N4001 Delegation

What is supervision?

-provision of guidance and direction, oversight, evaluation and follow-up by the licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel. -Delegating is the RNs first responsibility -When someone accepts responsibility for a task they are responsible to carry out the act ***if you feel unprepared or untrained to complete a task you should decline to perform that particular duty**** -It is the nurse's responsibility to know the scope of practice for anyone being delegated an assignment

How to ensure Safe and Effective Delegation?

-show respect for the individual you are delegating to -focus on safe client care -develop a good working relationship with 2 way communications -provide positive reinforcements -identify strengths as well as areas to be developed -create an environment for questions to be asked -confirm their training, their orientation, and their competencies -identify the purpose for the interventions you delegate -delegate stable patients with predictable outcomes -be clear , direct and specific with requests -be sure delegate understands priority of care

What are the Basic levels of priority setting?

1. ABC plus V - airway, breathing, cardiac status and circulation, and vital signs 2. concerns about mental status changes, untreated medical issues, *acute pain*, acute elimination problems, abnormal laboratory results, and risks 3. health problems other than those in the first two levels, such as more long-term issues in health education, rest, coping

A 5 year old asthmatic client , in acute respiratory distress is in the Emergency Room. You note a large bruise on his back: 1. provide client and patient admission kit 2. Administer oxygen 3. Call Social worker 4. Obtain an O2 saturation

1. Administer oxygen 2.Call socia 3.Provide pt. kit

A 6 year old post operative tonsillectomy client with old, dried blood in his mouth: 1. Fix leaking IV tubing 2. Assess client's mouth for further frank bleeding 3. Help client clean/rinse mouth 4. Offer a cherry popsicle

1. Assess client's mouth 2. Fix IV 3. Clean rinse mouth

Right communication (4 c's)

1. Clear communication is information that is understood by the listener 2. Correct communication is aligned to rules, regulations or job descriptions 3. Concise statements are those that giving mouth but not too much additional information 4. Complete communication leaves no room for doubt on the part of the supervisor or delegatee

What is the criteria for delegating to a UAP?

1. Frequently recur in the daily care of a client or group of clients 2. Are performed according to an established (standardized) sequence of steps 3. Involve little or no modification from one client-care situation to another 4. May be performed with a predictable outcome 5. Do not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure(s) itself 6. Do not endanger the health or well-being of clients 7. Are allowed by agency policy/procedures

What are the 5 rights of delegation?

1. Right task- can it be delegated 2. Right Circumstance- Should it be delegated 3. Right person- can this person do the task 4. Right direction/ communication- is the task being conveyed in a clear manner 5. Right supervision- is the task being followed up on once complete.

A 2 year old girl crying for her mother in her crib with a bloody nose: 1. Check/change client's diaper 2. Assist client to stop bloody nose by applying pressure to her nose 3. Hand client her favorite stuffed animal to calm her down 4. Instruct child to blow her nose

1.Assist client to stop bloody nose 2. Stuffed animal 3.Change diaper

Delegation in nursing

As the Professional Nurse, YOU hold the responsibility and final accountability for the effective completion of the task. YOU must know how and what to delegate.

Nurses are responsible for ATE

Assessment Teaching Evaluation

Right person (delegation)

Assess and identify the UAP's competency on an individual and client specific basis Take's steps to remedy failure to meet standards

Right task (delegation)

Must be within their scope of practice Matches complexity of activity with competency level of delegatee

What are the 12 STRATEGIES during testing?

Trust Yourself/Cover Answers No foreign Objects/Go with what you know No Absolutes Item Length- not associated Umbrella Option- both answers in one Priority questions Face value Pace yourself Never leave unanswered Negative words Position of the option

STOP (during answering questions)

S-STORY T-THINK OF THE ANSWER/OPTION O-OPTIONS P-PICK AND DON'T CHANGE

The care delivery system on a medical nursing unit is team nursing. On wing A, there is a registered nurse (RN) and licensed practical/vocational nurse (LPN/LVN) team to care for eight clients. Which tasks should the RN delegate to the LPN/LVN? 1. Vital signs and assessment on a postoperative client 2. Wound care and oral and intravenous (IV) medications for all clients 3. Vital signs and hygiene care on all eight clients 4. Assessments on two young, stable clients

# 3 Team nursing is being used. RN should perform do#1- &4requires assess and critical thinking, LPN- gives uncomplicated, stable and po meds not complicated wound or IV meds

A nurse delegates care of clients to the certified nursing assistant (CNA) and licensed practical/vocational nurse (LPN/LVN). Which tasks should the nurse assign to the CNA and LPN/LVN? 1. CNA - check vital signs; LPN - give oral meds to assigned clients 2. CNA - change noninfected dressing; LPN - administer intravenous piggyback (IVPB) medications 3. CNA - ambulate a client who had a stroke; LPN - assess two clients 4. CNA - take vital signs; LPN - complete all admission paperwork

#1 CNA's do vs LPN's do po meds CNA's can change some dressings but better for RN so to Assess #3 LPN do not assess Admission done by RN

What criteria do we follow when evaluating and weighing during prioritization?

1) Is it life-threatening or potentially life-threatening if the task is not done? Would another patient be endangered if this task is done now for the task is left for later? 2) Is this task or process essential to patient or staff safety? 3) Is this task or process essential to the medical or nursing care plan?

A registered nurse (RN) delegates complicated wound care to a licensed practical/vocational nurse (LPN/LVN). The LPN/LVN has only changed this type of dressing once. Which component of delegation has the RN neglected? 1. Authority 2. Competency 3. Communication 4. Responsibility

2- competency

Which of the following tasks is it appropriate for the nurse to delegate to an experienced nursing assistant? 1. Obtain a 24 hr. diet recall from a pt. recently admitted with anorexia nervosa. 2. Obtain a clean catch urine specimen from a patient suspected of having a urinary tract infection 3. Observe the amount and characteristics of the returns from a continuous bladder irrigation for a patient after a transurethral resection 4. Observe a pt. newly diagnosed with diabetes mellitus practice injection techniques using an orange

eliminate- nurse must assess diet intake. Routine - so keep for consideration Color and fluid needs to be assessed by the RN-eliminate Evaluate must be done by RN Best answer is #2

Outcomes of delegation

empowers others builds trust enhances communication encourages leadership develops teamwork increases productivity

YOU ARE A NEW GRADUATE WORKING ON A MEDICAL-SURGICAL UNIT. ONE OF YOUR PATIENTS IS ORDERED TUBE FEEDINGS AND YOU KNOW YOU MUST CHECK FOR PLACEMENT FIRST. YOU HAVE NEVER DONE THIS BEFORE. WHAT SHOULD YOU DO ? A. Ask the experienced nurse how to assess for placement and how to do the tube feeding B. leave this task until the end of the shift so someone else might be able to do it on the next shift C. Go to the Policy and Procedure manual D. Call the Nursing supervisor

C- policy and procedure manual

Right circumstance (delegation)

RN assesses health status and sets nursing goals Provides for monitoring and guidance of activity and personnel

A client experiences respiratory distress with shallow respirations at a rate of 32/minute. The client has assumed an orthopneic position and is pale and confused. Heart rate is 118 bpm and blood pressure is 90/40 mm Hg. Which task should the nurse delegate to the charge nurse? 1.Completion of a head-to-toe assessment 2. Insertion of a second IV line 3. Application of oxygen per protocol order 4. Paging of the respiratory therapist

#2 The client is deteriorating. You must work quickly to prepare for STAT meds and you need additional support especially from experienced nurses. You can apply O2, you complete assessment since you have been caring for pt. and best to assess change since earlier. Secretary can call Reir.

A nurse assists a client in room A with lunch. The charge nurse calls the nurse and reports the client in room C reports pain and is requesting pain medication. What is the nurse's best action? 1. Finish feeding client in room A, then medicate client in room C for pain. 2. Stop feeding client in room A and medicate client in room C for pain. 3. Finish feeding client in room A and ask charge nurse to medicate client in room C. 4. Ask charge nurse to feed client in room A while nurse medicates client in room C for pain.

#2While eating may be a priority, does not take precedence over pain-maintain continuity Delegate feeding but not pain med

What are some Patient Assignment Factors to consider?

-Job descriptions -abilities of coworkers -roles and functions -client's condition -complexity of care to be provided -potential risks for harming the client -degree of problem solving expertise needed by caregiver -type and level of client interaction that is needed

What are some delegation errors?

-Underdelegation: delegators thought of lack of ability or his ability to do the job -Overdelegating: burdening the subordinates -Inproperdelegating: delegating at the wrong time, to the wrong person or the wrong reason -Delegating without adequate information: improper

Things to NOT delegate?

-activities that includes Nursing Process -activities that require specialized knowledge, judgment and skill -initial nursing assessment -determination of nursing diagnoses, -establishment of goals, development of nursing care plan

What is the Role of the Licensed Practical Nurse?

-assists with implementation of care -perform procedures -recognize abnormalities with guidance -cares for stable patients with predictable conditions -has knowledge of asepsis -administers medications (PO & IM, not IV)

What is prioritization in nursing?

-deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent -Knowing the patient's purpose for care, current clinical picture, and picture of the outcome or result is necessary to be able to plan priorities

Nursing considerations when making assignments?

-determine nursing care required to meet client's need -knowledge and abilities of staff -continuity of care assign to increase efficiency -be specific about expected results -avoid assigning only procedures -assign total patient care -provide additional help

After receiving intershift report on a medical nursing unit, the registered nurse (RN) prepares for the work of the day. Which of the following activities can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? Select all that apply. 1. Irrigating a nasogastric tube on a client receiving tube feedings 2. Irrigating a clogged urinary drainage catheter on an older adult client 3. Rechecking vital signs on a post-surgical client with a previous BP of 98/60 mm Hg 4. Changing a dressing on a client admitted with an infected diabetic foot ulcer the previous day 5. Administering a unit packed red blood cells (RBCs) to a client with a hemoglobin of 10.2 grams/dL

1,2 within scope of the LPN #3 is borderline with postop and needs RN #4 needs RN assess #5 RN

The registered nurse (RN) has completed making client assignments for the shift and is preparing to delegate appropriate nursing care activities to the staff. Which tasks may the RN delegate to the certified nursing assistant (CNA)? Select all that apply. 1. Ambulating a client in the hallway 2. Recording intake and output from meal trays 3. Measuring and recording vital signs 4. Completing a skin risk assessment using the Braden scale 5. Recording a client's oxygen saturation measurements

1,2,3,5 delegate skills within scope of cna

A nurse leader reinforces the healthcare agency's vision of client-centered care. The manager supports the clinical environment by doing which of the following? Select all that apply. 1.Putting the nurses' needs first 2.Putting clients' needs first 3.Enhancing quality care 4.Focusing on early client discharge 5.Focusing on safety

2,3,5, Putting client's needs first supports the agency's vision and improves the quality of care provided to clients -(2&3) All care must be provided in a safe manner (5)Focusing on nurse's needs not right as well as early discharge may or may not support client care

The Nursing Team includes 1 LPN and 3 RN's. Select the appropriate patient assignment for the LPN. a. a two year old newly admitted with Rotovirus b. a 10 year old who had a spika cast applied today c. a 5 year old who had an appendectomy 3 days ago d. a 2 month old with RSV,hx. of 26 weeks preemie, BPD, and a feeding tube requiring 24 hr. special care.

A-needs RN to assess and plan B-RN needs to assess teach & plan C-LPN D-RN-increased level of care

After receiving report, which client should the nurse assess first? A. stage 3 anxiety with disorientation B. Severe agoraphobia refusing to leave the room C. paranoid schizophrenia pacing the halls D. Post traumatic stress disorder socially withdrawn

A. Disorientation can lead to self harm. Physical needs are a priority

The nurse is caring for patients on the surgical floor and has just received report from the previous shift. Which of the following patients should the nurse see first? A. A 35 year old admitted three hours ago with a gunshot wound;1.5 cm area of dark drainage noted on the dressing B. A 43 year old who had a mastectomy two days ago ;23 mL of serosanguinous fluid noted in the Jackson-Pratt drain. C. A 59 year old with a collapsed lung due to an accident; no drainage noted in the previous 8 hours D. A 62 year old man who had an abdominal resection 3 days ago : patient complains of chills

A.- dark drainage-old blood B. Normal drainage C. Stable *D* - think infection

What to do when Change of patient status?

-notify physician-resident/Medical Doctor: give specific descriptive objective changes -Notify Charge Nurse: state what you have done -Document specific changes, what you have done and who has been notified -Stay with your patient

What is included in Professional Nurse Practice?

-nursing assessment, diagnosis and treatment supervision and teaching -evaluate activities of Assistive personnel to achieve desired outcomes -delegate to qualified Assistive personnel -observation, care and counsel of patients -provide guidance and assistance to health team members -demonstrate competence with current technology -all activities that require the knowledge, skill and specialized judgment of the R.N. -assessment of accuracy of all medical orders

What is delegation?

-transferring to a competent individual the authority to perform a selected nursing task in a selected situation -The nurse retains the accountability for the delegation -In other words - assignments are work plans; the nurse "assigns" or distributes work and also "delegates" nursing care as she he/she works through others

How to make an assignment?

Assignments must be created with knowledge of the following: -How complex is the patience required care -What are the dynamics of the patient's status and their stability -How complex is the assessment and ongoing evaluation -What kind of infection control is necessary -Are there any safety precautions -Is there a special technology involved in the care and who is skilled in its use -How much supervision and oversight will be needed based on the staff's numbers and expertise -How available are the supervising RNs -How will the physical location of patients of fact the time and availability of care -Can continuity of care be maintained -Are there any personal reasons to allocate duties for a particular patient, or are there nurse or patient preferences that should be taken into account

Maslow's hierarchy of needs during prioritization

physiological needs before psychological

You are the charge nurse on the 3-11 shift. When you return from your dinner break, the unit secretary reports the following: a. Mrs. Jones IV has infiltrated b. The operating room staff are on their way to take Mr. Anderson to surgery. He has not received his preoperative medication yet. c. A parent has asked if her daughter, who is a new surgical patient, should have bright red blood on her dressing. d. Two patients haven't received their meal trays yet e. Someone spilled a bouquet of flowers in a patients room -The other RN is busy with his own patients. -You have yourself, a ward clerk and an IV certified LPN you can delegate to. Decide who should do what and in what priority

a. LPN b. take pt w/o pre-op meds c. NURSE d. UAP e. UAP

What is the Role of the Unlicensed Assistive Personnel (UAP)?

-direct patient care -stable clients -activities including bathing, vital signs, feeding, transferring, ambulating height and weight, Intake and Output, housekeeping, stocking supplies -scope of practice is limited