The Roles of Unlicensed Office Assistants and Licensed Nurses In A Physician's Office Practice

Assisting Clients with Self-Administration of Medications:
the Role of Unlicensed Assistive Personel

Assisting the client with self-administration of medications may be delegated by the licensed nurse to appropriately trained unlicensed personnel and in accordance with the established plan of care only when:

(1) assistance takes place in the client's place of residence* or in a day program in which the client's health care is incidental to the personal care required;
(2) the medication is prescribed by a physician or other person authorized by state law to prescribe and taken on a routine basis;
(3) the client requires physical and/or verbal assistance due to a disability or health impairment which prevents total independence in this act;
(4) the client, his/her significant other, or the registered nurse planning the care maintains ultimate responsibility for administration of the medication(s); and
(5) the client or significant other agrees in writing to the established plan of care for assistance with self-administration of medications; and when applicable, agrees in writing to accept ultimate responsibility for the medication administration.

*NOTE: Place of residence may be a private home, multi-unit independent living setting or community residential care setting.

Consistent with 21 NCAC 36.0221 (b) and the established plan of care, delegation of assistance with self-administration of medications to unlicensed personnel is limited toone or more of the following activities:

(1) reminding the client to take the medication through verbal suggestion, prompting and/or gesturing;
(2) handing a prefilled labeled medication holder, labeled unit dose container, or syringe; or handing an original marked labeled container to the client**;
(3) assisting with the removal of a medication from a container;
(4) breaking a tablet, crushing a tablet and, if necessary, mixing a medication in water or a food product;
(5) guiding the hand of the client to self-administer the medication; and
(6) observing the client take the medication.

**NOTE: Prefilling and labeling must be done by the licensed nurse or client's significant other and marked with client's name and time of dose. Prefilling and labeling may not be performed by the unlicensed assistant.

As with all client care services, those medication administration activities which require the judgment and decision-making of a licensed nurse must be provided by the appropriately qualified licensed nurse. The registered nurse who plans and coordinates medication-assisted activities maintains accountability for both the care provided by self and by other licensed and unlicensed assistive personnel to whom care activities are delegated.

Adopted 1/95

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The Roles of Unlicensed Office Assistants and Licensed Nurses In A Physician's Office Practice

As per Administrative Rule 21 NCAC 36.0221 (c):

"A license to practice nursing is required for implementing any treatment and pharmaceutical regimen which is likely to produce side or toxic effects, allergic reactions, or other unusual effects or which may rapidly endanger a client's life or well being and which is prescribed by a person authorized by state law to prescribe such a regimen."

Paragraph (b) of this same rule outlines the five criteria which must be met in order for a nursing function to be appropriately delegated by a licensed nurse to unlicensed personnel. Such tasks must:

1. frequently recur in the daily care of a client or group of clients;

2. are performed according to an established sequence of steps;

3. involve little or no modification from one client-care situation to another;

4. may be performed with a predictable outcome; and

5. do not inherently involve ongoing assessments, interpretations, or decision-making which cannot be logically separated from the procedure itself.

Client-care services which do not meet all of these criteria must be performed by a duly licensed nurse..."

In an office practice setting where both licensed and unlicensed personnel may be involved in patient care activities, unlicensed personnel who are accountable to and supervised by the licensed nurse may not be delegated any tasks with unpredictable outcomes or which require the judgment of a licensed nurse. Therefore, the licensed nurse may not delegate activities, such as medication administration, teaching and counseling of clients, to unlicensed personnel.

However, if the physician has total responsibility/accountability for the role of a medical office assistant including training, validation of competencies, delegation, supervision and evaluation, the nursing laws and standards do not apply to this physician-assistant relationship.

The licensed nurse is legally accountable for the care which he/she provides to clients as well as for care delegated to other licensed or unlicensed nursing personnel, all of which must be carried out within the legal framework for nursing practice. Refer to the Administrative Components of Nursing Practice and the proposed 21 NCAC 36.0224 Components of Nursing Practice for the Registered Nurse and .0225 Components of Practice for the Licensed Practical Nurse which define the legal scope of practice for each level of licensed nurse.

Further information regarding the legal scope of practice for licensed nurses and unlicensed personnel who perform nursing functions in office settings may be obtained by contacting a Practice Consultant at the Board office. (919) 782-3211

April 1991
Revised March 1994

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