Reopening Shuttered Hospitals to Expand Surge Capacity. Appendix C

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Appendix C. RN Nursing Skills for Possible Delegation

The table below is set up as a shell to illustrate the process that could be employed to identify RN skills that could be delegated to other staff types. Only those skills potentially applicable for other staff types are included. Knowledge of the training curriculum used with these other staff types would be essential. Tasks could be coded as "able" for those skills/tasks that the various staff types would be expected to know, "potential" for tasks that they, depending on training and experience, could do and "with training" for tasks that they could be trained to do. For example, nurse aides are taught how to take vital signs (temperature, pulse, respirations and blood pressure) and could likely be taught to do certain dressings and treatments.

	Nursing Student—4 Year BSN program	Nursing Student—2 year Program	Respiratory Therapy Student	Respiratory Therapist
Cardiac
Use of cardiac monitors	x Year 4	x If at all, Semester 4
Record/describe heart sounds	x Year 3	Only after work
CPR	x Year 3	x Semester 2	x	x
Care of a patient with:		x Semester 4
- CHF	x Year 3	x Semester 4
- Acute MI	x Year 4	x Semester 4
- Aneurysm	x Year 4	x Semester 4
- Angina	x Year 3	x Semester 4
- Cardiac arrest	x Year 4, with direct supervision	x Semester 4
Medications
- Digoxin	x Year 3, oral only
- Diltiazem	x Year 3, oral only
- Furosemide	x Year 3
- Nitroglycerin	x Year 3, no IV
- Thrombolytic therapy	No
Pulmonary
Record description of lung sounds	x Year 3		x Semester 1	x
Pulse oximetry	x Year 3	x Semester 2	x Semester 1	x
Airway management	x Year 3	x Semester 4, but depends on clinical experience	x Semester 2	x
- Endotracheal suctioning	x Year 4	x Semester 4, but depends on clinical experience	x Semester 2	x
- Nasal airway suctioning	x Year 3	x Semester 4, but depends on clinical experience	x Semester 2	x
- Oropharyngeal suctioning	x Year 3	x Semester 4, but depends on clinical experience	x Semester 2	x
- Sputum specimen collection	x Year 3	x Semester 4, but depends on clinical experience	x Semester 2	x
- Tracheostomy suctioning	x Year 4	x Semester 4, but depends on clinical experience	x Semester 2	x
Oxygen therapy and medication delivery systems	x Year 3	x Semester 2	x Semester 1	x
- Inhalers	x Year 3	x Semester 2	x Semester 1	x
- Nebulizer	x Year 3	x Semester 2	x Semester 1	x
- Face mask	x Year 3	x Semester 2	x Semester 1	x
- Nasal cannula	x Year 3	x Semester 2	x Semester 1	x
- Portable O2 tank	x Year 3	x Semester 2	x Semester 1	x
- Trach collar	x Year 3	x Semester 2	x Semester 1	x
Care of a patient with
- Ventilator	x Year 4	x Semester 4, if at all	x Semester 2	x
- Chest tube	x Year 3	x Semester 4	x Semester 2	x
- COPD	x Year 3	x Semester 4	x Semester 1	x
- Pneumonia	x Year 3	x Semester 4	x Semester 1	x
- Tuberculosis	x Year 3	x Semester 4	x Semester 1	x
Medications
- Theophylline	x Year 3
- Adrenalin	x Year 3, SC/IM/INH—no IV	Not at all
- Steroids	x Year 4
- Isuprel	x Year 3, SL/INH—no IV	Not at all
Neurological
Record/describe
- Glasgow coma scale	x Year 3	x Semester 4
- Reflex/motor deficits	x Year 3	x Semester 4
- Visual/communication deficits	x Year 3	x Semester 4
- Level of consciousness	x Year 3	x Semester 4
Care of a patient with:
- Alzheimer's disease	x Year 3	x Semester 2
- Closed head injury	x Year 4	x Semester 4
- CVA	x Year 3	x Semester 4
- Seizures	x Year 3	x Semester 4
- Spinal cord injury	x Year 3	x Semester 4
Medications
- Decadron	x Year 4	x Semester 2
- Dilantin	x Year 3, oral only
- Mannitol	No
- Phenobarbital	x Year 3, oral only
- Solu-Medrol	x Year 4

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