accountable for this task. Delegation of the subsequent activities associated with medication administration is prohibited except as outlined in COMAR 10.27.11.05H of the regulation:
- Calculation of any medication dose
- Administration of medications by injection route
- Administration of medications by way of a tube inserted in a cavity of the body; and
- Administration of medication by intravenous route.
The administration of medication as listed above may be delegated to certified medicine aides and medication technicians only in compliance with COMAR 10.27.11.05H(2) and when clients meet the requirements of Regulation .03F or .04D of COMAR 10.27.11 in situations which include.
- Supervised group living settings.
- Supervised or sheltered work settings
- Independent living settings
- Schools
- Correctional institutions
- Hospice care
- Adult medical day care centers; and
- Childcare centers were established for children with health or medical conditions, or both.
A nurse may delegate to a medication technician or certified medicine aide under this section when:
- The nurse has provided instruction and direction; and
- The medication technician or certified medicine aide is on-site in the unit of care on a continuing basis to:
- Monitor the therapeutic effects of the medication.
- Observe, record, and report untoward effects of the medication.
- Perform monitoring procedures required for each medication.
- Observe changes in the individual client’s behavior and clinical status.
- Record and report the changes observed to the delegating nurse; and
- Withhold administration of the medication.
A nurse may delegate the administration of the following medications to a medication technician or a certified medicine aide according to Regulations .03F, .04C, and .05H of COMAR 10.27.11
- Medication by metered dose inhalant, nebulizer, and oxygen by nasal cannula or mask.
- Medication by gastrostomy tube or rectal tube if the nurse has calculated the dosage.
- Oral medication, including:
- Measuring as prescribed an amount of liquid medication where the nurse has calculated the dose; and
- Administering a fraction of a tablet if the nurse has cut the tablet.
- Medication by subcutaneous injection if the nurse has calculated the dose.
- Medication administered by topical route, excluding stage III and IV pressure ulcers and wound care.
- Medication administered by suppository route.
- Medication drops are administered by routes involving eye, ear, nose; and
- Where the registered nurse makes an on-site visit at least every 7 days to assess the client status and the performance of the medication technician or certified medicine aide’s administration of topical medication to stage three or four pressure ulcers or wounds.
Staffing and Training:
The guideline for staffing needs and planning procedures is provided by Devine Home Support Services Inc. The agency ensures sufficient personnel to meet individuals’ service needs and adhere to their Person-Centered Plans. Recruitment or contracting strictly complies with training requirements and excludes individuals with criminal histories as per regulation.
In order to provide any direct support services or spend any time alone with a person, volunteers as well as employees of EBBY Healthcare Services, Inc. must adhere to the following basic requirements:
- Possess a valid Maryland and/or Compact Registered Nurse License
- Be active on the DDA registry of DD RN CM/DNS
- Attend mandatory DDA training.
- Successful completion of the DDA RN Case Manager/Delegating Nurse (CM/DN) orientation
- Complete the online HRST Rater and Reviewer training.
- Pass a credential’s verification.
- Attend a minimum of two (2) DDA-provided nurse quarterly meetings per fiscal year.
- Complete all necessary pre/in-service training based on the Person-Centered plan and other DDA-required training prior to service delivery.
Setting and Location :
EBBY Healthcare Services, Inc. will offer Nursing and Delegation assistance if a client is receiving services under the conventional program’s delivery model at a DDA-licensed community site, such as residential, day, or employment services. Persons receiving Personal Support services and individuals enrolled in the Self-Directed Services Program are also eligible. These services will be provided in the central, southern, eastern, and western DDA areas.
Don’t wait any longer to explore meaningful career opportunities. Join us now!