This rule was published in the July 15, 2019, issue (Vol. 2019, No. 14) of the Utah State Bulletin.
Commerce, Occupational and Professional Licensing
Nurse Practice Act Rule
DAR File No.: 43825
Filed: 06/25/2019 08:16:52 AM
The Board of Nursing (Board) recommends these proposed amendments to further define, clarify, and establish certain standards regarding nurse delegation of tasks in accordance with Subsections 58-31b-102(15), 58-31b-502(9), and R156-1-102a(4). These proposed amendments are based on extensive collaboration between the Board and multiple industry participants so as to incorporate generally accepted professional standards and the best practices in the industry with respect to nurse delegation.
In Subsection R156-31b-102(14), the proposed amendment conforms the definition of the "delegator" who may delegate certain tasks to another person to the requirements of Subsections 58-31b-102(15) and 58-31b-502(9) of the Nurse Practice Act, and Section R156-31b-701 of the Nurse Practice Act Rule. Instead of the delegator being defined generically as "a person", the delegator is more specifically defined as "a licensed nurse directly responsible for a patient's care". In Subsection R156-31b-102(35), the proposed amendment deletes the citation to Subsection R156-1-102a(4) and instead incorporates the detailed definitions and types of supervision of that subsection. The Board recommends this change to facilitate nurse licensees' understanding of and familiarity with nurse supervision requirements. In Section R156-31b-701, the proposed amendment: 1) makes numerous nonsubstantive formatting changes throughout this section to reorganize and renumber the rule for clarity; 2) provides a method in which the delegating nurse can review initial and ongoing competency documentation; 3) provides direction to the delegating nurse to document physical or verbal demonstrations of delegated tasks if the employing facility or agency does not require demonstration of competency or does not provide competency documentation that is satisfactory to the delegator, or if a delegated task falls outside of tasks in which the delegatee has previously shown competency; and 4) removes the word "physician" to provide generalization for the term medical assistant.
These proposed amendments may indirectly impact state departments who employ nurses as it clarifies the requirements for delegation of duties in nursing, who may delegate and the process for delegation, as well as a requirement for documentation of the competency to perform the duties. It is estimated that these proposed rule changes will almost entirely impact those receiving healthcare in homecare settings. The majority of the healthcare facilities will have delegation practices of patient/resident individualized care as further defined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers of Medicare and Medicaid Services (CMS). Therefore, this analysis will focus on home health, hospice, and personal care agencies. The NAICS code is 621610. The following are estimates related to the state budget costs: There are zero state-owned agencies in Utah out of a possible 332 agencies (source: Department of Workforce Services (DWS) Firm Find, 02/26/2019). However, these proposed rule changes may result in a slight increase in a state surveyor's time in reviewing sample number of charts for home health, hospice, and personal care agencies. These agencies are surveyed every two to three years. Therefore, this updated rule could result in an estimated extra 15 minutes per survey to review the delegation. Therefore, $27.08/hr X 0.25/hr (15 minutes) per surveying nurse X 332 agencies/3 (estimate that each agency is surveyed once every three years) = $749.21 cost for the surveying agency each year. Lastly, there would be a minimal cost to the Division of Occupational and Professional Licensing (Division) of approximately $75 to print and distribute the rule once these proposed amendments are made effective.
These proposed amendments may indirectly impact local governments who employ nurses as it clarifies the requirements for delegation of duties in nursing, who may delegate, and the process for delegation, as well as a requirement for documentation of the competency to perform the duties. It is estimated that these proposed rule changes will almost entirely impact those receiving healthcare in homecare settings. The majority of the healthcare facilities will have delegation policies further defined by JCAHO and CMS. Therefore, this analysis will focus on home health, hospice, and personal care agencies. The NAICS code is 621610. There are an estimated 3 local government-owned agencies in Utah out of a possible 332 healthcare agencies (DWS Firm Find and Health Facility Licensing Certification and Resident Assessment, 02/26/2019). It is estimated that the average wage rate of a nurse that delegates is $27.08/hr. It is estimated that the 3 county-owned agencies impacted could employ 5 nurses per agency and be impacted by the rule change. It is estimated that the time for a nurse delegator to teach a task would be 5 minutes, 2 minutes for the delegator to listen to the delegatee demonstrate appropriate performance of the task and 3 minutes for delegator to document the demonstration in writing. Therefore, the total additional time is estimated to be 10 minutes per delegated task. It is estimated that each nurse would delegate 6 specialized tasks per year since almost all of the delegated tasks would be considered routine care. If an unlicensed aide proves competency in the skill and the nurse is satisfied with this level of competency, then the actual assignment of the aide to a specific patient or multiple similar patients would involve simply a brief discussion about the unique needs of a given patient to whom the aide is assigned. This would be part of the regular assignment process. Additionally, many agencies already have implemented skill checks upon hire and annually thereafter. Additionally, these proposed rule changes do not prescribe how the documentation is to be carried out, therefore any impact would vary according to individual business policies. The impact for local governments would be estimated to be $4.51 per 10 minutes of the nurse's time. This equates to 3 agencies affected X 5 nurses employed per agency X 6 specialized tasks per year X $4.51/task = $405.90 for an annualized cost. An annualized cost per agency is $135.30. It is assumed that the cost per task would increase by 1% per year for inflation/wage increases.
These proposed amendments may indirectly impact small businesses (less than 50 employees) who employ nurses as it clarifies the requirements for delegation of duties in nursing, who may delegate and the process for delegation, as well as a requirement for documentation of the competency to perform the duties. It is estimated that these proposed rule changes will almost entirely impact those receiving healthcare in homecare settings since the majority of the healthcare facilities will have delegation policies further defined by JCAHO and CMS. Therefore, this analysis will focus on home health, hospice, and personal care agencies. The NAICS code is 621610. There are an estimated 284 small business (less than 50 employees) owned healthcare agencies in Utah out of a possible 332 (DWS Firm Find, 02/26/2019). It is estimated that the average wage rate of a nurse that delegates is $27.08/hr. It is estimated that the 284 small businesses impacted could employ 3 nurses/agency and be impacted by the rule change. It is further estimated that the time for a nurse delegator to teach a task would be 5 minutes, 2 minutes for the delegator to listen to the delegatee demonstrate appropriate performance of the task and 3 minutes for delegator to document the demonstration in writing. Therefore, the total additional time is estimated to be 10 minutes per delegated task. It is estimated that each nurse would delegate 6 specialized tasks per year since almost all of the delegated tasks would be considered routine care, if an unlicensed aide proves competency in the skill and the nurse is satisfied with this level of competency, then the actual assignment of the aide to a specific patient or multiple similar patients would involve simply a brief discussion about the unique needs of a given patient to whom the aide is assigned. This would be part of the regular assignment process. Additionally, many agencies have already implemented skill checks upon hire and annually thereafter. Additionally, these proposed rule changes do not prescribe how the documentation is to be carried out, therefore any impact would vary according to individual business policies. The impact for the small businesses would be estimated to be $4.51 per 10 minutes of the nurse's time. This equates 284 agencies X 3 nurses employed per agency X 6 specialized tasks per year X $4.51/task = $23,055.12 for an annualized cost. An annualized per agency cost would be $81.18. It is assumed that the cost per task would increase by 1% per year for inflation/wage increases.
There are approximately 42,033 licensed nurses in Utah that could potentially be impacted by these proposed amendments, including Licensed Practical Nurses (LPN), Registered Nurses (RN), Certified Nurse Midwifes (CNM), Advanced Practice Registered Nurses (APRN) and Certified Registered Nurse Anesthetists (CRNA). Only 1,317 nurses are projected to be impacted annually. There are approximately 10,903 uncertified and certified nursing assistants, 2,890 home health aides and 8,430 personal care aides within Utah. It is estimated that each delegated act will take 2 minutes for the delegatee to demonstrate appropriate performance of the task to the delegator. A blended wage rate is assumed to be $11.66/hr. Two minutes of an aide?s time equates to $0.39. This equates to 1,317 total nurses providing delegated tasks X 6 specialized tasks per year X $0.39/task = $3,081.78 total annualized cost for compliance costs for affected persons (individualized impact). The annualized cost per agency would be $9.28. It is assumed that the cost per task would increase by 1% per year for inflation/wage increases. These proposed rule changes are not expected to have any fiscal impact on other persons. There might be a very small cost of processing the additional time by the agency payroll processor linked to overtime, but most agencies utilize computerized timekeeping which would reduce the projected cost to virtually zero.
These proposed amendments are not expected to impose compliance costs on any affected persons except as described above.
Small Businesses: These proposed amendments may indirectly impact small businesses who employ nurses as it clarifies the requirements for delegation of duties in nursing, who may delegate, and the process for delegation, as well as a requirement for documentation of the competency to perform the duties. It is estimated that these proposed rule changes will almost entirely impact those receiving healthcare in homecare settings since the majority of traditional healthcare facilities will have delegation policies further defined by JCAHO and CMS. Therefore, this analysis will focus on home health, hospice and personal care agencies. The NAICS code is 621610. There are an estimated 284 small business-owned healthcare agencies in Utah out of a possible 332 healthcare agencies (DWS Firm Find, 02/26/2019). The impact on small businesses would result in an annual cost of approximately $23,000. An annualized per healthcare agency cost would be $81. It is assumed that the cost per task would increase by 1% per year for inflation/wage increases. Non-Small Businesses: There are an estimated 42,033 licensed nurses in Utah and an estimated 45 non-small businesses impacted by these rule changes. Based upon the foregoing assumptions, the impact for non-small businesses would result in an annual cost of approximately $12,177. An annualized per agency cost would be $270. It is assumed that the cost per task would increase by 1% per year for inflation/wage increases.
Francine A. Giani, Executive Director
Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY, UT 84111-2316