Accountability: Being responsible and answerable or actions or inactions of self in providing nursing care or others in the context of delegation
Advanced Registered Nurse Practitioner (ARNP) Practice: Performance of the acts of the registered nurse and the performance of an expanded role in providing health care services as recognized by the medical and nursing professions, the scope of which is defined by rule by the commission. Upon approval by the commission, the advanced registered nurse practitioner may prescribe legend drugs and controlled substances Schedule II-V.
Assistant Personnel (AP): Individuals health care providers trained to function in a supportive role by providing patient care activities through the nursing delegation process. The term applies to individuals who may have a health care credential (e.g. Nursing Assistant, Home Care Aide, Medical Assistant, and Surgical Technologist) or an individual without a credential. Also referred to as Unlicensed Assistive Personnel (UAP).
Assignment: The assignment of care to others that may include routine care, activities and procedures that are within the authorized scope of practice of the nurse or part of the core competencies of assistive personnel.
Authorized Health Care Practitioner: A licensed health care practitioner who provides general direction to the registered nurse or licensed practical nurse within the health care practitioner's scope of practice:
- Advanced Registered Nurse Practitioner (ARNP);
- Physician and surgeon (MD);
- Physician assistant (PA) and Osteopathic PA;
- Dentist (DDS);
- Osteopathic physician and surgeon (DO);
- Naturopathic physician (ND);
- Podiatric physician and surgery (DPM);
- Optometrist (OD); or
Client-Specific: Assistive personnel (unlicensed assistive personnel) must not perform the delegated tasks with another patient unless it is also delegated to assistive personnel by the nurse.
Clinical or Nursing Judgment: Observed outcome of critical thinking and decision making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify and prioritize patient concern, and generate the best possible evidence-based solutions in order to deliver safe patient care.
Complex Intervention, Activity, or Task: Require nursing judgment to safely alter standard procedures in accordance with the needs of the patient; or require nursing judgment to determine how to proceed from one step to the next; or require the multidimensional application of the nursing process. Complex interventions, activities are tasks may be more complicated because of the patient's condition, the setting, the task or activity involved and the skill level required to perform the intervention, activity, or task.
Complex Nursing Situation: Patient's clinical and behavioral state is not predictable and rapid change in that state is reasonably anticipated.
Competent: Demonstrated knowledge, skills, and ability in the practice of nursing or to perform a specific task.
Compounding: act of combining two or more ingredients in the preparation of a prescription.
Controlled Substance: Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules. An updated and complete list of the schedules is published annually in Title 21 Code of Federal Regulations (C.F.R.) §§ 1308.11 through 1308.15. Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused.
Credentialing: Process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner.
Delegatee: One who is delegated a nursing responsibility by either an advanced registered nurse practitioner, registered nurse, or licensed practical nurse, is competent to perform it and accepts the responsibility, such as nursing assistants, home care aides, medical assistants, surgical technologists, or non-credentialed individuals.
Delegation: Transferring the performance of a nursing task (that the person would not normally be allowed to do) to a competent individuals in selected situations following the delegation process.
Delegator: One who delegates a nursing responsibility.
Direction: Instructions or orders to provide nursing services or carry out medical regimen under the direction of an authorized health care practitioner.
Dispense: Interpretation of a prescription or order for a legend drug and, pursuant to that prescription or order, the proper selection, measuring, compounding, labeling, or packaging necessary to prepare the prescription or order for delivery.
Intervention: Any act or action, based on clinical judgment and knowledge, that a nurse performs to enhance the health outcome of a patient.
Legend drug or prescription drug: Any drugs which are required by state law or regulation of the pharmacy quality assurance commission to be dispensed on prescription only or are restricted to use by practitioners only.
Licensed Practical Nurse (LPN) Practice: The performance of services requiring the knowledge, skill, and judgment necessary for carrying out selected aspects of the designated nursing regimen under the direction and supervision of an authorized health care practitioner or under the direction and supervision of a RN.
Medication Administration: When a nurse or other health care provider prepares, gives, and evaluates the effectiveness of prescription and non-prescription drugs. It means the direct application of a drug or device, whether by injection, inhalation, ingestion, or any other means, to the body of a patient or research subject. It also refers to guidelines in medication management, ensuring that drugs are administered safely and legally.
Medication Assistance: assistance rendered by a non-practitioner to an individual residing in a community-based care setting or in-home care setting to facilitate the individual's self-administration of a legend drug or controlled substance. It includes reminding or coaching the individual, handing the medication container to the individual, opening the individual's medication container, using an enabler, or placing the medication in the individual's hand, and such other means of medication assistance as defined by rule adopted by the department. A non-practitioner may help in the preparation of legend drugs or controlled substances for self-administration where a practitioner has determined and communicated orally or by written direction that such medication preparation assistance is necessary and appropriate. Medication assistance shall not include assistance with intravenous medications or injectable medications, except prefilled insulin syringes.
Medication Assisted Treatment (MAT): Use of the Food and Drug Administration (FDA) and approved opioid agonist medications for the maintenance treatment of opioid use disorders and opioid and opioid antagonist medication to prevent relapse to opioid use. MAT is only one aspect of substance use disorder management and is intended to be used in conjunction with evidence based behavioral health interventions.
Non-Complex Interventions: Can be safely performed according to exact directions, does not require alternation of the standard procedure, and for which the results and patient responses are predictable.
Nurse Delegation Decision-Making Tool: Decision-making tool to determine if it is safe to delegate a task to unlicensed assistive personnel (UAP).
Nursing Judgment: Logical and systematic cognitive process of identifying pertinent information and evaluating data in the clinical context in order to produce informed decisions, which guide nursing actions and the delegation of nursing tasks.
Nursing Scope of Practice Decision Tree: Decision-making tool to determine if an activity is within the nurse's legal boundaries and competency.
Nursing Task: Activities that constitute the practice of nursing as a licensed nurse and may include, but are not limited to, assistance with activities of daily living that are performed to maintain or improve the patient's well-being, when the patient is unable to perform that activity for themselves.
Nursing Assistant (NA): Individual, regardless of title, who, under the direction and supervision of a registered nurse or licensed practical nurse, assists in the delivery of nursing and nursing-related activities to patients in a health care facility. The two levels of nursing assistants are nursing assistant-certified (NA-C) and nursing assistant-registered (NA-R) (RCW 18.88A.020).
Opioid Treatment Program (OPT): Licensed program engaged in treatment of opioid addicted patients with approved schedule II opioids. Medication is ordered and dispensed from the OTP. Must be certified by the Substance Abuse and Mental Health Services Administration (SAMSHA) and assigned a Drug Enforcement Administration (DEA) registration identification.
Office Based Opioid Treatment (OBOT): Engaged in treatment of opioid addicted patients with approved narcotics less than Schedule II. Stand-alone clinic-based provider whose primary service is Medication Assisted Treatment (MAT), who employs or contracts with a provider who holds a current waiver with the Substance Abuse and Mental Health Services Administration (SAMSHA) and assigned a Drug Enforcement Administration (DEA) number for Buprenorphine prescribing for opioid use disorders.
Opioid Maintenance Therapy (OMT): Can be provided under any level of care. May be provided in an Outpatient Treatment Program (OTP).
Practice Standards: Established practice that is accepted as correct within the nursing profession. These standards change as new methods and technology change. They are based on the most recent scientific data available and through the contribution of administrative, academic and clinical experts.
Privileging: Process of authorizing a health care practitioner's specific scope of content and patient care services.
Professionalism: Conduct, aims or qualities that characterize a profession or a member of the profession; competence or skills expected of a professional.
Registered Nurse (RN) Practice: Performance of acts requiring substantial specialized knowledge, judgment, and skill based on the principles of the biological, physiological, behavioral, and sociological sciences in either:
- The observation, assessment, diagnosis, care or counsel, and health teaching of individuals with illnesses, injuries, or disabilities, or in the maintenance of health or prevention of illness of others;
- The performance of such additional acts requiring education and training and that are recognized by the medical and nursing professions as proper and recognized by the commission to be performed by registered nurses licensed under this chapter and that are authorized by the commission through its rules;
- The administration, supervision, delegation, and evaluation of nursing practice. However, nothing in this subsection affects the authority of a hospital, hospital district, in-home service agency, community-based care setting, medical clinic, or office, concerning its administration and supervision;
- The teaching of nursing;
- The executing of medical regimen as prescribed by a licensed physician and surgeon, dentist, osteopathic physician and surgeon, podiatric physician and surgeon, physician assistant, osteopathic physician assistant, or advanced registered nurse practitioner, or as directed by a licensed midwife within his or her scope of practice.
Responsibility: Reliability, dependability, the obligation to accomplish work, and the obligation to perform at an acceptable level of the nurse's education.
Routine Nursing Situations: Relatively free of complexity, and the clinical and behavior state of the patient is relatively stable, requires care based upon a comparatively fixed and limited body of knowledge.
Stable and Predictable: Patient's clinical and behavior status is non-fluctuating and consistent. Stable and predictable may also include a terminally ill patient whose deteriorating condition is expected.
Supervision: Providing guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.
Telehealth Host Site: The location of the practitioner providing telehealth services. (Also referred to as Consulting Site, Originating Site, Physician Site, Provider Site, or Referral Site).
Telehealth – Mobile Health (mHealth): Health care and public health information provided through mobile devices. The information may include general educational information, targeted texts, and notifications about disease outbreaks. Examples include health care supported by mobile devices such as mobile phones, tablets, personal digital assistant (PDA), and wireless infrastructure. Within digital health, mHealth encompasses all applications of telecommunications and multimedia technologies for the delivery of healthcare and health information.
Telehealth Nursing: Method of delivering nursing care remotely using technology, including mobile devices, tablets, and computers.
Telehealth – Store-and-Forward (Asynchronous): the use of a camera (e.g., audio clips, video clips, still images) to record (store) an image that is transmitted (forwarded) to another site for review at a later time. Examples include remote patient monitoring using devices to remotely collect and send data to a health care practitioner, agency, or diagnostic testing facility for interpretation. Examples include vital signs, electrocardiograms, continuous positive airway pressure, monitoring, and blood glucose monitoring;
Telehealth – Remote Patient Monitoring (RPM): The use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.
Telehealth Remote Site: The location of the client/patient receiving telehealth services. (Also referred to as Client/Patient Site, Request Site, Distant Site, Participating Site, or Referring Site).
Telehealth – Telemedicine (Synchronous): The delivery of health care services using interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. It does not include the use of audio-only telephone, facsimile, or email.
Telepresenter: A health care professional at the originating site that presents a patient to the primary health care practitioner at the distant site who facilitates the visit including supporting communications, clinical, and technical workflows through the tele-encounter process.
Unlicensed Assistive Personnel (UAP): Individuals health care providers trained to function in a supportive role by providing patient care activities through the nursing delegation process. The term applies to individuals who may have a health care credential (e.g. Nursing Assistant, Home Care Aide, Medical Assistant, and Surgical Technologist) or an individual without a credential. Also referred to as Assistive Personnel (AP).