Transcript PowerPoint File - NC-NET

Dr. Sheryl Cornelius, EdD, MSN, RN
DELEGATION OF NURSING CARE
OBJECTIVES:
Upon completion of this module the student will be
able to:
 Define delegation and concepts surrounding the
management of patient care
 Utilize Five Rights of Delegation to determine
appropriate delegation of patient care
 Correlate barriers to delegation with methods for
success
 Outline the delegation process and key behaviors
when delegating tasks.
Definition:
the act
of empowering to
act for another
WHAT IS DELEGATION?
POSITION STATEMENT

NC Board of Nursing Position Statement for
RN and LPN practice on Delegation and
Assignment of Nursing Activities

http://www.ncbon.org
ASSIGN TO OTHER LICENSED OR UNLICENSED ASSISTIVE PERSONNEL (UAP)

Their own license

Assessment of the client’s
status

Clinical competence of the
person the duty is being
assigned

Any variables that may
impact
(NCBON, 2010)

Before assigning/delegating nursing activities
to staff, the licensed nurse needs access to
information about the RN-validated
competencies for each individual.
(NCBON, 2010)

Authority –

Accountability –

Assigning-

Delegating –

Supervision -
DEFINITIONS FROM NCBON

Right Task

Right Circumstances

Right Person

Right direction/communication

Right Supervision/Evaluation
(National Council of State Boards of Nursing, Inc, 1997)
THE FIVE RIGHTS OF DELEGATION
RIGHT TASK

Appropriate delegation
activities are identified for
specific client(s).

Appropriate activities are
identified for specific UAP.
(National Council of State Boards of Nursing, Inc, 1997)
RIGHT CIRCUMSTANCES

Assess health status of individual client(s), analyze the
data and identify client specific goals and nursing care
needs.

Match the complexity of the activity with the UAP
competency and with the level of supervision available.

Provide for appropriate monitoring and guiding for the
combination of client, activity and personnel.
(National Council of State Boards of Nursing, Inc, 1997)
RIGHT PERSON

Instruct and/or assess, verify and
identify the UAP’s competency on
an individual and client specific
basis.

Implement own professional
development activities based on
assessed needs; assess UAP
performance; perform
evaluations of UAP based upon
standards; and take steps to
remedy failure to meet standards.
(National Council of State Boards of Nursing, Inc, 1997)
RIGHT DIRECTION/COMMUNICATION

Communicate delegation decision on a client specific
and UAP-specific basis. The detail and method (oral
and/or written) vary with the specific circumstances.

Situation specific communication includes:



specific data to be collected and method and timelines for
reporting,
specific activities to be performed and any client specific
instruction and limitation, and
the expected results or potential complications and time
lines for communicating such information.
(National Council of State Boards of Nursing, Inc, 1997)
RIGHT SUPERVISION/EVALUATION

Supervise or assign
supervision to other licensed
nurses

Provide directions and clear
expectations

Evaluate the entire delegation
process
BARRIERS TO DELEGATION
Lack of trust/confidence in delegatee
 Preference for working alone
 Lack of experience in the job or delegating
 Fear of loss of control
 Fear of being disliked
 Lack of organization
 Perfectionism

HOW TO…DELEGATE TO A UAP
NC Board of Nursing
Decision Tree for Delegation to UAP

www.ncbon.org

Assessment

Care of invasive lines

Interpretation of data

Administering medications

Making a nursing diagnosis

Client education

Creation of a care plan

Performing triage

Evaluation of care
effectiveness

Giving telephone advice
TASKS THAT MAY NOT BE DELEGATED TO A UAP
HOW TO… DELEGATE TO AN LPN

Follow up assessments

Reinforcement of
teaching

Procedures

Medication
administration

Continued
implementation of the
established care plan
IN CONCLUSION…

Delegator ultimately responsible

Communication is key

Follow up is essential
Question 1
The nurse has assigned the vital signs and daily
weights of her patients to the unlicensed assistive
personnel (UAP) on duty for that shift. It is still
important for the nurse assigned to the patient to
reassess each patient throughout the shift
because:
A) The nurse remains accountable for the patients'
care.
B) The UAP is not trustworthy.
C) The UAP cannot report to the next shift.
D) The nurse maintains the authority to care for the
patients.
(NC Concept-Based Learning Editorial Board, 2011)
Answer 1
The nurse has assigned the vital signs and daily
weights of her patients to the unlicensed assistive
personnel (UAP) on duty for that shift. It is still
important for the nurse assigned to the patient to
reassess each patient throughout the shift
because:
A) The nurse remains accountable for the patients'
care.
B) The UAP is not trustworthy.
C) The UAP cannot report to the next shift.
D) The nurse maintains the authority to care for the
patients.
Question 2
Toward the end of the shift, an LPN reports to the RN
that the recently hired UAP has not totaled client's
I&O for the past 12 hours. Which action should the
nurse take?
A) Confront the UAP about not completing the intake
and output measurements.
B) Delegate this task to the LPN since the UAP may
not have been educated on the task.
C) Ask the UAP if assistance is needed to complete
the I&Os.
D) Notify the nurse manager to include this on the
UAP's evaluation.
(NC Concept-Based Learning Editorial Board, 2011)
Answer 2
Toward the end of the shift, an LPN reports to the RN
that the recently hired UAP has not totaled client's
I&O for the past 12 hours. Which action should the
nurse take?
A) Confront the UAP about not completing the intake
and output measurements.
B) Delegate this task to the LPN since the UAP may
not have been educated on the task.
C) Ask the UAP if assistance is needed to complete
the I&Os.
D) Notify the nurse manager to include this on the
UAP's evaluation.
Question 3
For client education about non pharmacological
alternatives, which topic could you delegate to
an experienced LPN, who will function with your
continued support and supervision?
A) Therapeutic touch
B) Application of heat and cold
C) Meditation
D) Transcutaneous electrical nerve stimulation
(TENS)
(LaCharity, Kumagai, & Bartz, 2011)
Answer 3
For client education about non pharmacological
alternatives, which topic could you delegate to
an experienced LPN, who will function with your
continued support and supervision?
A) Therapeutic touch
B) Application of heat and cold
C) Meditation
D) Transcutaneous electrical nerve stimulation
(TENS)
Question 4
Which pediatric pain client should be assigned to a newly graduated
RN?
A) An adolescent who has sickle cell disease and was recently
weaned from morphine delivered via a patient-controlled
analgesia (PCA) device to a long acting oral analgesic; he has
been continually asking for an increased dose.
B) A child who is receiving palliative end of life care; the child is
receiving analgesics around the clock to relieve suffering , but
there is a progressive decrease in alertness and
responsiveness.
C) A child who needs premedication before reduction of a
fracture; the child has been crying and is resistant to any
touch to the arm or other procedures.
D) A child who has chronic pain and whose medication and
nonpharmacological regimen has recently been changed; the
mother is anxious to see if the new regimen is successful.
(LaCharity, Kumagai, & Bartz, 2011)
Answer 4
Which pediatric pain client should be assigned to a newly graduated
RN?
A) An adolescent who has sickle cell disease and was recently weaned
from morphine delivered via a patient-controlled analgesia (PCA)
device to a long acting oral analgesic; he has been continually
asking for an increased dose.
B) A child who is receiving palliative end of life care; the child is
receiving analgesics around the clock to relieve suffering , but there
is a progressive decrease in alertness and responsiveness.
C) A child who needs premedication before reduction of a fracture; the
child has been crying and is resistant to any touch to the arm or
other procedures.
D) A child who has chronic pain and whose medication and
nonpharmacological regimen has recently been changed; the
mother is anxious to see if the new regimen is successful
Question 5
In care of the client with pain and discomfort, which
task is most appropriate to delegate to the UAP?
A) Assisting the client with preparation for a sitz bath
B) Monitoring the client for signs of discomfort while
ambulating.
C) Coaching the client to deep breathe during painful
procedures
D) Evaluating relief after applying a cold compress
(LaCharity, Kumagai, & Bartz, 2011)
Answer 5
In care of the client with pain and discomfort, which
task is most appropriate to delegate to the UAP?
A) Assisting the client with preparation for a sitz bath
B) Monitoring the client for signs of discomfort while
ambulating.
C) Coaching the client to deep breathe during painful
procedures
D) Evaluating relief after applying a cold compress
Question 6
The nurse is caring for a client with esophageal
cancer. Which task could be delegated to a
UAP?
A) Assist the client with oral hygiene.
B) Observe the patient’s response to feedings.
C) Facilitate expression of grief or anxiety.
D) Initiate daily weights.
(LaCharity, Kumagai, & Bartz, 2011)
Answer 6
The nurse is caring for a client with esophageal
cancer. Which task could be delegated to a
UAP?
A) Assist the client with oral hygiene.
B) Observe the patient’s response to feedings.
C) Facilitate expression of grief or anxiety.
D) Initiate daily weights.
Question 7
When care assignments are being made for patients
with alterations related to gastrointestinal (GI)
cancer, which patient would be most appropriate
to assign to an LPN under the supervision of a
team leader RN?
A) A patient with severe anemia secondary to GI
bleeding
B) A patient who needs enemas and antibiotics to
control GI bacteria
C) A patient who needs pre op teaching for bowel
resection surgery
D) A patient who needs central line insertion for
chemotherapy
(LaCharity, Kumagai, & Bartz, 2011)
Answer 7
When care assignments are being made for patients with
alterations related to gastrointestinal (GI) cancer, which
patient would be most appropriate to assign to an LPN
under the supervision of a team leader RN?
A) A patient with severe anemia secondary to GI bleeding
B) A patient who needs enemas and antibiotics to control
GI bacteria
C) A patient who needs pre op teaching for bowel resection
surgery
D) A patient who needs central line insertion for
chemotherapy
Question 8
An 8 year old child has stomatitis secondary to
chemotherapy. Which task would be best to
delegate to a nursing assistant?
A) Report evidence of severe mucosal ulceration
B) Assist the child in swishing and spitting an
anesthetic mouthwash
C) Assess the child's ability and willingness to
drink through a straw
D) Help the client to eat a bland, moist, soft diet
(LaCharity, Kumagai, & Bartz, 2011)
Answer 8
An 8 year old child has stomatitis secondary to
chemotherapy. Which task would be best to
delegate to a nursing assistant?
A) Report evidence of severe mucosal ulceration
B) Assist the child in swishing and spitting an
anesthetic mouthwash
C) Assess the child's ability and willingness to
drink through a straw
D) Help the client to eat a bland, moist, soft diet
CASE STUDY
Concept: Managing Care
Exemplar: Delegation
Course: NUR 213
Delegation: A registered nurse (RN) has a group of
ten clients on a medical surgical unit in an acute
care setting. There is also assigned a licensed
practical nurse (LPN) and unlicensed assistive
personnel (UAP) to the same group.
The clients are as follows:
Room 101: A 48 year old female with breast cancer one day post bilateral mastectomy that has been
crying all night and is asking that no visitors be allowed. She refuses to get out of bed and refuses to
look at her bandages.
Room 102: A 92 year old male with dementia and pneumonia. He has a bed alarm and has a history of
falls. He has a large list of medications to be administered daily crushed and in applesauce.
Room 103: An obese 72 year old female with a diabetic foot ulcer. Blood sugars have been
250400 mg/dL since admission and her family continues to bring her food from fast food restaurants.
She is on a calorie and carbohydrate restricted diet which she eats in addition to the food her family
brings.
Room 104: A 36 year old male three days status post open spleenectomy following a motor vehicle
accident. He is anxious to get home and back to work for fear he will lose his job. He is being
discharged today. He is employed as a stone worker where he lifts heavy stones every day.
Room 105: A 54 year old female three days status post abdominal hysterectomy with subsequent
dehiscence of wound 12 hours post op. The wound is being packed with normal saline soaked
Nugauze three times a day.
Room 106: A 67 year old male with Clostridium Difficile and Vancomycin Resistant Enterococcus (VRE).
He has been complaining of abdominal cramps and diarrhea all night. The stools have subsided and
he has just gone to sleep.
Room 107: A newly admitted 55 year old female with anemia and possible gastrointestinal (GI) bleed that
has not been assessed. She does not have an IV access. She will be receiving 2 units packed red
blood cells (PRBC) ASAP.
Room 108: An 89 year old male with resolving pneumonia that is being discharged back to the nursing
home later this afternoon. He requires turning, feeding, and bathing.
Room 109: A 49 year old male with hypertension and resolved stroke for possible discharge today.
Room 110: A 43 year old female with new onset Type II diabetes mellitus. She has met with the diabetic
educator and has been checking her own blood sugars and ordering her own meals.
QUESTIONS TO ANSWER
Which duties cannot be delegated therefore the
RN must complete? Provide rationale.
 What clients or tasks should be delegated to the
LPN? Provide rationale.
 What tasks should be delegated to the UAP?
Provide rationale.
 What is the RN’s responsibility before the end of
the shift in reference to the delegated activities?
Provide rationale.
 Should the charge RN need to help with any of the
days tasks? Why or why not?

REFERENCES AND FURTHER READINGS
AACN Delegation Handbook 2nd edition
American Association of Critical Care Nurses
www.aacn.org
Guidelines to Effective Nursing Delegation
www.nursetogether.com
Position Statement on Delegation and Assignment of Nursing Activities
North Carolina Board of Nursing
www.ncbon.org
LaCharity, L., Kumagai, C. & Bartz, B., (2011) . Prioritization, Delegation, and
Assignment. Port Ludlow, Washington: Mosby, Elsevier.
National Council of State Boards of Nursing
www.ncsbn.org
North Carolina Concept-Based Editorial Board, (2011). Nursing: A Concept Based
Approach. Upper Saddle River, New Jersey: Pearson Education, Inc.