Transcript Decision-Making and Delegation in the Dynamic Health Care

Today’s Decision-Making and
Delegation
RN
LVN
UAP
By Nancy Jenkins, RN, MSN/Carolyn Morse Jacobs Rn, MSN, ONC
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!!!
Why is it so important?
• Critical thinking skills are needed to
– Early detection of problems
– Interventions to prevent adverse occurrences
– Interventions to decrease mortality and
morbidity and failure to rescue rates
– Improving patient outcome rates
Characteristics of Critical
Thinkers
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Open minded
Systematic
Analytical
Inquisitive
Judicious
Truthseeking
Confident in reasoning
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.
Steps in the Decision-Making Process
• Data gathering
• Analysis
• Establishing Goals/Outcomes/Strategies
– Short term
– Long-term
– Plan Actions- prioritize these!
• Implement chosen alternatives- policies and procedures
and protocols
• Evaluate Outcomes- ask was this the best way?
• Resources
– Textbooks, professional journals
– Policy and procedure manual and protocols (risk
management)
• Pre-arrest protocols
• Heparin protocols
– Experienced colleagues-”novice to expert”
– Clinical Pathways or critical paths
Decision-Making Tools
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Listing Pros and cons- helpful for jobs
Algorithms- critical care,CPR and ACLS
Clinical pathways
Thinking hats-different perspectives
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 Participative 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 Participative Group
Decision Making
• Majority Rule
– Def-vote is taken and the most votes winelections
– Advantage- quick
– Disadvantage- may have large number refuse
to follow the plan
Other 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
Sources of Ethical Guidance
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Beneficence: do or bring about
good (similar to nonmaleficence –
do no harm)
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Autonomy: each individual
makes personal decisions
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Justice: obligation to be fair to all
people, non-discrimatory. Pt.
should be informed of wrongs.
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Fidelity: carry out the agreement
and responsibilities one has
undertaken: faithful to the clientsopposite of patient abandonment
•
Veracity: to tell the truth…
Supporting ethical
decision-making by
patient and families
Supporting Ethical Decision Making
• Knowing- using assessment skills and
knowledge base as well as selfassessment
• Facilitating- acquiring pertinent information
and facilitating communication
• Guiding- have you thought about? It
sounds to me…
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?
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
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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?
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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
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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
Person
Right
Direction/
Communi
cation
Right
Supervision/
Evaluation
5 Rights of Delegation (NCSBN)
Right task – Nurse Practice Act, Job Descriptions,
1.
Is assessment involved?
Should be routine in nature
Right circumstances – What are the circumstances of
patient at this time?
2.
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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 –
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Who is competent to perform task?
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Job description? Training? Scope of practice?
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Ind. Strengths and weaknesses
4.
Right Directions/Communication
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Clear, Concise, Complete
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Who, what, when, where, why, how?
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Include parameters and timeframes
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Help them prioritize
5.
Right Supervision/Evaluation
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Supervision is the active process of directing, guiding and
influencing the outcome
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Initial direction
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Periodic inspection
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Follow-up/feedback and appropriate action
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Evaluation of patient outcomes and the person
Evaluation and Feedback
• Evaluation – What do I see?
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Was task completed correctly, on time?
Was info reported correctly?
Documented?
What was patient response?
• Feedback – What do I do about it?
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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
Questions to ask before
delegating
• What is the task or job to be delegated?
• Are the expected results predictable?
• Does the task require on-going nursing
assessment?
• To whom shall the task be delegated?- skill level
and time
• Does the task involve critical thinking or nursing
judgment?
• If the delegatee needs help, am I available to
help?
Nursing Practice Act
Delegation Resource
RULES AND REGULATIONS
related to PROFESSIONAL
NURSE EDUCATION,
LICENSURE AND PRACTICE
Rule 224
Rule 224
BON 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
• 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
Which of the following situations 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
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 Tasks
More 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:
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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 reorder the medications
• C. Have the patient reorder 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:
–
–
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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 reorder the medications
• C. Have the patient reorder the medications
Test your Understanding of Delegation
General 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 Delegation
General 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 assessment
Ok 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
224.10 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 BON, 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
The Power to Delegate?
• BON 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
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
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b. unit manager
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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)
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
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 Usually 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 some 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 minutes
• 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 minutes
• 4. Assess for indicators of fluid imbalance
Taking accuchecks require additional training and is not
automatically delegated without asking questions
Key Points
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RN Assessment
Reasonable and Prudent RN
Ask can the task be delegated
No Nursing Judgment
Identify UAP
Verify Competency
Supervision
RN Accountable
Clear Communication
Careful Follow-up/evaluation
Right Circumstance
7/4/2006
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Delegation!
The End!
Review your Nurse Practice Act; and Apply the 5 rights of
Delegation (task, circumstance, person,
direction/communication, supervision/evaluation)