02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

380 BOARD OF NURSING

Chapter 5 REGULATIONS RELATING TO TRAINING PROGRAMS AND DELEGATION BY REGISTERED PROFESSIONAL NURSES OF SELECTED NURSING TASKS TO CERTIFIED NURSING ASSISTANTS

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SUMMARY: This chapter defines delegation; states the responsibilities of a registered professional nurse in delegating selected nursing tasks to certified nursing assistants; sets forth the requirements relating to training programs; and states the criteria for listing on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS.

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DEFINITION: Delegation is the transferring to a competent individual authority to perform a selected nursing task in a selected situation.

1. General Regulations Relating to Delegation of Selected Nursing Tasks by Licensed Nurses

A. The registered professional nurse is responsible for the nature and quality of all nursing care that a patient                    receives. Assessment of the nursing needs of a patient, the plan of nursing actions, implementation of the plan,           and evaluation are essential components of professional nursing practice and are the functions of the registered            professional nurse. Although other personnel may be employed to assist the registered professional nurse in                the performance of these functions, such personnel cannot be used as a substitute for the registered                                professional nurse. The services of registered professional nurses may be supplemented and complemented by           the services of licensed practical nurses and certified nursing assistants.

1.  The registered professional nurse in a hospital, nursing facility, skilled care facility, ambulatory care,                              community health agency, a facility providing assisted housing services as defined in 22 M.R.S.A., Section                     7852 (3), correctional facilities, and county jails shall determine those nursing tasks that may safely be                          delegated to nursing assistants. No task shall be delegated that is not listed in the Skills Checklist of the                          PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT TRAINING PROGRAMS or                         authorized after additional training by a facility or organization as described in this chapter. When the task                   is the administration of medications, nothing may be delegated that is not listed in the Skills Checklist of the                 Standardized Medication Course for Certified Nursing Assistants.

2.  In assigning selected nursing tasks to certified nursing assistants, the registered professional nurse is                             responsible for complying with the provisions of this chapter and for exercising the judgment and                                   knowledge  ordinarily expected of a registered professional nurse. The nursing employer shall determine                      that the nursing assistant is listed on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS and                    will ensure that the certified nursing assistant meets the competency requirements of the facility or                                  organization.

3.  The registered professional nurse also is responsible for supervision of certified nursing assistants to whom                  a delegation is made. The degree of supervision needed shall be determined by the registered professional                    nurse after an evaluation of all factors involved, including without limitation:

a)  The right task: the activity falls within the certified nursing assistant job description and is included as                            part of the established written policies and procedures of the nursing practice setting; and

b)  The right circumstances: the stability of the condition of the patient; and

c)  The right person: the training and capability of the certified nursing assistant to whom the delegation is                          being made; and

d) The right direction and communication: each delegation should be specific to the patient, the registered                        professional nurse, and the certified nursing assistant. The registered professional nurse is expected to                          communicate specific instructions for the delegated activity to the certified nursing assistant and                                      ascertain that the certified nursing assistant understands what is expected of him/her and agrees to                                accept the delegation; and

e)  The right supervision and evaluation: supervision may require direct, continuing presence of the                                      registered professional nurse to observe, guide and direct the nursing assistant; intermittent                                              observation  and direction by the registered professional nurse who may only occasionally be physically                          present; or development of a plan of care, in advance, by the registered professional nurse which will be                        implemented by the nursing assistant without the physical presence of the registered professional nurse.                        In the latter situation, the registered professional nurse must be available for supervision, in person, in                          the event circumstances arise that cause the registered professional nurse to believe such supervision is                          necessary.

B.  Home Care Setting. In the home care setting only the registered professional nurse may delegate certain                        aspects of medication administration to the certified nursing assistant who has not completed the                                    Standardized Medication Course for Certified Nursing Assistants.

1.  Delegation by the registered professional nurse may only occur if:

a)  There is a stable predictable pattern of need;

b)  There is consent of the patient, family, or patient’s designee as indicated with a signature on the care                               plan; and

c)  The training, capability, and competency of the certified nursing assistants is appropriate to the                                         identified need.

2.   The registered professional nurse shall ascertain that the certified nursing assistant in the home care                              setting who has not completed the Standardized Medication Course for Certified Nursing Assistants has                        documented competencies according to the facility or organization’s policies and procedures to perform                        any of the following skills prior to delegating: oral medications; ear and eye drops; non-narcotic patches;                      insulin injections for stable diabetics using pre-filled syringes; topical medications; inhalants (hand held                       manufactured inhalers) and long term nebulizer therapy); vaginal/rectal medications; scheduled Schedule                   IIs, gastrostomy G-Tube feedings and gastrostomy-jejunostomy G-J tube feedings (established, stable G                         tubes and G-J tubes).

3.  Medication that may not be delegated include PRN medication and those administered via intrathecal,                           intravenous, intramuscular, subcutaneous (except insulin), and gastronomy routes nor any other invasive                     methods.

C.   Additional Skills. Additional skills of nursing care are skills of nursing care beyond those listed in the Board                 approved PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT TRAINING                                    PROGRAMS for certified nursing assistants. These additional skills may be performed by certified nursing                     assistants when taught and assigned in accordance with the organization or facility’s established policies                       and  procedures. Certified nursing assistants’ documented competencies of additional skills are not                                 transferrable from one facility to another, except that facilities within the same organization may share staff                 with additional skill training as described above in this subsection. Documentation of this additional skills                     training must be maintained at each organization or facility as indicated by the organization or facilities                         document retention policies.

1.  Certified nursing assistant additional skills(s) eligibility will be determined by the facility or                                               organization’s evaluation of readiness to participate.
2.   The registered professional nurse will not teach or assign the certified nursing assistant tasks that are                             categorized as health counseling, teaching/instruction, or any tasks that require independent, specialized                       nursing knowledge, skill, or judgment.

3.  The Certified Nursing Assistant Additional Skills List includes but is not limited to:

a)   Perform an electrocardiogram (EKG).

b)   Perform venipuncture for blood collection purposes.

c)   Perform a straight catheter procedure on an adult patient 18 years or older.

d)   Provide gastrointestinal-tube (G-tube) and percutaneous gastronomy (PEG) gravity tube feeding only                             to an established G-Tube, G-T Tube or PEG Tube.

e)   Assist a patient with eye drops.

f)    Perform a bladder scan.

g)    Obtain a swab for surveillance culture.

h)   Assist with Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure                                           (BIPAP) for  patients with chronic respiratory conditions such as sleep apnea.

D.   Under the assignment and supervision of a registered professional nurse, pursuant to an established                               nursing plan of care a licensed practical nurse may delegate to and oversee completion of selected nursing                     tasks by certified nursing assistants.

2.   General Regulations Relating to the PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT TRAINING PROGRAMS

Approval and monitoring of training programs for nursing assistants shall be carried out in accordance with 32 M.R.S.A. Section 2104.

A.   The Board’s PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT BASIC TRAINING                   PROGRAMS shall be utilized for nursing assistant training programs.

1.   The registered professional nurse, by law, is responsible for the supervision and teaching of nursing                                 personnel. Therefore, a registered professional nurse shall be in charge of the instructional program to                           prepare assistants to nurses.

2.   No program shall be conducted that includes less than 70 hours of classroom instruction, 20 hours of                             skills laboratory and 40 hours of correlated, supervised clinical practice. (Shall be effective September 1,                         2021).

3.   The clinical instructor/student ratio of one to onemay at times be necessary for adequate learning and                             safe patient care. The clinical instructor/student ratio must be at least one instructor for every ten                                   students. The registered professional nurse instructor must provide direct onsite supervision during                               clinical learning experiences.

4.   All course objectives must be met to successfully complete this program. All skills must be demonstrated,                      and the student must perform return demonstrations satisfactorily, either in the clinical setting or in the                        skills laboratory.

5.  Content need not be taught in the order listed. Time may be added and emphasis made by the instructor                        to highlight certain aspects of the curriculum.

6.   Certified nursing assistant program students will not be taught content beyond what is included in the                             Board approved PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT TRAINING                        PROGRAMS.

B.   Accreditation or Approval by Other Organizations

The institution or agency conducting the training program or course, as well as the institutions or agencies                    cooperating with the program, shall be licensed or approved by the appropriate State licensing authority or                  accredited by the appropriate organization.

C.   Instructional Staff

1.    Each registered professional nurse shall be currently licensed to practice as a registered professional                                nurse in Maine or hold a current registered nurse multistate license issued by a state that has adopted the                     Nurse Licensure Compact in which the licensee legally resides and meet the federal requirements for                               nursing assistant instructors [42 CFR 483.152 and 42 CFR 484.36(a)(2)(ii)].

2.   Only registered professional nurses shall serve as classroom and clinical instructors. Members of other                           disciplines may assist in the teaching as necessary and desirable

D.   Students

1.   Qualifications for Admission

a)   Completion of the ninth grade of school (high school graduation or high school equivalency diploma                                preferred);

b)   Minimum age of 16 years; and

c)   Ninth-grade English reading and writing competency level on the Test of Adult Basic Educate (TABE),                           Comprehensive Adult Student Assessment System (CASAS), or other competency assessment                                           mechanisms as approved by the Board.

2.   Requirements for Retention and Completion

a)   The instructional staff shall develop requirements for class attendance, scholastic achievement                                          (minimum of 70%), clinical competence, and personal growth that shall be consistent with the goal of                            maintaining the highest quality of health care for the patient.

b)   Criteria for determining student progress shall be developed and used by the instructional staff in the                              evaluation of the students at intervals throughout the training program.

c)   Policies or procedures pertaining to dismissal shall be clearly stated and shall adequately safeguard the                          rights of both the students and the institution or agency conducting the training program.

d)    All the above shall be available in writing to the students.

E.   Certificate of Training

1.   The institution or agency conducting the program shall issue a certificate of training to each student who                       satisfactorily completes the training program. Such certificate shall clearly designate the following:

a)   Completion of the Board’s PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT                             TRAINING PROGRAMS;

b)   Number of classroom, skills laboratory, and supervised clinical hours;

c)   Beginning and ending dates of the program;

d)   Name of the agency conducting the training program;

e)   Signature of the registered professional nurse director of the training program; and

f)   Statement of approval by the Department of Health and Human Services.

2.   The director of a nursing educational program preparing persons for admission to a licensure examination                    may issue a certificate of training to a currently enrolled student or to a former student who has terminated                  enrollment in the program when such individual has satisfactorily completed at least the equivalent of the                    Board’s PRESCRIBED GENERALIST CURRICULUM FOR NURSING ASSISTANT TRAINING PROGRAMS.

F.   Facilities and Resources

  1.   The physical facilities utilized for the training program shall be adequate to the needs of the program and to  the size of instructional staff and student body. These include classrooms, conference rooms, and laboratories  sufficient in numbers and size to facilitate scheduling classes on a sound educational basis and to fulfill the  objectives of the program.

2.   The resources for planned learning experiences shall include the quality and variety needed for the objectives                of the training program.

3.    Hospitals, nursing homes, home health agencies, and facilities providing assisted housing services as                              defined  in 22 M.R.S.A., Section 7852(3) may be utilized for clinical learning experiences. Such health care                    facilities shall meet federal requirements for nursing assistant training [42 CFR 843.151(b)(2) and (3) and 42                CFR 484.36(a)(2)(i)(ii) with the exception that a licensed practical nurse may not be used as a clinical site                    instructor]. The registered professional nurse instructor shall provide direct on-site supervision during                          clinical learning experiences.

Up-to-date Learning resources shall be available for use by students and instructors, consistent with the needs of the curriculum
G.    Evaluation of Training Program

The registered professional nurse director of the training program and the instructors shall be responsible for              determining and developing methods and procedures to be used in measuring the extent to which the                            objectives of the training program have been achieved. The results shall be the basis for future action in                          planning improved program delivery.

3.   General Regulations Relating to Accepting the Certified Nursing Assistant Who Has Been                        Educationally Prepared in a State Other Than Maine.

A.   Consideration for listing on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS:

1.   The nursing assistant has passed a nationally certified nursing assistant testing process that includes the                       evaluation of both theory and clinical competence; and

2. The nursing assistant:

a)  Has graduated from a certified nursing assistant program outside of the State of Maine within the last                            year; or

b)   Has been employed as a certified nursing assistant outside of the State of Maine for the last two years.

B.   A nursing assistant who does not meet the above requirements must complete a Department of Health and                     Human Services approved certified nursing assistant training program and meet the Maine requirements for                 listing on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS.

4.    General Regulations Relating to the STANDARDIZED MEDICATION COURSE FOR CERTIFIED            NURSING ASSISTANTS

The purpose of this course is to teach experienced certified nursing assistants to administer selected                                noninjectable medications to patients who are 4 years of age and older. This complex nursing task shall be                    performed under the direct on-site supervision of a licensed nurse, only in long term care nursing facilities,                  state mental health institutions, county jails and state correctional facilities and assistive living settings.

A.  Approval Process For the Board’s STANDARDIZED MEDICATION COURSE FOR CERTIFIED NURSING                     ASSISTANTS

1.    Requests for approval to teach the medication course shall be submitted to the Board at least 60 days prior                    to the desired starting date of the course.

2.   Board approval shall be received by the educational institution or health care facility/agency prior to                              implementation of the medication course.

B.   General Requirements for Teaching the Course

1. Only the Board’s STANDARDIZED MEDICATION COURSE FOR CERTIFIED NURSING ASSISTANTS                         shall be utilized for medication courses.

2.   The registered professional nurse, by law, is responsible for the supervision and teaching of nursing                               personnel. Therefore, a registered professional nurse shall be in charge of the medication course.

3.   Only registered professional nurses shall serve as classroom and clinical instructors. Members of the other                   disciplines may assist in the teaching as necessary and desirable.

4.   No medication course shall be conducted that includes less than 60 hours of classroom instruction, 20                            hours of skills laboratory and 40 hours of correlated, supervised clinical practice.

5.   The clinical instructor/student ratio must be one to three when the student is administering medications                       in the clinical setting.

6.   All course objectives must be met to successfully complete this course. All skills listed in the Skills Check                       List must be demonstrated and the student must perform return demonstrations satisfactorily, either in                         the clinical setting or in the skills laboratory.

7.   Content need not be taught in the order listed. Time may be added and emphasis made by the instructor                        to highlight certain aspects of the curriculum. Nothing may be taught that is beyond the listed skills.

C.   Faculty Qualifications

1.   Current licensure in Maine as a registered professional nurse is required.

2.   Two years of clinical experience is required.

3.   Written recommendation attesting to previous teaching experience and ability is required.

4.    Evidence of continuing education is recommended.

5.   Baccalaureate degree in nursing is recommended.

D.    Student Requirements for Admission

1.   successful completion of a nursing assistant training program, in accordance with 32 MRSA Section 2102

2.   listing on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS

3.   equivalent of at least one year of full-time employment as a certified nursing assistant

4.   tenth grade competency level on the Test of Adult Basic Education (TABE) or other competency                                       assessment mechanisms as approved by the board

E.     Certificate of Training

1.    The institution or agency conducting the Board’s medication course hall award a certificate of training to                       each student who satisfactorily completes the course. Such certificate shall clearly designate the                                       following:

a)   completion of the Board’s STANDARDIZED MEDICATION COURSE FOR CERTIFIED NURSING                                  ASSISTANTS;

b)   the specific number of classroom/laboratory hours;

c)   the specific number of correlated, supervised clinical hours;

d)    the exact beginning and ending dates of the course;

e)    the skill level achieved in the course;

f)    name of institution or agency conducting the course;

g)    signature of the registered professional nurse director of the course; and

h)  statement of approval by the Board.

2.    The certificate awarded shall remain the property of the certified nursing assistant to whom it is                                      awarded.

3.    Certificates of training will be awarded only to certified nursing assistants who have successfully                                       completed the Board’s medication course. There is no mechanism to award certificates for comparable                            training, nor can this medication course be challenged.

4.   Certified Nursing Assistant-Medications (CNA-M) shall be the title.

F.    Continuing Competency

1.    Health care facilities that employ CNA-M to administer selected noninjectable medications shall provide                        a mechanism for maintaining competency.

2.    The CNA-M is responsible for maintaining an active status on the MAINE REGISTRY OF CERTIFIED                            NURSING ASSISTANTS.

3.    It is recommended that 4 hours of continuing education annually be devoted to topics pertinent to                                   medication administration.

G.    Facilities and Resources

1.    The physical facilities utilized for the medication course shall be adequate to the needs of the course and                        to the size of instructional staff and student body. These include classrooms, conference rooms, and                                laboratories sufficient in numbers and size to facilitate scheduling classes on a sound educational basis                          and to fulfill the objectives of the course.

2.    The resources for planned learning experiences shall include the quality and variety needed for the                                   objectives of the course.

3.    Only long term care nursing facilities and state mental health institutions shall be utilized for clinical                             learning experiences.

4.    A well-organized and up-to-date library shall be available for use by students and instructors. The                                    holdings shall be consistent with the needs of the curriculum, the student body, and the instructors.

H.     Records and Reports

1.    The institution or agency conducting the training program shall make provisions for the safe                                              maintenance of the necessary records.

a)   Significant, accurate, complete, and concise records and reports that clearly reflect the conduct of the                             medication course shall be maintained.

b)   Essential data relating to educational preparation and professional experience shall be maintained                                 for  each instructor.

c)    Records of authorization to conduct the medication course shall be kept on file.

I.    Evaluation of Medication Course

The registered professional nurse director of the medication course and the instructors shall be responsible for             determining and developing methods and procedures to be used in measuring the extent to which the                              objectives of the medication course have been achieved. The results of such self-appraisal shall be the basis                 for future action in planning improved course delivery.

5.    Eligibility Requirements for Entry on the Maine Registry of Certified Nursing Assistants

A.   To be eligible for listing on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS, the nursing                      assistant shall be in compliance with one of the following:

1.    has successfully completed competency testing and meets one of the following criteria:

a)     has successfully completed the Board’s PRESCRIBED CURRICULUM FOR NURSING ASSISTANT                                 TRAINING PROGRAMS;

b)    has been awarded a certificate of completion of nursing assistant training from the Department of                                   Educational and Cultural Services (DECS);

c)    has been awarded a certificate of training that identifies that such course;

d)    met requirements set forth in Chapter 5 of the Board’s Rules and Regulations at the time the                                             training took place;

e)    provides documentation of nurse assistant training in Maine prior to 1975.

2.    has been awarded a certificate of equivalent training from the director of an educational program in                                 nursing preparing individuals for admission to the licensure examination;

3.   has provided additional documentation that the criteria set for in Chapter 5 were met at the time the                              training took place;

4.   has submitted documentation of employment for 24 consecutive months between December 19, 1987 and                    December 19, 1989 at one or more Maine facilities of the same employer, as set forth in 42 CFR 483.150(b)                    (1) and is currently employed by that facility; or

5.    has met the requirements for nursing assistants who have been educationally prepared in a state other                          than Maine as set forth in Section 3 above.

B.    A nursing assistant who has received training in another jurisdiction, may request temporary listing on the                   MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS, pending consideration for permanent listing on              the MAINE REGISTRY OF CERTIFIED NURSING as set forth in Section 3 above. Such temporary listing                      shall be in effect for a maximum of 4 months and shall not be renewed.
6.    Fraud or Deceit in Obtaining a Certificate of Training

An individual who practices fraud or deceit in obtaining a certificate of training as a nursing assistant shall                   not be eligible for listing on the MAINE REGISTRY OF CERTIFIED NURSING ASSISTANTS.

STATUTORY AUTHORITY: 22 MRSA Section 1812-G (3), 32 MRSA Sections 2102, 2104 and 2153

EFFECTIVE: