Guidelines for licensed nurses to use in judging whether to delegate tasks to non-nurses will be issued this fall by Connecticut's nursing licensing board.
The ruling will address an issue that's heating up nationwide as hospitals use more unlicensed assisting personnel, such as nursing assistants.
It's a potentially divisive debate, pitting healthcare organizations that seek to contain costs against labor organizations that have concerns about the delivery of care by non-nurses.
If attendance at a hearing this spring is any indication, interest in the issue is widespread. More than 70 individuals, including hospital, labor and consumer representatives, presented testimony to the Connecticut Board of Examiners for Nursing.
The board decided to take up the matter because it was getting an increasing number of "scope-of-practice" questions from nurses seeking clarification on what tasks they may delegate, said Marie T. Hilliard, a registered nurse and the board's executive officer.
"The real question is, `What is the exclusive purview of the nurse?'*" said Diana Weaver, president of the American Organization of Nurse Executives and senior vice president for patient relations at Yale-New Haven (Conn.) Hospital.
The board of examiners began its fact-finding process last week with the intent of issuing a declaratory ruling within the next few months.
According to the Connecticut Hospital Association, 21 other states have addressed the issue: seven through statutory language, 11 through regulations and three through board position statements or declaratory rulings.
Nurses are concerned about the adequacy of training that unlicensed assisting personnel receive and about responsibility for monitoring their work, said Richard Tricarico, director of government relations for the 1,700- member Connecticut Nurses' Association.
And although nurses worry about the widening scope of non-nurses' duties, hospitals have been "so secretive regarding nursing and staffing issues" that the CNA doesn't really know whether nurse-to-patient ratios have eroded to an unacceptable level. It believes, however, that several hundred nurses have been laid off from hospitals this year, but no exact figures have been compiled.
The CHA said nurses haven't been targeted in layoffs but have been affected by downsizing initiatives encountered by all healthcare workers.
Meanwhile, a number of the state's 34 acute-care hospitals have been redesigning patient-care delivery systems. Hospitals are trying to strike an appropriate balance between licensed and unlicensed workers while preserving quality and promoting cost-effectiveness, said Jennifer D. Jackson, the CHA's general counsel and vice president of clinical services. "We stressed that our hospitals recognize and assume responsibility for assuring and documenting the competency of (unlicensed assisting personnel)," she said.
As part of its work redesign, Yale-New Haven provides training for nurses and unlicensed assisting personnel. In addition to teaching delegation skills to nurses, the hospital stresses the need for individual healthcare workers to determine which tasks to perform.
"If a nurse is uncomfortable delegating a certain aspect of care," he or she shouldn't feel compelled to assign the task to someone else, Yale-New Haven's Ms. Weaver explained. If unlicensed workers are uncomfortable performing an assigned task, they can refuse to accept it, she said.