Coordinating and Delegating Care
Communication Template
State exactly what is being delegated and what the expected outcome is Convey recognition of the authority to perform what is expected Acknowledge monitoring activities you may perform Specify deadlines, including exact timing if that is important Specify report time lines and data expected Specify parameter deviations, including when immediate action must be taken Identify appropriate resources, including people who may be consulted Be clear about what may not be delegated
Critical Communication
1. State the facts (ex. this care is substandard), if that does not correct the situation 2. Challenge (use his/her first name and qualifier) and if that doesn't correct situation, 3. Take action (intervene)
Licensed Practical Nurse (LPN)
12-18 months edu Hold a license to practice A dependent role with limited scope No IV's unless complete LPN-C
Registered Nurse (RN)
2-4 years of education Hold a license to practice Independent and dependent functions
A nurse in the med-surg unit is assigning client care to a nurse who is floating from the PACU. The nurse should recognize that the float nurse is most qualified to care for which of the following clients? A. A client who is post-op following a lobectomy and has a chest tube B. A client who is being discharged to a long-term care facility C. A client who needs teaching about insulin self-administration D. A client who needs teaching prior to initiating cardiac rehabilitation activities
A
A nurse on the postpartum unit is caring for a group of clients with an AP. Which of the following tasks should the nurse plan to delegate to the AP? A. Provide a sitz bath to a client who has 4th-degree laceration and is 2 days postpartum B. Observe an area of redness on the breast of a client who is 1 day postpartum C. Monitor VS during admission of a client who has gestational hypertension D. Change the perineal pad of a client who just transferred from labor and delivery
A
An AP reports a client's VS as tympanic temperature of 98.8 F, pulse 92/min, respiratory 18/min, and BP 80/58 mmHg. Which of the following should the nurse re-measure? A. BP B. Respiratory C. Pulse D. Temp
A
What might change for the RN delegator?
Amount of direct care work may decrease But the supervisory work increases
What are key questions to consider when delegating?
Are there practice acts, laws, rules or regulations that restrict delegation? Are there policies (organizational) that support delegation? Does my delegate have the knowledge and skill for the intended delegation? Is the delegator authorized to delegate? Is the delegator familiar with the KSA's to delegate safely? Does the patients condition influence the decision making? Does the delegate know appropriate untoward signs and symptoms for the specific situation> Will you be able to supervise appropriately?
Assessment Selection of the RN Leader
Asking critical questions, evaluates if task is safe to delegate Legally does delegation support practice? Know states laws Is the task appropriate to delegate? Know UAP's background knowledge Clear communication
What are 4 things you can't delegate?
Assessment Planning Evaluation Nursing judgment
A nurse in a long-term care facility is planning care for several clients. Which of the following activities should the nurse delegate to the LPN? A. Admission assessment of a new client B. Scheduling a diagnostic study for a client C. Evaluating changes to a client's pressure ulcer D. Teaching a client insulin injection technique
B
When planning delegation of tasks to assistive personnel, an nurse considers the 5 rights of delegation. Which of the following should the nurse consider when using one of the five rights of delegation? A. The AP's ability to prioritize B. The AP has the knowledge and skill to perform the task C. The AP's rapport with clients D. The AP's ability to complete the task without assistance
B
A nurse is planning care for a group of clients. The nurse should delegate obtaining VS to an AP for which of the following clients? (select all that apply) A. A middle adult client who has status asthmaticus B. An older adult client who has a hx of HF and is ready for discharge C. A younger adult client who is 24 hrs post-op following an appendectomy D. An older adult client who is 36 hrs post-op from a traditional cholecystectomy E. A younger adult client receiving a continuous IV infusion of regular insulin for diabetic ketoacidosis
B, C, D
Delegation Communication
Be specific Who, What, When, Where, How Communication must be open Feedback is essential Seek clarity and advice Advocate for your patient
A nurse manager is providing an inservice program about delegation to assistive personnel with staff nurses on the unit. Which of the following statements by a staff nurse indicates an understanding of the teaching? A. The nurse relinquishes accountability for client outcomes when care is delegated to an AP B. The AP can provide client education about how to perform basic self-care to the client C. The nurse should consider the AP's level of experience when making delegation decisions D. The AP can re-delegate a task to another AP who has similar work experience
C
An RN is making nursing staff assignments for his team consisting of himself, two LPN's, and an assistive personnel. Which of the following clients should he assume responsibility for? A. The client who requires frequent ambulation B. The client who is in protective isolation C. The client who is actively dying are requires IV pain medication D. The client who is 3 days post-op and requires a dressing change
C
A charge nurse is making assignments for nursing personnel who will be caring for clients during the oncoming shift. Which of the following factors should the charge nurse consider? A. The most experienced nurse receives the more complex clients B. Personal comfort level in making the assignments C. Social relationship between nurses working on the oncoming shift D. The physiological status of the clients on the unit
D
A nurse checks with assistive personnel on the unit throughout the shift to determine if they are completing tasks. The nurse is demonstrating which of the following rights of delegation? A. Right circumstances B. Right communication C. Right person D. Right supervision
D
Summary of Delegation
Delegation is complex, but important Know what you know, and know what you don't know Assess the knowledge level of your support staff Know the 5 rights of delegation Communication! Follow-up, evaluate and be accountable
Planning
How should tasks be completed, does UAP understand Are there parameters I want to be notified from Was I clear on situations that warrant immediate RN notification Was I clear on timing? Documentation? Did I determine any patient specific factors
Accountability
Means that someone must be able to explain actions and results Legally- the RN is accountable for nursing care
Responsibility
Means the reliability, dependability and obligation to accomplish work at an acceptable level
Nursing Assistant or UAP
National curriculum- 75 hrs Take a registry exam (NOT a license) Basic tasks in support of nursing - bathing, feeding, I&O's, VS, ambulation - no legal scope of practice, but has knowledge of basic tasks
Can a scope of practice be expanded?
No, but it can be limited
What are the 5 rights of delegation?
Right task Right circumstance Right person Right direction/communication Right supervision
What are the 4 key client factors that must be considered in the delegation process?
Safety Critical thinking Stability Time
Medication Aid
Similar to Nurse aide Take a registry exam for basic medications, still need RN to pass certain medications
Implementation
Reinforce expected outcomes, patient requirements Provide resources Supervise UAP Provide feedback
When supervising the delegatee what is the RN responsible and accountable for?
Responsible for analyzing data gathered Accountable for initial assessment and for intermittent evaluations especially if there is a change in condition
What can you delegate?
Tasks Functions in support of nursing care if the 5 right are met
Authority
The ability to perform duties in a specific role Legal authority to provide nursing care granted through licensure
Assignment
The distribution of work that each staff member is responsible for during a given work period This is NOT the transfer of authority Routine care activities and procedures that are within the authorized scope of practice of the RN or LPN/VN or part of the routine function of the UAP
Supervision
The provision of oversight and includes maintaining accountability to determining whether or not nursing care is adequate. Includes assessments, evaluation, responses to nurse care plan and evaluation of competence of persons providing nursing care
Delegation
The transfer of the authority, responsibility to perform some type of task or work while retaining accountability for the outcome Care itself is not delegated Transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome
Why should we delegate?
To effectively expand you care giving ability to a large group of clients
Evaluation
Was task performed successfully Was it timely Were there challenges? Strengths? Use quality improvement if opportunity exists Acknowledge team for contributions
