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Delegation of clinical practice
This applies to registered nurses employed in PFSHS where a director or medical officer responsible for medical services asks a nurse to provide care and treatment on their behalf within the PFSHS.
The care is only delegated to a nurse deemed competent to carry out the procedure, assessment, management and follow-up required. Accreditation within PFSHS is achieved when the nurse has (1) completed the clinical accreditation process and (2) been deemed competent by the director or senior medical officer acting on the advice of the clinical nurse consultant, nurse unit manager or senior nurse.
Clinically accredited registered nurses employed within sexual health services who have delegated authority must adhere to the Nursing and Midwifery Board of Australia’s Professional standards and remain accountable for their nursing practice. Registered nurses must conform to the NSW Sexual Health Standard Operating Procedures, Local Health District policy and procedures and/or business rules.
Clinically accredited registered nurses may be delegated all or some of the outlined clinical practices (see Table 1).
Consultation
Clinically accredited registered nurses remain accountable for their nursing practice and this includes seeking consultation with a medical officer. Depending on the outcome of the consultation, the nurse may either proceed with care and management or have the patient reviewed by a medical officer. In acute presentations, this may require urgent referral to an emergency department or general practitioner. Services where there is no on-site medical officer must have established consultation and referral pathways in place to respond to acute patient presentations. All management plans, consultations and referrals must be documented in the patient’s medical record.Discussions around a patient’s management plan may also occur with other members of the healthcare team such as counsellors, women’s health workers or Aboriginal healthcare workers and these should also be documented in the medical record.
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Outcomes
Registered nurses employed within PFSHS in NSW operate within delegation of clinical practice and according to individual clinical management guidelines, local policies and procedures.
Patient safety is maintained and appropriate assessment is performed.
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Procedure
The nurse assesses, plans, implements and evaluates nursing care in collaboration with the individual client and the multidisciplinary team. Delegation of clinical practices (Table 1) can be adapted to the capacity and requirements of each service. Clinically accredited registered nurses may be delegated all or some of the outlined clinical practices.
Table 1. Clinical practices that may be delegated to a clinically accredited registered nurse Asymptomatic members of priority populations presenting for STI and BBV screening Management of clinical findings including patient education, administration and supply of treatment for uncomplicated STI
Patients presenting for STI and BBV screening with the following signs and symptoms suggestive of uncomplicated
- urethritis
- vaginitis
- cervicitis
- genital lumps
including management of clinical findings of these conditions.
Intake and triage processes
Ongoing HIV monitoring in well HIV patients including HIV co-morbidity screening
Pre-exposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP) assessments for HIV prevention; consultation required with medical officer for prescription
Test result management and follow-up
Other procedures at the request of a medical officer and/or within registered nurse scope of practice and maintaining professional standards, e.g. administration of medication or treatment, cervical screening, contraceptive discussion and referral, correspondence with referring general practitioner.
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Documentation
Information related to client care provided under this delegation must be documented in the patient’s medical record.
- References and further reading