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Todays DecisionMaking and Delegation

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Key to delegation is ability to make correct decisions and think critically! ... d. Mr. A a 70 yr old confused, incontinent male ... – PowerPoint PPT presentation

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Title: Todays DecisionMaking and Delegation


1
Todays Decision-Making and Delegation
RN
UAP
LVN
  • By Nancy Jenkins, RN, MSN/Carolyn Morse Jacobs
    Rn, MSN, ONC

2
Introduction to delegation (song)
Pushin' the Papers
3
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)

4
Decision-Making and Delegation
  • Key to delegation is ability to make correct
    decisions and think critically!
  • What is decision-making in nursing?
  • Its 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 ones thinking
  • The essential element in decision-making
    supports effective and appropriate actions!

5
Steps in the Decision-Making Process
  • Data gathering
  • Analysis
  • Establishing goals/Outcomes and Plan Actions
  • Implement chosen alternatives
  • Evaluate Outcomes
  • Resources
  • Textbooks
  • Policy and procedure manual
  • Experienced colleagues
  • Other decision-making tools!

6
Sources of Ethical Guidance
  • 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
  • Fidelity carry out the agreement and
    responsibilities one has undertaken faithful to
    the clients
  • Veracity to tell the truth

Supporting ethical decision-making by patient and
families
7
Decision-Making Tools
  • Listing Pros and cons
  • Algorithms
  • Clinical pathways
  • Thinking hats-different perspectives

8
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9
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10
What is critical thinking anyway??
NOT!!!
11
What is critical thinking anyway??
  • A complex thinking process that is
  • Disciplined and self-directed
  • Based on mastery of many thinking skills and
    abilities
  • Best developed when applied to actual or
    simulated real world situations
  • Involves thinking about the thought process as it
    is occurring
  • Evaluates the solution or decision against a
    standardized set of criteria

12
Characteristics of Critical Thinkers
  • Open minded
  • Systematic
  • Analytical
  • Inquisitive
  • Judicious
  • Truthseeking
  • Confident in reasoning

13
Why is it so important?
  • Critical thinking skills are needed to
  • Decrease patient mortality and morbidity rates
  • Decrease failure to rescue rate

14
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

15
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?

16
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

17
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?

18
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

19
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

20
National Council of State Boards of Nursing
  • 1987 - NCSBN became concerned about ability of
    nurses 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

21
Delegation
  • You must delegate if you want to deliver quality
    care to all of your patients in a timely manner!!

22
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23
Delegation What is it?
  • It is giving someone authority and responsibility
    to do something that is normally part of someone
    elses 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.

24
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25
Why the need to delegate?
  • Shortage of RNs
  • Cost containment
  • Sicker patients
  • Shorter length of stay
  • Increased number of UAPs
  • Encourages team building

26
Why RNs dont 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
  • Dont have time

27
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28
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

29
5 Rights of Delegation (NCSBN)
Right Task
Right Direction
Right Circumstances
Right Supervision/ Evaluation
Right Person
30
5 Rights of Delegation (NCSBN)
  • Right task Nurse Practice Act, Job Descriptions
  • 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?

31
5 Rights of Delegation (NCSBN)
  • 3. Right Person
  • Who is competent to perform task?
  • Job description? Training? Scope of practice?
  • 4. Right Directions/Communication
  • Clear, Concise, Complete
  • Who, what, when, where, why, how?
  • Include parameters and timeframes
  • 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

32
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 delegatees input
  • Be specific with feedback
  • Make a plan, with time frame for checking
    progress

33
Delegation
There is no blanket delegation of tasks
34
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

35
To delegate or not. That is the Question.
  • Patients 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

36
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?

37
Nursing Practice Act
Delegation Resource
  • RULES AND REGULATIONS related to PROFESSIONAL
    NURSE EDUCATION, LICENSURE AND PRACTICE

38
Rule 224
Rule 224
39
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

40
The Power to Delegate?
  • MDs 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 MAand verify training of
    the UAP, can verify task and can supervise the
    UAP
  • LVNs may not delegate
  • RNs do not delegate to LVNs
  • RNs make assignments to LVNs
  • BNE of Texas
  • RNs cannot give-away accountability or quality
    of care

41
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
    UAPnot jeopardizing clients welfare
  • (4) requires no professional judgment !!!
  • (5) adequate identification by individual
    training, education and/certification,
    experience/ permit etc.

42
224.6 General Criteria for Delegation
  • (6) RN shall either instruct the UAP in the
    delegated task or verify UAPs competency
  • (7) RN must adequately supervise
  • (8) if the delegation continues over time, the RN
    must periodically evaluate the delegation of
    tasks

43
224.7 Supervision
  • (2) RN or equally qualified RN shall be available
    in person or by telecommunicationsand make
    decisions about levels of supervision using the
    following examples as guidelines
  • (A) RNspresence required to provide nursing
    services, include assessment, planning,
    intervention and evaluation of client whose
    health status is changing and/or to evaluate the
    clients health status.the RN must be readily
    available to supervise the UAP in the performance
    of delegated taskssettings include..acute
    carelong term care.
  • (B)situations where nursing care provided in the
    clients residence the clients statusunstable
    and unpredictable and RN required to assess,
    plan intervene, and evaluate the clients
    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

44
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
45
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 RNs
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 RNs presence and
supervision is required Ted has training and
experience your best answer.
46
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, IO, Glucose
    monitoring Environmental situations Client or
    family comments .relating to clients care
  • (3) ambulation, positioning, and turning
  • (4) transportation of patient in the facility

47
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

48
224.8 Delegation of Tasks
  • (b) Discretionary Delegation TasksYellow 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

49
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 RNs professional judgment. Most
    critical !

50
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
    clients response to the care rendered
  • (3) specific tasks involved in the implementation
    of the NCP which require professionals nursing
    judgment or intervention

51
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
    clients significant others
  • Remember the UAP can only reinforce health
    teaching!
  • (5) administration of medication, except by
    medication aides as permitted under 224.9

52
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

53
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..

54
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 clients
    medication from the pharmacy

55
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

56
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

57
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

58
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 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

59
  • 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

60
Determine in the following situations which are
exclusions to the Nurse Practice Act according to
224.2.
  • As an RN you assign the LVN on your team to
    provide care for a group of 6 patients
  • As an RN you work with a nursing student in an
    externship and supervise the student while he/she
    gives IV push medications
  • As an RN you assign the CA to check intake and
    outputs for patients in room 1-10
  • As an RN you provide complicated wound care for a
    neighbor you refuse compensation

61
Determine in the following situations if and how
224.2 of the Nurse Practice Act applies.
  • 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
  • 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
  • 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
  • As an RN you provide complicated wound care for a
    neighbor you refuse compensation Yes, exclusion
    in 224.2

62
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 (AKAnursing 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

63
Test your Understanding
  • 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 (AKAnursing 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 answeras a CA your job
    description would not include this role, though
    you had training in nursing programmight be
    permitted to do this IF directly assisting the RN
    in performing the procedure. 224.2)
  • 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

64
The responsibility of the total nursing care of
the patient rests on the RNs shoulders
65
You might ask- What is my liability and how does
delegation affect my license?RNs 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
supervisionUAPs carry some accountability of
their own and always have
http//www.lopez1.com/lopez/clinical.cases/092699.
htm
66
224.5 RN Accountability for Delegated Tasks
  • (a) The RNs accountability to the BNE with
    respect to its taking disciplinary action against
    the RNs 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 RNs civil
    liability.
  • The RNs best protection is to adhere the nurse
    practice act!

67
224.10 Supervising UAP Performing Task Delegated
by Other Practitioners
  • (a) Applies to professional nurse who
    practiceswith a licensed practitioner who has
    delegated tasks to an UAP over whom the RN has
    supervisory responsibilities. The RNs
    accountability to the BNE, with respect to its
    taking disciplinary action against the RNS
    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 metmust communicate this
    fact to the licensee who delegated the task

68
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 patients p02
    is 84.

69
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 nurses action.
  • (Good example in book p. 192)

70
  • 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?

71
Tips for Effective Delegation
  • Start with a positive attitude.
  • Clarify availability- especially if UAP with many
    RNs
  • Give clear directions in a respectful manner.
    Include reportable parameters.
  • Be fair about undesirable activities.
  • Indicate priorities
  • Give and receive feedback

72
Where do the LVNs 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)

73
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.

74
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."
75
Questions
  • You are caring for a patient with esophageal
    cancer. Which task could be delegated to the
    nursing assistant?
  • Assist the patient with oral hygiene
  • Observe the patients response to feedings
  • Facilitate expressions of grief
  • Initiate daily weights

76
1 is correct. Oral hygiene is a green light task
77
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 gt100.4 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.

78
Questions
  • In caring for a patient with neutropenia, what
    tasks can be delegated to the nursing assistant?(
    Choose all that apply)
  • gt1. Take vital signs every 4 hours.
  • gt2. Report temperature elevation gt100.4F
  • 3. Assess for sore throat, cough or burning
    with urination.
  • gt4. Gather the supplies to prepare the room for
    protective isolation.
  • 5. Report superinfections, such as candidiasis.
  • gt6. Practice good handwashing technique.

79
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.

80
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?
  • gt1. 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
81
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

82
Question
  • Which actions should you delegate to the nursing
    assistant for the client with diabetic
    ketoacidosis?
  • 1.Check fingerstick glucose every hour.
  • gt2. Record intake and output every hour
  • gt3. 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
83
(No Transcript)
84
Delegation!
The End! Review your Nurse Practice Act and
Apply the 5 rights of Delegation (task,
circumstance, person, direction/communication,
supervision/evaluation)
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