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Delegation, How and When? Assessing Priorities Practice Test
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CONSIDERING DELEGATION AND NURSING MANAGEMENT OF PERSONNEL

Points to Ponder

TEST POINT 1:
Decide on priorities of care.
APPLY THE ABCS THEORY OF PRACTICE
LOOK for situations which have a Life Threatening Potential
(These are associated with RN actions)
The RN must see and work with patients who
  • have any type of reaction to medications, tests or treatments
  • require complex treatment via tubes such as CT, or penrose (but not feeding via ng tube)
  • experience fluctuations in their vital signs (recovery type issues)
  • present with any new onset problem (such as confusion)
  • need to have any emergency medications administered
  • are having a blood or other type of transfusion?
  • in a complex precaution situation such as for severe burns or neutropenia
    • LOOK for situations which require Patient Safety
    (PN/VN and UAP (unlicensed assistive personnel) activities)
    The PN/VN and UAP can work with patients being placed in a simple precaution situation (contact precautions)
  • who will need to have vital signs monitored frequently, as long as they have been trained to report any changes based on parameters provided by the RN
  • experiencing some sensory deficits such as hemianopsia, and dementia
  • who may be confused or are a safety risk that may require restraints or side rails
    • LOOK for situations that can be handled at the least trained level
    The UAP can be involved in care associated with (as long as they are supervised) patients who require
  • personal care such as bathing and dressing
  • assistance with feeding; even if confused
  • support in ambulating as part of a routine treatment (not first time)
  • dietary monitoring for intake and output information
    • TEST POINT 2:
    Know what different workers do.
    HERE ARE A FEW TASKS/ABILITIES TO REMEMBER
    The Registered Nurse will
  • Perform all complex assessments.
  • Do all analysis; planning of patient care can be done with LPN/VN; coordinate all patient care; and act as liaison with all health care team
  • Direct, delegate and supervise the care provided by LPN/VNs and UAPs
  • Directly manage patients who have intravenous medications; central line care; TPN; lipids; CVP measurements; PCWP measurements; Central Line dressings; blood transfusions; extensive dressing/wound care; and surgical drains
  • Determine who should be seen in what order during emergencies
  • Develop assignments for float nurses that will match their expertise and area of practice
    • The Practical/Vocational Nurse will
  • Perform any simple admission assessments such as obtaining simple admission history and measuring vital signs
  • Measure and record intake and outputs; vital signs; collection of specimens
  • Deliver all forms of basic care to all kinds of patients
  • Participate in, assist in, and direct patient care such as feeding patients, obtaining weights, can oral suction patients, change simple dressings, and start IV's if trained
  • Be able to assist in teaching patients in areas of diabetes, bowel and bladder issues, simple wound care, and dressing changes
  • Assist in developing the nursing care plans
  • Be able to assist in OR sponge counts
  • Will be able to work with ostomy patients
    • The Unlicensed Assistive Personnel (UAP) or Nursing Assistant (NA) will
    (When trained and supervised)
  • Be able to provide basic care for patients including performing ADLs; collecting specimens of urine and stool; obtain vital signs gather initial admission information
  • Be able to test urine and stool for S&A and OB
  • Be able to apply and monitor protective restraints
    • TEST POINT 3:
    Most opportunities for delegation will be in the area of assessment or implementation.
    Simple assessment and reporting of vital signs, and collecting and recording I&Os is reserved for the UAP. They may also provide basic care. They should not be used to answer complex assessment and analysis questions. Implementation (interventions) include providing basic ADL care and feeding of patients. Any problems anticipated in patients would not be delegated by the RN.
    TEST POINT 4:
    Discharge planning, and all complex teaching of families and patients will be performed by the RN.
    The LPN/VN can do noncomplex teaching All complex teaching about Central lines; PICC lines; TPN; lipids; Central Line dressings; extensive dressing/wound care; and surgical drains must be done by the RN LPN/VN can do simple diabetic teaching, reinforce colostomy care, and can teach about simple dressing changes. The UAP is not involved in teaching in any of these areas.
    TEST POINT 5:
    When making assignments consider the following:
    1. How often does the delegatee perform the assigned task?
    2. What is the level of complexity of the care?
    3. What type of technology is involved in the care?
    4. Who can perform the care responsibly?
    5. How will the delegatee be properly supervised?

    Using the Test Points

    "Don's Delegation Decision Path"

    Step 1
    Which patient is most stable?
    (Look at Test Point Number 1)
    Step 2
    What type of activities are going to be performed?
    (Look at Test Points Number 2, 3, & 4)
    Step 3
    Which patient would the delegatee be least likely to hurt based on the activity that is to be done for the patient?
    (Based on the NSCBN decision tree for delegating activities, 1977)

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