Today’s Decision-Making and Delegation

By Nancy Jenkins, RN, MSN/Carolyn Morse Jacobs Rn, MSN, ONC

RNLVN UAP

Introduction to delegation (song)

Pushin' the Papers

Decision-Making and Delegation

•Key to delegation is ability to make correct decisions and think critically!

•What is decision-making in nursing?

•What are some examples of nursing decisions?

•What are the ethical principles involved? (p.180-182)

Decision-Making and Delegation

•Key to delegation is ability to make correct decisions and think critically!

•What is decision-making in nursing?

•It’s a systematic cognitive process in which you:

•identify alternatives, evaluate those alternatives, come to a conclusion, and select an action

•As RN you must exercise judgments make decisions based upon education and experience

•Critical thinking and decision-making: systematic way to form and shape one’s thinking

•*Critical Thinking Def.- the ability to focus your thinking so that you get the results you need.

What is critical thinking anyway??

NOT!!!

Critical Thinking and Decision Making

• Characteristics that support critical thinking– Nurse’s own philosophy, beliefs, and

knowledge about nursing, human beings, and health care

– Ability of the nurse to communicate and reason

– Maintaining a current knowledge base

Characteristics of Critical Thinkers

• Open minded

• Systematic

• Analytical

• Inquisitive

• Judicious

• Truthseeking

• Confident in reasoning

Why is it so important?

• Critical thinking skills are needed to

– Decrease patient mortality and morbidity rates

– Decrease failure to rescue rate

Nurses are the surveillance system

• Nurses use critical thinking skills for

– Early detection of problems– Interventions to prevent adverse occurrences– Interventions to decrease mortality and

morbidity and failure to rescue rates– Improving patient outcome rates

Perspectives for Critical Thinking

• Reflective thinking

– Thinking ahead

– Thinking in action

– Thinking back

• Parallel thinking

– Using critical thinking from multiple perspectives

– Six thinking hats

Question

• What is a critical thinking disposition?

A. Authoritarian

B. Systematic

C. Laissez-faire

D. Ambitious

Answer

B. Systematic

Rationale: critical thinking dispositions include systematic.

Problem Solving and Decision Making

• Data gathering

– Use others as resources

– Use standardized assessment tools

– Use institutional policies, procedures, and protocols

– Moving forward with limited data

• Analysis

Problem Solving and Decision Making (cont’d)

Establishing goals, outcomes, and strategies

– Recognizing the discrepancy

– Establishing a goal or outcome

– Strategies for action

Implementing the chosen action

– Manager is accountable

Problem Solving and Decision Making (cont’d)

Evaluating outcomes and your problem-solving process

– Final step in the problem-solving process

– Compare the actual outcomes to the goals or outcome criteria

– What do we do if we find that the outcomes are not what we wanted or anticipated?

Steps in the Decision-Making Process

• Resources– Textbooks, professional journals– Policy and procedure manual and protocols

(risk management)• Pre-arrest protocols• Heparin protocols• Algorithms

– Experienced colleagues-”novice to expert”– Clinical Pathways or critical paths

Group Decision Making Questions

• Does the group have sufficient knowledge?

• Is there enough time?

• Is the group mature enough?– Conflict– Individual differences

• Will management support the group?

Methods of Group Decision Making

• Consensus– Def-general agreement that members will

support a strategy even if not their chosen one

– Involves compromise and revisions of original– Disadvantage- time and need to be present

for all discussion– ** Good for professionals with same goals and

work well together

Methods of Group Decision Making

• Majority Rule– Def-vote is taken and the most votes will-

elections– Advantage- quick– Disadvantage- may have large number refuse

to follow the plan

Approaches used for Participative Decision Making

• Brainstorming- time and is expensive, ex: retreat• Task force- group formed to discuss a certain problem.

Ex- HESI• Quality circles- people working in same area with

common concerns meet on a regular basis- level or faculty meetings

• Nominal group technique- manager selects 7-10 members and presents a problem. Each ind. writes a solution and then all solutions are discussed and ranked

• Delphi- person selects members and polls them for alternatives. Membership is anonymous so can’t influence decisions

Evaluating Your Critical Thinking

• Clarity – Have I clearly stated problem? Is data clear?

• Accuracy – Are my facts accurate? Reliable? Source? Is there bias?

• Precision – Am I generalizing? Am I being precise enough?

• Relevance – What data is relevant? Do I need more data?

Evaluating Critical Thinking

• Depth – Have I explored the issue in the appropriate depth? Is my data or analysis too superficial

• Breadth – Do I have the breadth of info needed? Is there a related topic that might shed light on issue?

• Logic – Are my conclusions based on facts that I have? Could someone else follow my reasoning from data to conclusion?– Page 168

Question

• Is the following statement true or false?

One of the advantages to participative decision making in the task force model is that the people with dominant personalities can influence others in the group.

Answer

False.

Rationale: a disadvantage of a task force is that members with dominant personalities may influence the group.

Critical Thinking Exercise, p 179

• As new assistant charge nurse, you have responsibility for scheduling employees assigned to your unit. This has in past been done by one individual without consultation from others. You would like to try a group decision making process. – What factors need to be considered in moving

to this process?– What will be the benefits? Drawbacks?– If you decide to go ahead with the plan how

will you structure it?

Ethical Decision Making

• Beneficence: do or bring about good (similar to nonmaleficence – do no harm)

• Autonomy: each individual makes personal decisions

• Justice: obligation to be fair to all people, non-discrimatory. Pt. should be informed of wrongs.

• Fidelity: carry out the agreement and responsibilities one has undertaken: faithful to the clients- opposite of patient abandonment

• Veracity: to tell the truth…

Identifying and supporting ethical decision-making by patient and families

Supporting Ethical Decision Making

• Knowing- using assessment skills and knowledge base as well as self-assessment

• Facilitating- acquiring pertinent information and facilitating communication

• Guiding- have you thought about? It sounds to me…

Decision-making to Delegation

• Delegation: When you authorize a competent person to act for or in your stead while still retaining accountability and using a UAP

• What is a UAP?

• The Registered Nurse is empowered to make that decision

Problems with delegating and UAPS

• There are 65 job titles for UAP

• There is no universal training

• There is no universal hiring

• Lack of consistent job descriptions between different settings in same facility

National Council of State Boards of Nursing

• 1987 - NCSBN became concerned about ability of nurse’s to delegate

• 1990-1995 – conceptual papers written. Defined delegation:

Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for this delegation.

Delegation

• You must delegate if you want to deliver quality care to all of your patients in a timely manner!!

Delegation: What is it?• It is giving someone authority and

responsibility to do something that is normally part of someone else’s job.

• It is not “dumping problems on someone else.

• It is not abandonment. The “manager” retains accountability and needs to supervise .

• It is giving the employee appropriate authority to act alone.

Why the need to delegate?

• Shortage of RN’s

• Cost containment

• Sicker patients

• Shorter length of stay

• Increased number of UAP’s

• Time management

• Encourages team building

Why RN’s don’t delegate

• Fear• Lack of knowledge• Lack of communication skills• Loss of control• They can do it better• Lack of confidence in their staff• Unclear job descriptions• Might lose license• Don’t have time

Assignment versus Delegation

• Assignment – dividing workload to be done: describes entire set of tasks and responsibilities given to an individual Also refers to workload given to licensed staff

• Delegation – giving authority to unlicensed person for specific task in a specific situation

5 Rights of Delegation (NCSBN)

Right Task

Right Circumstances

Right Direction/Communication

Right Person

Right Supervision/ Evaluation

5 Rights of Delegation (NCSBN)1. Right task – Nurse Practice Act, Job Descriptions,

Is assessment involved? Should be routine in nature

2. Right circumstances – What are the circumstances of patient at this time?

• Has assessment been done?– Is patient stable, or unstable?– What is potential for harm?– Does task require problem solving/decision-making?– Level of technology?– Is teaching required?– Exactly what is needed at this time?

5 Rights of Delegation (NCSBN)3. Right Person –

– Who is competent to perform task? – Job description? Training? Scope of practice?– Ind. Strengths and weaknesses

4. Right Directions/Communication– Clear, Concise, Complete– Who, what, when, where, why, how? – Include parameters and timeframes– Help them prioritize

5. Right Supervision/Evaluation– Supervision is the active process of directing, guiding and

influencing the outcome– Initial direction– Periodic inspection– Follow-up/feedback and appropriate action– Evaluation of patient outcomes and the person

Evaluation and Feedback• Evaluation – What do I see?

– Was task completed correctly, on time?– Was info reported correctly?– Documented?– What was patient response?

• Feedback – What do I do about it?– Start with positive first– Give constructive feedback- increases motivation– Ask for delegatee’s input– Be specific with feedback– Make a plan, with time frame for checking progress

Delegation

There is no blanket delegation of tasks

Stay Focused

• Delegation will never occur in isolation– There will be:

• Internal Forces• External Forces

– Most “Peer Review” incidents occurred as a result of distractions.

• Rushed• Poor systems or infrastructures• Taking short cuts with policies and procedures

To delegate or not. That is the Question.

• Patient’s condition , including complications and stability.

• Complexity of the assessment• Intricacy of the task• Capabilities of the UAP• Amount of technology required• Infection control and safety precautions• Potential for harm• Level of supervision required• Predictability of outcome• Extent of patient interaction• Environment

Question

• The charge nurse on a step-down unit has just delegated some responsibilities to the LPN on her shift. The charge nurse knows that by delegating these responsibilities appropriately she has done what?

A. Provided an essential foundation for patient

safety

B. Decreased her work load so she could get

paper work done

C. Made sure the LPN stays busy the entire shift

D. Showed good management principles to the

new unit manager

Answer

A. Provided an essential foundation for patient safety

Rationale: delegating appropriately provides an essential foundation for patient safety.

Common Errors in Delegation

• Overloading yourself

• Adapting to old patterns of behavior

• Unclear communications

• Failing to release control

• Yielding to pressure to delegate inappropriately

Nursing Practice Act

RULES AND REGULATIONS related to PROFESSIONAL

NURSE EDUCATION, LICENSURE AND PRACTICE

Delegation Resource

Rule 224

Rule 224

BNE Delegation Rules

• Rule 224 – Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personal for Clients with Acute Conditions or in Acute Care Environments

• Rule 225 – RN Delegation to Unlicensed Personnel and Tasks not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions

The Power to Delegate?

• BNE of Texas

• RN’s cannot “give-away” accountability or quality of care

– MD’s from the BME • MD employs MA; Can RN

supervise the MA in office situation?

• No. 224.10 “depends if RN has ‘supervisory responsibility over the MA…and verify training of the UAP, can verify task and can supervise the UAP…”

– LVNs may not delegate – RN’s do not delegate to

LVNs– RN’s make assignments to

LVN’s

224.6 General Criteria for Delegation

– (1) RN must make an assessment of the clients nursing care needs….prior to….delegating!

– (2) nursing task must be one that a reasonable and prudent RN would find is within the scope of sound nursing judgment 5 rights!

– (3) can be properly and safely performed by the UAP…not jeopardizing client’s welfare

– (4) requires no professional judgment !!!– (5) adequate identification by individual training,

education and/certification, experience/ permit etc.

224.6 General Criteria for Delegation

– (6) RN shall either instruct the UAP in the delegated task or verify UAP’s competency

– (7) RN must adequately supervise – (8) if the delegation continues over time, the RN

must periodically evaluate the delegation of tasks

224.7 Supervision– (2) RN or equally qualified RN shall be available in person or by

telecommunications…and make decisions about levels of supervision using the following examples as guidelines…

• (A) RN’s…presence required to provide nursing services, include assessment, planning, intervention and evaluation of client whose health status is changing and/or to evaluate the client’s health status….the RN must be readily available to supervise the UAP in the performance of delegated tasks…settings include…..acute care…long term care….

• (B)…situations where nursing care provided in the client’s residence… the client’s status…unstable and unpredictable and RN required to assess, plan intervene, and evaluate the client’s unstable and unpredictable status and need for skilled nursing service, the RN makes supervisory visits at least every 14 calendar days. group homes, foster homes

Supervision

What is the best action for the nurse to take in the following situation? Sue, RN, has provided careful instructions to Ted a UAP that she has worked with on many occasions and has had instructions on the task assigned. He is to feed a patient with some history of swallowing difficulties.

a. Allow Ted to do his assigned task

b. Work side by side with Ted

c. Do not assign task to Ted as the patient is unstable

d. Check with Ted throughout the day

Supervision

What is the best action for the nurse to take in the following situation? Sue, RN, has provided careful instructions to Ted a UAP that she has worked with on many occasions and has had instructions on the task assigned. He is to feed a patient with some history of swallowing difficulties.

No a. Allow Ted to do his assigned task 224.7 states that an RN’s presence and supervision is required

No b. Work side by side with Ted The task can be delegated; Ted has the experience and training; this is unnecessary.

No c. Do not assign task to Ted as the patient is unstable The task can be delegated; patient is not unstable at this time; Ted has experience and training in feeding

Yes d. Check with Ted throughout the day 224.7 requires that an RN’s presence and supervision is required; Ted has training and experience; your best answer.

224.8 Delegation of Tasks Green Light Tasks

• (a) Tasks) Most Commonly Delegated….– (1) non-invasive and non-sterile treatments – (2) the collecting, reporting, and

documentation of data (but not interpreting it) including…

• Vital signs, height, weight, I&O, Glucose monitoring; Environmental situations; Client or family comments ….relating to client’s care

– (3) ambulation, positioning, and turning– (4) transportation of patient in the facility

224.8 Delegation of TasksMore Green Light Tasks

• (a) Tasks) Which are Most Commonly Delegated….– (5) personal hygiene and elimination,

including vaginal irrigations, sitz baths and cleansing enemas

– (6) feeding- cutting up of food or placing of meal trays

– (7) socialization activities– (8) ADLs– (9) reinforcement of health teaching

planned and/or provided by the RN

224.8 Delegation of Tasks

• (b) Discretionary Delegation Tasks…Yellow Light Tasks– (2) nursing tasks not usually within the scope of sound

professional to delegate…• (A) sterile procedure …a wound or an anatomical

site which potentially can become infected• (B) non-sterile procedure , such as dressing or

cleansing penetrating wounds and deep burns• (C) care of broken skin other than minor abrasions

or cuts generally classified as requiring only first aid treatment

224.8 Delegation of Tasks• (b) Discretionary Delegation Tasks…• (1) may be delegated to UAP if

• (A) RN delegating task is directly responsible for nursing care given to the client

• (B) Agency employing UAP follows current protocol for training of UAP with input by RN currently employed in the facility that includes…

– Complexity of the task– UAP demonstrates competency of the delegated task– Mechanism for re-evaluation of competency– Mechanism to identify the individuals to whom to delegate

task• (C) Protocol recognizes that what can be safely delegated in

ANY situation is within the specific scope of the RN’s professional judgment. Most critical !

224.8 Delegation of Tasks

– (c) Nursing Tasks Prohibited from Delegation

Red Light Tasks!!– (1) physical, psychological and social assessment

which require professional nursing judgment, intervention, referral, or follow-up

– (2) formulation of the NCP and evaluation of the client’s response to the care rendered

– (3) specific tasks involved in the implementation of the NCP which require professionals nursing judgment or intervention

224.8 Delegation of Tasks cont

• (cNursing Tasks Prohibited from Delegation…

Red Light Tasks– (4) the responsibility and accountability for client health

teaching and health counseling which promotes client education and involves the client’s significant others…

• Remember the UAP can only reinforce health teaching!

– (5) administration of medication, except by medication aides as permitted under 224.9

224.9 The Medication Aide Permit Holder

(a) RN may delegate to medication aides the administration of medication to clients in long term care facilities and home health agencies if:

– (1) medication aide holds valid permit– (2) RN assures that the medication aide functions

in compliance with laws and regulations of the agency issuing the permit

– (3) route of administration is oral, via permanently placed feeding tube, sublingual or topical including eye, ear or nose drops and vagina or rectal suppositories

224.9 The Medication Aide Permit Holder

• (b) The following tasks may NOT be delegated to medication aides (unless in compliance with Chapter 225 (Independent Living Environments….)– (1)calculation of any medication except for

measuring a prescribed amount of liquid amount of medication and breaking tablet that the RN has calculated

– (2)Administration of the initial dose of a medication – (3)Administration of medications by an injectable

route except as permitted for administration of insulin under 225.11 of this title..

224.9 The Medication Aide Permit Holder

(b) The following tasks may NOT be delegated to medication aides (unless in compliance with Chapter 225)– (4) administration of medication of medications

used for intermittent positive pressure breathing …(225.10)

– (5) medications by way of a tube inserted in a cavity of the body except as stated in 225.11

– (6) responsibility for receiving verbal or telephone orders from a physician, dentist…

– (7) responsibility for ordering a client’s medication from the pharmacy

–

Answer These Questions about the Medication Aide Permit Holder in a Long Term Care Facility

1. The Medication Aide can do all the following except:

– A. administer eye drops – B. administer an enema– C. administer insulin– D. administer first dose

of new medication

2. The home care patient that the UAP is caring for has run out of her medication and needs to have her medications re-ordered. What action is appropriate?

• A. Contact the RN to order the medication

• B. Have the UAP re-order the medications

• C. Have the patient re-order the medications

Answer These Questions about the Medication Aide Permit Holder in a Long Term Care Facility

1. The Medication Aide can do all the following except:

– A. administer eye drops – B. administer an enema– C. administer insulin– D. administer first dose

of new medication (224.9)

2. The home care patient that the UAP is caring for has run out of her medication and needs to have her medications re-ordered. What action is appropriate?

• A. Contact the RN to order the medication (224.9)

• B. Have the UAP re-order the medications

• C. Have the patient re-order the medications

Test your Understanding of DelegationGeneral Criteria

• As a new RN you have this patient assignment with a UAP. It is 8 am. Determine, based upon the Nurse Practice Act, which assignment should be given to the UAP and why.

– a. Mr. C a 20 year post op ORIF– b. Mr. Z. an 80 year old demanding that he wants

breakfast! – c. Ms. F a 40 yr old male stating that she has “heart

burn” and wants breakfast to relieve the discomfort.– d. Mr. A a 70 yr old confused, incontinent male– e. Ms. G. a first day post-op hernia repair who needs

to ambulate.– f. Ms. R. who has discharge orders and demands to

go home

Test your Understanding of DelegationGeneral Criteria

As a new RN you have this patient assignment with a UAP. It is 8 am. Determine, based upon the Nurse Practice Act, which assignment should be given to the UAP and why.

a. Mr. C a 20 year post op ORIF No; requires RN assessmentOk b. Mr. Z. an 80 year old demanding that he wants breakfast! c. Ms. F a 40 yr old male stating that she has “heart burn” and wants

breakfast to relieve the discomfort. No; needs RN assessment, “heartburn may indicate more serious problem, needs assessment

Ok d. Mr. A a 70 yr old confused, incontinent male An Ok, but , so long as only personal needs only to be met, get patient clean and dry , no assessment expected.

e. Ms. G. a first day post op hernia repair who needs to ambulate. No, still requires assessment, is first day post-op

f. Ms. R. who has discharge orders and demands to go home No, requires teaching; UAP can only reinforce teaching

• 224.2 Exclusions from Chapter

• (A) Supervise or instruct others in the gratuitous nursing care of the sick

• (B) Qualified nursing faculty or preceptors directly supervising or instructing nursing students…

• (C) Instruct/Supervise an UAP in the performance of nursing tasks as a part of an educational…

• (D) Assign tasks to or to supervise LVNs or other licensed practitioners practicing within the scope of their licenses

Determine in the following situations which are exclusions to the Nurse Practice Act according to 224.2.

1. As an RN you assign the LVN on your team to provide care for a group of 6 patients

2. As an RN you work with a nursing student in an externship and supervise the student while he/she gives IV push medications

3. As an RN you assign the CA to check intake and outputs for patients in room 1-10

4. As an RN you provide complicated wound care for a neighbor; you refuse compensation

Determine in the following situations if and how 224.2 of the Nurse Practice Act applies.

1. As an RN you assign the LVN on your team to provide care for a group of 6 patients No….does not apply, do not delegate to LVN; have own practice act; only make assignments to them

2. As an RN you work with a nursing student in an externship and supervise the student while he/she gives IV push medications Yes,does apply, exclusion in 224.2

3. As an RN you assign the CA to check intake and outputs for patients in room 1-10 No, No, this is delegation according to 224 should be in an acute care setting environment where nursing services are continuously available; can delegate to UAP

4. As an RN you provide complicated wound care for a neighbor; you refuse compensation Yes, exclusion in 224.2

Test your Understanding

• In an emergency situation, Mary the RN requests Ed, the UAP, to assist in inserting a Foley catheter into an uncooperative patient. Ed had previous training in the skill; Mary directly supervises the procedure.

– Is this delegation?

• As a RN you have an eager nursing student working as a CA on your team. A NG tube needs to be inserted. The CA (AKA…nursing student) wants the opportunity to perform the skill. What is your best response?

– A. Sure, go ahead.– B. Have you ever done it

before?– C. In your role as CA you

cannot insert an NG tube

Test your Understanding

• In an emergency situation, Mary the RN requests Ed, the UAP, to assist in inserting a Foley catheter into an uncooperative patient. Ed had previous training in the skill; Mary directly supervises the procedure.

– Is this delegation?

– No this is not delegation: Mary is directly assisting Ed in the procedure. See 224.2

• As a RN you have an eager nursing student working as a CA on your team. A NG tube needs to be inserted. The CA (AKA…nursing student) wants the opportunity to perform the skill. What is your best response?

– A. Sure, go ahead.– B. Have you ever done it

before?– C. In your role as CA you

cannot insert an NG tube – C. In your role as CA you

cannot insert an NG tube (Your best answer…as a CA your job description would not include this role, though you had training in nursing program…might be permitted to do this IF directly assisting the RN in performing the procedure. 224.2)

The responsibility of the total nursing care of the patient rests on the RN’s shoulders

You might ask- What is my liability and how does delegation

affect my license?

RN’s are not automatically held liable for all acts of negligence on the part of those they

supervise, but they can be if they were negligent in their supervision

UAP’s carry some accountability of their own and always have

http://www.lopez1.com/lopez/clinical.cases/092699.htm

224.5 RN Accountability for Delegated Tasks

• (a) The RN’s accountability to the BNE with respect to its taking disciplinary action against the RN’s license is met when delegating RN has complied with and can verify compliance with this chapter specifically 224.6 and 224.8

• (b) does not change or apply to a RN’s civil liability.

• The RN’s best protection is to adhere the nurse practice act!

224.10 Supervising UAP Performing Task Delegated by Other Practitioners

(a) Applies to …professional nurse who practices…with a licensed practitioner who has delegated tasks to an UAP over whom the RN has supervisory responsibilities. The RN’s accountability to the BNE, with respect to its taking disciplinary action against the RN’S license is met if the

RN:– Verifies the training of the UAP– Verifies that the UAP can properly perform the task and not

jeopardize the clients welfare…– Adequately supervises the UAP

• (b) If the above not met…must communicate this fact to the licensee who delegated the task

Answer a couple of challenging questions!

1. A nurse delegates a glucose fingerstick to UAP who records a result of 40, but fails to notify the RN of the finding. Legal accountability for the delayed intervention would be with the

• a. RN

• b. unit manager

• c. UAP

• d. hospital

2. Which statement to a UAP is MOST likely to accomplish the desired result of getting a blood gas to the lab immediately?

• a. “This is stat!”

• b. “Take this specimen to the lab immediately. We need the results now.”

• c. “Please do this as soon as possible!”

• d. “I need this in lab now as the patient’s p02 is 84.”

Answer some challenging questions!

3. A patient reports that he feels “faint”. The RN is very busy and asks the UAP to check on the patient and obtain vital signs. What, if anything was incorrect, with the nurse’s action.”

(Good example in book p. 192)

Discuss situations in which the RN might incorrectly delegate.

You are the charge nurse on a pediatric unit. You have 16 patients. Staffing is yourself, one UAP and one LVN who routinely work on this unit, and an ER nurse who has been pulled to your unit for the shift. This is the first time he has worked on your unit. What criteria would you use to make assignments?

Tips for Effective Delegation

• Start with a positive attitude.

• Clarify availability- especially if UAP with many RN’s

• Give clear directions in a respectful manner. Include reportable parameters.

• Be fair about undesirable activities.

• Indicate priorities

• Give and receive feedback

Where do the LVN’s fit into this?Most, but not all, limit LPN scope of practice to:

–collects, validates, organizes, and reports data,

–contributes to assessment (not initial assessment),

–selects standardized plan of care based on nursing diagnoses,

–contributes to identification of priorities/goals/nursing activities,

–implements teaching plans, &

–evaluates client responses & revises plan of care.

–See link to compare LVN-RN Scope of Practice (print)

Activities Outside LVN Scope of Practice

•Administering infusions of blood/blood products;

•Administering infusions of total parenteral nutrition;

•Administering infusions of chemotherapeutic or antineoplastic agents;

•Administration of IV therapy to neonates.

•Administration of IV push medications.

•Mixing IV medications.

•Initiation of TPN in peripheral lines.

•Ongoing administration of TPN in central lines.

3 Nurses and a Wish

A nursing assistant, floor nurse, and charge nurse from a small nursing home were taking a lunch break in the break room. In walks a lady dressed in silk scarfs and wearing large polished stoned jewlery.

"I am 'Gina the Great'," stated the lady. "I am so pleased with the way you have taken care of my aunt that I will now grant the next three wishes!" With a wave of her hand and a puff of smoke, the room was filled with flowers, fruit and bottles of drink, proving that she did have the power to grant wishes before any of the nurses could think otherwise.

The nurses quickly argued among themselves as to which one would ask for the first wish. Speaking up, the nursing assistant wished first. "I wish I were on a tropical island beach, with single, well-built men feeding me fruit and tending to my every need." With a puff of smoke, the nursing assistant was gone.The floor nurse went next."I wish I were rich and retired and spending my days in my own warm cabin at a ski resort with well groomed men feeding me cocoa and doughnuts." With a puff of smoke, she too was gone.

"Now, what is the last wish?" asked the lady.

The charge nurse said," I want those two back on the floor at the end of the lunch break."

Questions

You are caring for a patient with esophageal cancer. Which task could be delegated to the nursing assistant?

1. Assist the patient with oral hygiene

2. Observe the patient’s response to feedings

3. Facilitate expressions of grief

4. Initiate daily weights

Questions

You are caring for a patient with esophageal cancer. Which task could be delegated to the nursing assistant?

1. Assist the patient with oral hygiene

2. Observe the patient’s response to feedings

3. Facilitate expressions of grief

4. Initiate daily weights

1 is correct. Oral hygiene is a green light task

Questions

• In caring for a patient with neutropenia, what tasks can be delegated to the nursing assistant?( Choose all that apply)

• 1. Take vital signs every 4 hours.• 2. Report temperature elevation >100.4 F• 3. Assess for sore throat, cough or burning with

urination.• 4. Gather the supplies to prepare the room for

protective isolation.• 5. Report superinfections, such as candidiasis.• 6. Practice good handwashing technique.

Questions

• In caring for a patient with neutropenia, what tasks can be delegated to the nursing assistant?( Choose all that apply)

• >1. Take vital signs every 4 hours.• >2. Report temperature elevation >100.4F• 3. Assess for sore throat, cough or burning with

urination.• >4. Gather the supplies to prepare the room for

protective isolation.• 5. Report superinfections, such as candidiasis.• >6. Practice good handwashing technique.

Question

• The charge nurse assigned the care of a client with acute renal failure and hypernatremia to you a newly graduated RN. Which actions can you delegate to the nursing assistant?

• 1. Provide oral care every 3-4 hours.• 2. Monitor for indications of dehydration.• 3. Administer.45NS by IV.• 4. Assess daily weights for trends.

Question

• The charge nurse assigned the care of a client with acute renal failure and hypernatremia to you a newly graduated RN. Which actions can you delegate to the nursing assistant?

• >1. Provide oral care every 3-4 hours.• 2. Monitor for indications of dehydration.• 3. Administer.45NS by IV.• 4. Assess daily weights for trends.

Oral care is a green light task

Question

• Which actions should you delegate to the nursing assistant for the client with diabetic ketoacidosis?

• 1.Check fingerstick glucose every hour.

• 2. Record intake and output every hour

• 3. Check vital signs every 15 miinutes

• 4. Assess for indicators of fluid imbalance

Question

• Which actions should you delegate to the nursing assistant for the client with diabetic ketoacidosis?

• 1.Check fingerstick glucose every hour.

• >2. Record intake and output every hour

• >3. Check vital signs every 15 miinutes

• 4. Assess for indicators of fluid imbalance

Taking accuchecks require additional training and is not automatically delegated without asking questions

7 / 4 / 2 0 0 6 2 8

K e y P o i n t s

• R N A s s e s s m e n t• R e a s o n a b l e a n d P r u d e n t R N• A s k c a n t h e t a s k b e d e l e g a t e d• N o N u r s i n g J u d g m e n t• I d e n t i f y U A P• V e r i f y C o m p e t e n c y• S u p e r v i s i o n• R N A c c o u n t a b l e• C l e a r C o m m u n i c a t i o n• C a r e f u l F o l l o w - u p / e v a l u a t i o n• R i g h t C i r c u m s t a n c e

Delegation!

The End!

Review your Nurse Practice Act; and Apply the 5 rights of Delegation (task, circumstance, person, direction/communication, supervision/evaluation)