Delegating Nursing Care

It is no secret that communication is key when providing direct patient care in a skilled nursing facility. However, there is a noticeable lapse in the communication between the care team when providing care to the individual or groups of individuals. Two main parts of any care team are the registered nurse and the certified nursing assistant, as these are the two people whom have the most direct and impactful roles with residents in a skilled facility. The Registered Nurse and the Certified Nursing Assistant play similar roles in providing patient care, but have different roles in its entirety. The role of the Registered Nurse (RN) is defined as having the competency and skill to provide direct and indirect health care to individuals, their families, and communities around them. Services are also provided designed to give out medications, to promote comfort or healing, promote healing, and to also provide the dignity of their patients and patient’s families (American College of Rheumatology, 2015).

The National Council of State Boards in Nursing defines delegation as “transferring to a competent individual the authority to perform a selected nursing task in a selected situation” (National Council of State Boards of Nursing, Resources section, 4). When delegating, the registered nurse (RN) assigns nursing tasks to unlicensed assistive personnel (UAP) while still remaining accountable for the patient and the task that was assigned. Delegating is a management strategy that is used to provide more efficient care to patients. Authorizing other individuals to take on nursing responsibilities allows the nurse to complete other tasks that need tended to. However, delegation is done at the nurses’

Nursing tasks delegated should be considered routine care for a specific patient, pose little potential harm, performed with a predictable outcome, and administered according to the plan of care. There should be an assessment of nursing needs including the frequency of nursing care and, the stability of the patient (UT Admin Code R156-31b. Nurse Practice Act Rule, 2013).

As a supervisor in my facility it is not uncommon to be asked to float a staff member to another area within the hospital due to staffing shortages. Two weeks ago, I was approached by my director to do just that. However, in this circumstance, I felt the request was inappropriate. The radiology registered nurse had more tasks to accomplish than normal and had requested that one of my nurses, a former radiology nurse, insert PICC lines for the afternoon. My nurse had been in the cardiology department for three years and had not placed a PICC line since leaving the radiology department. In my facility, it is a requirement that the nurse place a minimum of five PICC lines a year to be deemed competent, so from my perspective, my nurse was fifteen lines too short. However, in an attempt to make every effort to assist the radiology nurse, I approached my nurse to verify how long it had been since she had placed a PICC line. Much to her surprise, it truly had been way too long. Despite this fact, she still wanted to help with the line placements. In an attempt to protect my nurse from practicing outside of her scope and to protect myself from delegating tasks to an incompetent nurse, I refused to send the nurse. I did, however, offer to send her for training for future possibilities of assistance.

Nurses that work in a psychiatric clinical setting deal with ethical dilemmas daily. One of the ethical issues that are common in psychiatric nursing is autonomy. Autonomy is defined as the patients’ rights to make decisions about their own lives and health without interference from the nurse, physician, or other team member that is included in the care. As a nurse this right must be respected.

Great post, I liked the way that, you have explained autonomy in your post. I think that you have made a great point that nurses are reasonable for their own profession autonomy by maintaining their license, along with, with the continuing their education throughout their practice. Thanks for sharing.

Watching the youtube video of how to effectively delegate had me realize even more so of the responsibility a registered nurse has. The video shows and states that a nurse is accountable for three aspects of delegation: decision to delegate, delegating tasks and client outcomes. Nurse’s need to take these roles seriously as it impacts them, the clients, employer, licensing board and the nursing profession. If I was in the scenario, caring for Mrs. Campbell would have been different by following the delegation process more closely. Multiple mistakes were made through the video, by inaccurately assessing the situation of how much care each patient needed and by providing the client with an individual that is not qualified

What I find most influential about the shared governance model when it comes to implementing evidence-based practice into the clinical setting is how the “model encourages clinicians to routinely question their practice” ( pg 326). The model provides structures, processes, and outcomes that support and reinforce professional autonomy in nursing (pg 326). It gives nurse the voice to be able to make the changes they want to see in their clinical practice.

I have similar experiences while delegating the tasks the nursing assistant. Once I had a patient with a Jackson Pratt (jp) drainage valve from her surgical site. The patient’s jp was getting full frequently. There was a nursing assistant who floated from another floor. I asked her if she knows how to empty the jp. She said she knew it. So, I told her to empty the jp and record output when I went to my lunch break. After lunch break, when I went to assess the patient I found out that she emptied the jp, however, she did not squeeze it to close the clamp. That’s why the JP Valve was empty. Because with jp, we need to squeeze it prior closing, so it would create vacuum and drain the body fluid. Later on, I thought I did not properly delegate

“The ability to delegate, assign, manage, and supervise is a critical competency for all healthcare workers, especially nurse leaders” (p. 435). This is true at my place of employment; its is required of the units charge nurse to delegate the days task to the licensed practical nurse, medication aides and certified nurses aids working. “Nursing delegation involves the transferring to a competent individual of the authority to perform a selected nursing task in a selected situation”. It's important to realize that delegation is not pushing a task onto another individual to lighten a nurse's work load, but that patients have multiple needs that can be met by multiple different healthcare providers, so that the nurse's time can be used more effectively

Managing the variety of interruptions throughout the day as a nurse is one of themain skills that need to be mastered. Inevitably people will want the nurse’s attention formultiple reasons, such as a family member asking for an update on their spouse. If thenurse is in the middle of medication administration, it is critical to communicateeffectively to other staff member, visitors and patients the importance of focusing on themedications given at that time to ensure patient safety. The nurse may need to delegatecertain tasks to other qualified staff members, in order to stay on time with medicationadministration for their patients. Preparing a priority list at the beginning of the shift willhelp organize the nurse’s schedule and be more likely

As healthcare providers, our role is to ensure the safety well-being of our patients and advocate appropriately with their best interest in mind. While it is important to be our patient’s advocate, we must also stay within the parameters that are set by our state governing boards. Although the 15 y/o is a runaway, it is more important that we assess the well-being of the teen mom, her infant, and maintain a trusting patient-provider relationship. I would ask the Nurse Manager to room the patient and baby, and keep others out of the room until after I perform a full physical on both of them. The time in the exam room will allow for further investigation of the current situation.

With the changing healthcare environment, the roles of nurses have also increased. Because nursing is becoming an independent profession, nurses also gained authority, autonomy and accountability in their practice. The increase of their practice role also means that they also carry a huge responsibility and accountability to patients. Furthermore, the increasing practice roles are putting nurses at high risk of being sued (Marquis & Huston, 2015). The National Practitioner Data Bank (NPDB) reported that the malpractice claims filed against nurses demonstrated an increase from 483 in 2003 to 711 in 2012 (Cooper, 2016).

Thank you for your post. I agree that the topic is broad; but you hit the mark when the nurses must take control of his practice in the daily basis. I feel the same way about the extensive work of nursing. You were right to say that one has to have the right mind-set and solid composure to meet the day in nursing. One of our theories mentioned that the more one knows himself, the more he’s capable of caring for the patient. I believe this is true, because it is a selfless, serving task the minute you take the patient assignment. Fortunately, nursing is also a very rewarding job and it happens in the environment when nurses have the autonomy of their practice and the effective team support of nurses. I remember during my early years

Did you know that nursing did not start out like how it is today? Yes, that’s correct! There has been numerous changes in the nursing field over the last hundred years. Let’s take a look at the factors that influenced the development of the nursing profession, the roles and responsibilities of nurses, and different career opportunities. These changes are what played a vital role in my desire to become a nurse.