<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.27.28.04" title_num="10" subtitle_num="27" chapter_num="28" heading="Scope of Delegation to an Assistant.">
  <paragraph num="A.">
    <text>An APRN may not delegate nursing and technical tasks to an assistant which shall, by law or regulation, be performed only by an individual that is required to be licensed, certified, registered, or otherwise recognized pursuant to any State laws.</text>
  </paragraph>
  <paragraph num="B.">
    <text>An APRN may delegate nursing and technical tasks, consistent with national guidelines for nursing delegation established by the National Council of State Boards of Nursing and the approved policies and procedures of the site, in the following categories:</text>
    <paragraph num="(1)">
      <text>Surgical technical tasks that the delegating APRN directly orders while present and personally performing the surgery in the same surgical field; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Nonsurgical technical tasks while the assistant is under the delegating APRN’s direct supervision or on-site supervision.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Except as provided in §§B(1) and D of this regulation, an APRN shall provide at minimum on-site supervision when delegating nursing or technical tasks to an assistant, including, but not limited to, the following:</text>
    <paragraph num="(1)">
      <text>Patient preparation for physical examination;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Patient history interview;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Collecting and processing specimens, such as performing phlebotomy, inoculating culture media, pregnancy tests; dipstick and microscopic urinalysis, and microbiology including rapid streptococcal testing and throat cultures;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Preparing and performing laboratory tests that the APRN is satisfied the assistant is trained and qualified to perform under State and Clinical Laboratory Improvement Amendments regulations;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Clinical tests including, but not limited to:</text>
      <paragraph num="(a)">
        <text>Application of tuberculin skin tests;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Electrocardiography;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Administering basic pulmonary function tests; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Visual field tests;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Transmitting prescriptions to a pharmacy;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Preparing and administering oral drugs;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Preparing and administering injections limited to intradermal, subcutaneous, and intramuscular within the deltoid, gluteal, or vastus lateralis muscles including small amounts of local anesthetics;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Establishing a peripheral intravenous line; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Injecting fluorescein-like dyes for retinal angiography.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>When delegating injecting intravenous drugs or contrast materials to an assistant, an APRN shall provide direct supervision.</text>
  </paragraph>
  <paragraph num="E.">
    <text>An APRN who is authorized to dispense prescription medication under Health Occupations Article, Title 8, Annotated Code of Maryland may delegate only mechanical acts involved in dispensing a drug.</text>
  </paragraph>
  <paragraph num="F.">
    <text>An APRN may not delegate to an assistant any act that requires the exercise of clinical judgment by an APRN, including, but not limited to:</text>
    <paragraph num="(1)">
      <text>Conducting physical examinations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Administering any form of anesthetic agent or agent of conscious sedation other than topical anesthetics or small amounts of local anesthetics;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Initiating independently any form of treatment, except for cardiopulmonary resuscitation or other forms of emergency treatment authorized to be performed by non-clinicians under State law;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Establishing a diagnosis or giving clinical advice; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Providing physical therapy.</text>
    </paragraph>
  </paragraph>
</regulation>