Delegation and Management Principles - Exam 2 Flashcards
Management principles to support managing care
- Assessment of the skills, strengths, and weaknesses of the work team
- Planning for the accomplishment of tasks and goals
- Organizing, controlling, and constantly monitoring when and how tasks and goals will be accomplished
- Assigning and/or delegating appropriatly
Responsibilities of the organization
- Develop appropriate position descriptions
- Recruit qualified individuals
- Determine initial competency
- Provide appropriate education and training to maintain competency
- Communicate the competencies to RN supervisors
- Prepare Rns for supervision and evaluation
- Provide the appropriate time for supervision
- Conduct ongoing evaluation of staff at all levels
- Take corrective action for substandard performance
Scope of professional nursing practice in New York state
- Activities requiring assessment, monitoring, planning, diagnosing, evaluation, judgement, and problem-solving (ie. nursing process except implementation)
- Implementing a plan of care including but not exclusive to, such activities as:
- Sterile procedure
- Invasive techniques/procedures
- Nasogastric/gastrostomy tube feedings
- Oxygen administration
- Tracheostomy care/suctioning
- Catheterization
- Administration of medications
- Administration of blood and blood products
** Certain categories of unlicensed health care workers can perform some of these activites in a limited manner. Some examples are: operating room technicians, dialysis patient care technicians and nuclear medicine technicians. However, the supervising RN or physician, not the technician must remain responsible for patient assessment.
Health-related Activities
Activities that are not in the legally protected scope of nursing practice and can be assigned to unlicensed assistive personnel who have demonstrated competency
An appropriate health-related activity:
- Does not involve the use of professional judgment, critical thinking, or provision of skilled care
- Involves predictable results
- Can be completed using standard procedures requring no modification
- Can be assigned by either verbal direction or from an approved list of activities after an RN’s assessment/evaluation of the patient’s need and the UAP’s competencies
Examples:
ADLs, VS, clean dressings without assessment, basic I&O, oral suctioning and mouth care, care of nails/hair/skin, using glucometers, assistance with braces and prosthesis, external catheter care, taking EKGs, venipuncture, non-nursing functions (transporting, cleaning, clerical work, answering the telephone)
Supervision
Process of directing, guiding and influencing the outcome of an individual’s performance of an activity. Providing initial direction and peiodic inspection of the task/activity through completion.
It is unprofessional conduct in NYS for a licensee to fail to exercise appropriate supervision over persons who are authorized to practice only under the supervision of a licensed professional.
Delegation
Designation of professional responsibilities to a person who is qualified by training, experience, and licensure to perform them.
Assignment
Designation of nonprofessional health care tasks to an unlicensed individual that is trained and competent to perform them.
Exemption that permit nursing activities or tasks to be performed by non-nurses
- Family members
- Nursing students
- OMH/OMRDD attendants
- Caregivers for self-directing individuals in special state-autorized home care programs
The Fiver Rights of Delegation
- Right Task (one that is delegable for a specific patient)
- Right Circumstances (appropriate patient setting, available resources, and other relevant factors considered
- Right Person (right person is delegating the right task to the right person to be performed on the right person)
- Right Direction/Communication (clear, concise description of the taks, including its objective, limits and expectations)
- Right Supervision (appropriate monitoring, evaluation, intervention, as needed)
Potential for Harm
What is the particular activity’s potential for harm? Certain nursing activities, particularly the more invasive ones, carry a greater risk for harming a patient. The greater the potential for harm, the more necessary it may be for a professional nurse to render care. The RN must determine how much risk the activity carries for an individual patient.
Complexity of Task
What psychomotor and cognitive skills are required to perform a particular activity? Activities involving more complex psychomotor skills, expert nursing assessment and judgment should only be perofrmed by a professional nurse. Support personnel may learn to perform activities ranging from custodial to more difficult. But as the required skills increase in complexity, greater attention must be given to the support person’s prior training and demonstrated competence.
Problem Solving and Innovation Required
If a problem is suspected, does it require individualized problem solving to achieve a successful outcome? An otherwise uncomplicated activity may require special adaptation and innovative approches for particular patient. Adapting such an activity and evaluating its outcome are the responsibility of the professional nurse
The Required Coordination and Consistency of an Individual’s Care
Will assigning a health-related activity increase or decrease the amount of time a professional nurse can spend with a patient and the patient’s family? The nurse’s ability to effectively plan, coordinate, and evaluate a patient’s care is restricted when support personnel have most of the direct patient contact. The education, skill, and time needed for an adequate assessment also vary from one patient to another and subtle clinical cues may be missed when too many direct care activities are assigned. The nurse must determine how much time can be spent away from the bedside. The nurse also must consider how many people will interact with a patient and the effect of those interactions on the patient.
RN Scope of Practice in NYS
The practice of the profession of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential health problems through such services as casefinding, health teaching, health counseling, and provision of care supportive to or restorative of life and well-being, and executing medical regimens prescribed by a licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the comissioner’s regulations. A nursing regimen shall be consistent with and shall not vary and existing medical regimens.
Nurse Practitioner Scope of Practice in New York State
The diagnosis of illness and physical conditions and performance of therapeutic and correct measures within a speciality area of practice…in collaboration with licensed physician…in accordance with written practice agreement and written protocols…prescriptions for drugs, devices, and immunizing agents may be issue by a nurse practitioner…in accordance with the practice agreement and practice protocols
