1. Review the following case studies regarding nurse liability associated with inappropriate delegation: Show Reflective Questions: What delegation errors occurred in each of these scenarios and what were the repercussions of these errors for the nurses involved? 2. The RN is delegating tasks to the LPN/VN and AP on a medical-surgical unit. Using the columns as reference, indicate where delegation errors occurred using the 5 Rs of delegation. You probably count on unlicensed assistive personnel (UAPs) to help you care for your patients. As an RN or LPN, however, you're ultimately responsible for your patients, even when you've delegated some of their care to a UAP. To delegate legally, safely, and effectively, you need to know a few rules. Before handing off duties to UAPs, check the following five points to make sure you're meeting your responsibilities.
Your judgment is always key because whether or not delegating care is appropriate isn't always obvious. A patient may appear to be independent, yet still need care from someone skilled in communication. For example, a patient with newly diagnosed diabetes will benefit from the teaching and support you can offer while performing hands-on care you might otherwise delegate. Although delegating this “bed and bath” to a UAP is legal and safe, it may not be in this patient's best interest. Although you need to maintain standards, you should also be flexible. Acknowledge that some things can be done more than one way. You'll foster cooperative attitudes if you act as a guide and teacher, rather than a dictator. Just as you need to trust the UAPs assigned to you, the UAPs need to trust you. The end result will be better patient care—the one goal shared by everyone on staff. DELEGATIONTransferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation. Mark is a new graduate registered nurse who has recently completed nursing orientation. He is now on his second week of non-precepted practice on a busy medical-surgical unit. During the middle of his busy night shift, Mark has several tasks that need to be completed quickly. These tasks include a linen change for a patient who just vomited, an assessment of a possibly infiltrated intravenous line, and the administration of intravenous pain medication for a patient who rates her pain 10 out of 10. Mark also needs to make hourly rounds within the next few minutes, and he is very behind on his charting. He knows he must delegate some of the tasks to his coworkers. However, Mark is unsure what he can delegate and to whom. He decides to use the five rights of delegation to help with his delegation decisions. Right tasks First, Mark needs to determine which tasks are right to delegate. Some questions he may ask at this time would include (1) which tasks are legally appropriate to delegate and (2) can I delegate these tasks based on this organization’s policies and procedures? Correctly answering these questions will require familiarity with institutional and nurse practice act guidance. Generally, registered nurses are responsible for assessment, planning, and evaluation within the nursing process. These actions should not be delegated to someone who is not a registered nurse. Right circumstances After determining the right tasks for delegation, Mark considers the right circumstances of delegation. In so doing, Mark may ask the following questions: (1) are appropriate equipment and resources available to perform the task, (2) does the delegatee have the right supervision to accomplish the task, and (3) is the environment favorable for delegation in this situation? To appropriately answer these questions, it is imperative that Mark completes an assessment on each client. Patients who are or may become unstable and cases with unpredictable outcomes are not good candidates for delegation. For example, it may be appropriate for unlicensed assistive personnel to feed patients requiring assistance with the activities of daily living. However, if a patient has a high risk for aspiration and a complicated specialty diet, delegation of feeding to unlicensed assistive personnel may not be safe. Right person If a task and circumstance are right for delegation, the next “right” of delegation is the right person. Mark needs to consider if the potential delegatees have the requisite knowledge and experience to complete delegated tasks safely, especially concerning the assessed patient acuity. Before delegating a task, the registered nurse must know the delegatee’s job description and previous training. Mark may be unsure about his potential delegatee’s qualifications. Therefore, he might ask the following questions before delegating a task: (1) have you received training to perform this task, (2) have you ever performed this task with a patient, (3) have you ever completed this task without supervision, and (4) what problems have you encountered in performing this task in the past? Right supervision The right supervision must be available in all delegation situations. Nurse practice acts require the registered nurse to provide appropriate supervision for all delegated tasks. In the case study, Mark must be sure that the delegatee will provide feedback after the task is complete. Following task completion, Mark is responsible for evaluating the outcome of the task with the patient. Registered nurses are accountable for evaluation and the overall patient outcomes. Right direction and communication Finally, the delegator must give the right direction and communication to the delegatee. All delegators must communicate performance expectations precisely and directly. Mark should not assume that his delegatee knows what to do and how to do it, even for routine tasks. Mark must consider whether the delegatee understood the assigned task, directions, patient limitations, and expected outcomes before the delegatee assumes responsibility for it. The delegatee also must comprehend what, how, and when to report back after the delegated task is complete. Delegatees also need a deadline for task completion for time-sensitive tasks. Using the five rights of delegation, Mark appropriately took care of his patients’ needs. Mark delegated the linen change to trained unlicensed assistive personnel, and he entrusted his hourly rounds to his shift charge nurse. Mark opted to assess the patient with a possibly infiltrated intravenous site first. Upon finding the site infiltrated, he assessed his patient, removed the intravenous line, and placed a warm compress on the patient’s elevated extremity. He then administered another patient’s requested pain medications after delegating new intravenous catheter placement to an intravenous-certified coworker for the patient with the infiltration. Mark was able to complete all his documentation requirements by the end of his shift. What are three tasks that a registered nurse may assign to an assistive personnel?Three tasks a nurse can assign to an assistive personnel can be, take the patients vital signs, help patients with bathing, grooming, and dressing, and they can help the patient with mobility assistance like repositioning, ambulation, and transfers.
What can an RN delegate?Nurses may also delegate tasks to those with a more narrow scope of practice. For example, an RN might delegate PO med passes to the LPN. An LPN may delegate tasks such as ambulating or feeding a patient to the CNA. The question of when a nurse should delegate is dependent on many factors.
What type of assessment nurses Cannot delegate to AP?The licensed nurse cannot delegate any activity that requires clinical reasoning, nursing judgment or critical decision making.
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