Premier Nurse Delegation
We take pride in our quality of service and attention to detail. Our services are tailored to meet what is most important to you. As an AFH Provider, there are many things you need to keep track of. Let us help make nurse delegation one less things you need to worry about. Your nurse delegation documents will be organized in a custom made binder. This allows ease of access to the written nurse delegation task instructions as well as keeps your documents organized and complete. Nurse delegation and training can be provided using various methods to meet you and your caregivers' individual needs. As your Nurse Delegator, we are an extension of your care team. We strive to bring you value and support as a former AFH Provider and an experienced Nurse Delegator.
I am a Registered Nurse and a Washington State Contracted Nurse Delegator. I have been providing nurse delegation services since 2014 to Adult Family Homes (AFHs) in Snohomish County and King County, Washington. I delegate and train specific nursing tasks to qualified credentialed and certified caregivers. I provide thorough nurse delegation instructions using various teaching methods. As a former AFH Provider, the knowledge and experiences that I have gained carry over to support the homes that I serve.
Nurse delegation services are detailed in the Washington Administrative Code (WAC) WAC 246-840-910 through 246-840-970. A registered nurse is to provide training and nursing management for nursing assistants who perform delegated nursing tasks. Services include the initial visit, care planning, competency testing of the nursing assistants, consent of the client, additional instruction and supervisory visits. Clients who receive nurse delegation services must be considered “stable and predictable” by the delegating nurse.
My approach to nurse delegation is as follows: after communication with the AFH Provider to discuss the client’s delegation needs, I review of the client’s assessment, current medications and orders, medical history, determine if the client is stable and predictable, then identify the nursing tasks that require delegation, (i.e. oral medication administration, topical medications, eye drops, inhalers, suppositories, blood sugar monitoring, insulin injections, etc.) The tasks that require nurse delegation are those that the resident cannot perform the last step (i.e. placing medication in the ordered route) or if the resident has an impairment in cognition/awareness (i.e. Alzheimer’s, Dementia, Confusion, Seizure disorders, etc.) or if the client does not know how to ask for the needed medication. After verifying the caregivers’ credentials and training certificates, I then delegate and teach the tasks to the caregivers. I delegate using various methods, including oral instructions, written instructions, physical demonstrations, visual job aids, videos, using actual medications/supplies, etc. The caregivers’ understanding and ability to carry out the delegated tasks accurately is verified by return demonstration and by their oral explanation of how to perform the tasks. As mentioned earlier, one of my responsibilities is to continue to provide ongoing supervision and evaluation of the tasks. A Supervisory visit is required every 90 days or sooner.
As a Nurse Delegator, I do NOT provide emergency/on-call services or independent nursing duties. Nurse delegators cannot delegate injections (other than insulin injections), sterile procedures, central line maintenance, and acts that require nursing judgement. The client must be stable and predictable. The AFH Provider or Resident Manager is responsible to notify me of any changes in client’s condition, medications, or treatment plan.
A comprehensive placement assessment is required by law for residents moving into AFHs. This assessment is required to be updated annually, upon significant change in condition and after readmission from the hospital. For Medicaid clients, the state-appointed Case Manager has the responsibility of creating and updating this assessment. The Case Manager will also send a referral to a nurse delegator when nurse delegation is needed. For private-paying clients, a Nurse Assessor creates and updates this assessment and the AFH Provider contacts the Nurse Delegator when nurse delegation services are needed.
Each Nurse Delegator determines his/her own fees for the above tasks. No insurance
company, long-term care policy or Medicare covers Nurse Delegation Services. (State Medicaid clients are the only clients whose fees are covered by their state insurance.)
Thank you for inviting me to be a partner with you in providing excellent care. I look forward to an on-going relationship with you. If you have any questions, please feel free to call or email me.
-Bonnica Vuong, RN, RND Premier Nurse Delegation