Introduction:

The Board of Nursing's mission is to protect the health, safety and welfare of New Jersey citizens. The Board licenses nurses to ensure safe, competent care. The Board is committed to educating nurses in safe decision making, including Registered Nurse decisions to delegate selected nursing tasks to Licensed Practical Nurses and ancillary nursing personnel.

This Decision Making Model has been designed by the Board to assist nurses in using the information available to them for resolving scope of practice issues.

If you have a question about nursing practice, follow each step of this model to make your decision. If you are not able to answer your question after going through each step of this model, consult with your institution's Nursing Practice Committee. If the Nursing Practice Committee of your institution, agency or health care provider cannot resolve the scope of practice issue, the committee may submit a written request to the Executive Director of the Board for an opinion from the Board's Practice Committee. Please include documentation from your Practice Committee on the practice issue addressed in each step of the model.

Decision Making Model Algorithm:

1. Is the act consistent with your scope of practice in the New Jersey Nursing Practice Act? Do the Board's regulations address this specific act? (This may be all the information you need to make your decision. If not, continue to the next step.) Resource documents you might need include: a. Nursing Practice Act: N.J.S.A. 45:11-23, 11-23, 46: b. Delegation Rule: N.J.A.C. 13:37-6.2; c. Standards of Nursing Practice from your professional nursing organization; d. Board Licensed Practical Nursing Standards of Practice and Board Guidelines, such as the LPN Role in IV Therapy-Available upon request. If NO,the act is NOT within your scope of practice without the above. If YES, continue to the next step.
2. Is the activity authorized by a valid order, an in accordance with established institutional/agency or provider protocols, policies and procedures? The nurse is accountable for clarifying any order or treatment regimen believed to be inaccurate or contraindicated by consulting with the licensed prescribing practitioner, and notifying the prescribing practitioner when the RN makes a decision not to administer the medicine or treatment. If NO, the act is NOT within your scope of practice without the above. If YES, continue to the next step.
3. Is the act supported by research data from nursing literature and/or research from a health related field? Has a national nursing organization issued a position statement on this practice? If NO, the act is NOT within your scope of practice without the above. If YES, continue to the next step.
4. Do you possess the knowledge and clinical competence to perform safely? Documentation to validate your educational and clinical competence should be maintained for a four year period. If NO, the act is NOT within your scope of practice without the above. If YES, continue to the next step.
5. Is the act to be performed within accepted "standards of care" which would be provided in similar circumstances by reasonable, prudent nurses with similar education and clinical skills? Nurses are accountable for knowing and conforming to their scope of practice in the Nursing Practice Act, Board regulations, and any other State and Federal laws impacting their practice. If NO, the act is NOT within your scope of practice. Performance of the act may place the patient and the nurse at risk. If YES, continue to the next step.
6. Are you prepared to assume accountability for the provision of safe care? If NO, the act is NOT within your scope of practice. If YES, you may perform the act based upon a valid order in accordance with the institution/agency or provider's established protocols, policies and procedures.

Seven Step Decision Making Model: Algorithm for Determining Scope of Nursing Practice

New Jersey Board of Nursing Fact Sheet: Decisions Making Model for Delegations of Selected Nursing Tasks
N.J.A.C. 13:37-6.2, Delegation of Selected Nursing Tasks