Delegation

what are the five rights of delegation?

A. Right task

B. Right circumstance

C. Right person

D. Right direction or communication

E. Right supervision

What dictates the SOP in the state that you are in?

the board of nursing

What is the difference between delegation and assignments?

Assignment transfers rights and benefits from one party to another while delegation transfers duties and responsibilities.

Assignment refers to the distribution of tasks to nurses and other nursing care providers. On the other hand, a delegation would be a passing over of an intervention or task to another team member whose scope of practice does not cover the said task.

delegation

transferring responsibility to a person for a specific task

YOU ARE RESPONSIBLE

Assignment

a piece of work or job that you are given to do

YOU GAVE UP THAT RESPONSIBILITY

example: you gave ur pt to another nurse while you went to lunch

Who is liable when you delegate?

if you went through the five rights, then it depends on the task! If you delegated it to the right person with the right responsibilities then they are responsible.

A nurse retains _________ for delegation

accountability

you should always delegate to who?

Delegate to the lowest possible person that you can given the task

How should a nurse supervise a UAP during delegation?

They should guide the UAP on what they need done, then evaluate the work, and follow up with the UAP on the job done

What is the CA Nurse Practice Act

A nurse practice act (NPA) is a series of state statutes that define the scope of practice, standards for education programs, licensure requirements, and grounds for disciplinary actions. The law provides a framework for establishing nursing actions in the care of clients.

CA code of regulations Title 22 Section 70215 (A) (2)

registered nurse shall directly provide:

The planning, supervision, implementation and evaluation of the nursing care provided to each patient. The Implementation of nursing care may be delegated by the RN responsible for the patient to other licensed staff, or may by assigned to unlicensed staff subject to any limitation of the licensure

The nurse practice act is determined by

each state

(it can also change by employer)

The nurse practice act is defined as

the aspects of care that can be delegated and which must be performed by the RN

A nurse should provide _____________ after a job is complete

feedback

Even though a task is delegated, a nurse maintains

accountability

The RN is accountable for

making the decision to delegate

assessing the pts needs

planning the desired outcome

giving clear instructions

following up

PACET method

P-planning

A-assessment

C-collaboration

E-evaluation

T-teaching

Only an RN can do a ________ not LVNs or CNAs

Referrals

What should a nurse NOT delegate

Activities that include the core of the nursing process. Any activity that will involve nursing judgement or critical decision making Functions of assessment, evaluation, and nursing judgement to an LVN/CNA/UAP

Examples:

Admitting a patient from the OR to the unit

Establishing a plan of care

Nursing interventions that require professional knowledge, judgement and skill

Handling of invasive lines

Patient teaching

Give telephone advice

What is an LVN?

An entry level health care provider who is responsible for rendering basic nursing care. A vocational nurse practices under the direction of a physician or registered nurse

The licensee is not an independent practitioner

What can an LVN do?

Uses and practices basic assessment (data collection), participates in planning, executes interventions in accordance with the care plan or treatment plan, and contributes to evaluation of individualized interventions related to the care plan or treatment plan.

(b) Provides direct patient/client care by which the licensee:

(1) Performs basic nursing services as defined in subdivision (a);

(2) Administers medications;

(3) Applies communication skills for the purpose of patient/client care and education; and

(4) Contributes to the development and implementation of a teaching plan related to self-care for the patient/client

what can an LVN do (in simpler terms)

maintain and document flow of IV

implement care plan

reinforce teaching

can change post op

can feed stroke patients

ambulate post op

Rns should delegate pts with ____________ to LVNs

predictable outcomes

predictable outcomes for patients include

vital signs

clean caths

simple dressing changes

chronic trach suctioning using clean techniques

Oral/IM/SUBQ meds

IV starts and fluids

The RN may delegate ________ to LVNs

feeding

drinking

positioning

ambulating

grooming

toileting

dressing

socializing

housekeeping

transporting

record keeping

maintaining supploes

What should a nurse ask before delegating?

Do you feel comfortable with this assignment?

Have you ever done this procedure/task before?

Have you had training in __?

What will you do if ____?

what is the number one most important thing when delegating?

ENSURE PT SAFETY

whats an assignment

The downward or lateral transfer of both the responsibility and accountability of an activity from one individual to another"

When you have a charge nurse, they assign two different people (Nurses), they are no longer responsible for the patients (unless the staff member is not trained in that position yet)

The nurse is making the assignment for the floor. There is one LVN and three RN's. Which client should the RN assign to the LVN?

A client awaiting a nursing home bed and a client who is one day post hernia repair.

A gunshot victim was treated in the ED and died. What should the nurse direct the UA{ to do during the postmortem care? Select all that apply?

Cover the body with a sheet

Transport the body to the morgue

The RN is delegating activities to the nursing staff. Which is the least appropriate task for nursing assistance?

Assist a profoundly developmentally disabled 12-year-old to eat

The Rn working at a rehabilitation center is making assignments. Which of the following clients would the RN delegate to the Nursing Assistant?

A client on a strict bed rest who need 24-hour urine collection

The RN is supervising a newly CNA. an adult patient just arrived from surgery. Which of the following is the most appropriate task for the nurse to delegate to the CNA and under what time of supervision?

Testing urine with a reactant strip, record the findings and report the results to the RN

Management skills needed for effective client care include

Effective communication

Be honest, be clear with patients

Management of time in the clinical setting

Knowing time management

Management of other members of the healthcare team

Effective delegation

What are the types of decisions that can be made?

Time management decisions

-cluster care

Scheduling decisions

-bathing times

-med administration

Priority decisions

-ABCs

-which pt will u see first

what are the priority rankings for patient needs

First order: priority pt needs:

-An immediate threat to pt's survival or safety

Second-order priority client needs:

-Actual problems for which the pt or family has requested immediate help

Third-order priority client needs:

-Actual or potential problems that are unrecognized by the pt or family

Fourth-order priority client needs:

-Anticipated actual or potential problems for which the client or family will need help in the future

priority settings may be guided by

principles, models, and/or theories, such as Maslow's Hierarchy of Needs, ABC's.

what are the pitfalls of prioritizations

incomplete assessments

relying on anothers assessment

failing to do periodic reassessments

poor time management

what are the three components that aid the nurse in decision making

knowledge

skills

past experience

what are the methods of problem solving

the nursing process

trail and error

intuition

intuition

scientific method

what is SBAR

Situation:

Pt name, location, be specific, vitals, change in status.

Background:

State the history of the problem we are calling about.

Assessment:

Problem that is due to the assessment, what is stable versus what is unstable

Recommendation:

I need you to...

I think we should ...

I was wondering if ...

If we change treatment order, then ask specifically

what are some ways to enhance client care time management

Start organizing your nursing care at report

Plan your day around whom you perceive to be your sockets pt (physically check immediately after report for safety)

Proceed to the neck sickest pt

Prioritize/organize the day with specific time frames (provide time for unexpected tasks

Delegate tasks when appropriate

Plan for charting: not all to be done at the end of the shift

Observe nurses that always seem to get everything done, well done, and enjoy nursing - learn and take lessons from them