Delegation, Assignment, and Supervision (Exam 2) Flashcards
need competent, appropriately supervised AP and LPNs/LVNs in pt care. RN’s confidence with delegation and supervision skills is essential. RNs must understand legal responsibility related to delegation and supervision. Delegating tasks safely is essential to allow nurses time to attend to the most important aspects of professional nursing care.
delegation
what is important to know about delegation?
Transfer of responsibility for the performance of an activity from 1 person to another while accountability for the outcome is retained. Legal and management concept. RN transfers responsibility and authority for the performance of an activity but remains accountable for overall nursing care. Management strategy used to ensure the accomplishment of cost-effective pt care.
what cannot be delegated?
No definitive list of what can/cannot be delegated. Varies among states, organizations, and specific situations. Assessment, evaluation, and nursing judgment cannot be delegated.
RNs must integrate info from?
State nurse practice acts
Pt needs
Job descriptions
Employee competency
Policies and procedures
Clinical situation
Professional standards of nursing practice
what are pt needs associated with delegation?
RN required to perform a pt assessment and to know the level of care required. The more stable the pt, the more likely delegation is to be safe. Many tasks that can be delegated may be intertwined with a nursing responsibility.
what is important to know about high risk delegation?
Delegated task can be performed only by the RN according to law, organizational policies, or professional standards of nursing practice
Delegated task could involve substantial risk or harm to a pt
RN knowingly delegates a task to a person who doesn’t have appropriate training
RN fails to provide adequate supervision
RN does not evaluate the delegated action by reassessing the pt
what are activities RNs cannot delegate?
Initial and any subsequent assessment that requires nursing knowledge, judgement, and skill
Determination of nursing diagnoses
EST. of nursing care goals
Development of nursing plan of care
Evaluation of pt progress
Health counseling or teaching
Activities that require specialized nursing knowledge, skill, or judgement.
what are tasks that UAPs can and cannot be delegated to do?
Cannot be given any activity that requires nursing judgement. These include assessing, teaching, evaluation, or admin of meds to any pt
The collecting, reporting, and documentation of simple data
Simple, repetitive tasks (ex: ADLs, hygiene, feeds, and ambulation)
I/Os, specimen collection, VS (stable pts)
what are tasks that LPNs can/can’t be delegated to do?
Cannot be assigned to initially assess, initially teach, or evaluate any client
Can reinforce client teaching
Cannot delegate the care of an unstable pt
Can give some meds but not all meds
Trach care, suctioning, inserting urinary cath, and admin of enteral feeds.
Data collect, monitor, observe
Reinforce teachings from plan of care
Admin IVPB meds
Monitor transfusions of blood
Admin topical, PO, or IM pain meds
Admin meds and nutrition via NG tube, G-tube or button, J-tube
Insert, maintain, and remove NG tube and urinary caths
Maintain and remove peripheral IV caths
Calculate and monitor IV flow rate
what can LPNs NOT be delegated to do?
initially assess, evaluate
Initiate teaching of plan of care
Admin IV push meds
Initiate transfusions of blood products
Admin IVP pain meds
Admin meds and nutrition via mental line (NO TPN)
what is the delegation criteria?
Low potential for harm
The activity has minimal complexity
Problem solving/innovation involved is minimal
Outcome is highly predictable
Pt has ample opportunity to interact with RN
RN is available to supervise activity and its outcome
what are safe delegation practices?
Develop a foundation of knowledge (ex: nurse practice act, policies, standards of care, competencies, etc.)
Know the pt
Know the staff and their skills/competencies
Know the task
Explain tasks and expected outcomes
Expect responsible action
Assess and supervise
Evaluate and follow-up
what are the 5 rights of delegation?
Right task: delegated tasks must conform to EST. guidelines
Right circumstances: delegated tasks do not require independent nursing judgement
Right person: 1 who is qualified and competent
Right direction and communication: clear explanation ab the task and outcomes and when the delegatee should report back to the RN
Right supervision and evaluation: feedback to assess and improve the process; evaluate pt outcomes
what is important to know about assignments?
distribution of work that each staff member is responsible for during a given work period. Designates activities consistent with job position and description, legal scope of practice, and edu background. The staff member assumes responsibility and is accountable for completing the assignment.
Assigning groups of pts to various care providers, including AP and LPNs/LVNs is not appropriate. AP assignments include functions and tasks. LPNs/LVNs may be assigned specific pts for which to perform care, but RNs remain responsible for all nursing practice activities.
RN responsible for assignments made to nursing personnel and should consider?
Pt physiological stats and complexity of care
Infection control or cross-contamination issues
Level of supervision required
Staff development opportunities such as assigning a less experienced nurse to a more complex pt with an increased level of supervision.
what is important to know about the nurse practice act?
Will provide guidance for legal delegation
Delegation criteria may not be clear or may be presented in various parts of the act
State board of nursing may offer guidance
RN should understand the legal scope of practice for an LPN/LVN
Practice by AP is generally governed by the HC organizations standards
what are the levels of supervision?
unsupervised
initial direction/periodic inspection
continuous supervision
what is unsupervised?
1 RN works with another RN in a collegial relationship
Neither RN is in the position of supervising the other
what is initial direction/periodic inspection?
RN is supervising a licensed or unlicensed caregiver
Knows the persons training and competencies
Had developed a working relationship with the person
what is continuous supervision?
RN has determined that the delegatee will need very frequent to continual support and assistance
what are the levels of prioritization?
Acute v chronic
ABCs
Maslow’s Hierarchy of Needs
Urgent v Non-urgent
Survival potential
what is Maslow’s hierarchy of needs?
Basic needs:
Physiological needs: food, water, warmth, rest
Safety needs: security and safety
Psychological needs:
Belongingness and love needs: intimate, relationships, friends
Esteem needs: feeling of accomplishment
Self-fulfillment needs:
Self-actualization: achieving ones full potential, including creative activities
what is triage?
emergent/immediate
urgent/delayed
non-urgent/minimal
expectant
second highest priority is given to pts who have major injuries that are not yet life-threatening and can usually wait 30 M to 2 H for treatment
urgent/delayed (yellow)
highest priority is given to pt who have life-threatening injuries but also have a high possibility of survival once they are stable
emergent/immediate (red)
the next highest priority is given to pts who have minor injuries that are not life-threatening and do not need immediate attention
non-urgent/delayed (green)
the lowest priority is give to pts who are not expected to live and are allowed to die naturally. Comfort measures can be provided, but restorative care is not.
expectant (black)
