Nursing Five Rights of Delegation Discussion
Nursing Five Rights of Delegation Discussion
ORDER NOW FOR AN ORIGINAL PAPER!!!NUR 514 Nursing Five Rights of Delegation Discussion
1. Why is it important that registered nurses delegate effectively?
2. State the five rights of delegation, choose one, and discuss how its absence poses hazards to patients.
3. Identify educational experiences that have prepared you to function in the role of supervisor of LPNs/LVNs and UAP.
Note: I am BSN (Bachelor of sciences in nursing) student in my last 2 semester and would graduates this December. I am also a certified nursing assistant. This information will help with question 3
4. For which functions do you believe you are well prepared, and for which do you feel less prepared? Discuss how you will improve on your perceived deficits
Effective delegation and supervision Barbara Cherry, DNSc, MBA, RN, NEA-BC, Margaret Elizabeth Strong, DNP, RN, NE-BC Source: Delegation—linking together for better care. Additional resources at: http://evolve.elsevier.com/Cherry/ are Learning outcomes After studying this chapter, the reader will be able to: available online 1. 1. Evaluate the effect of changes in the current health care system on nurse staffing patterns and responsibilities. 2. 2. Outline six topic areas that the professional nurse should consider when making delegation decisions. 3. 3. List nine essential requirements for safe and effective delegation. 4. 4. Incorporate principles of delegation and supervision into professional nursing practice to ensure safe and legal patient care. KEY TERMS Accountability “To be answerable to oneself and others for one’s own choices, decisions and actions” (American Nurses Association [ANA], 2015a). Assignment The distribution of work that each staff member is responsible for during a given work period; includes routine care, activities, and procedures that are within the staff member’s authorized scope of practice and/or job description (National Council of State Boards of Nursing [NCSBN], 2016; ANA and NCSBN, 2014). Competency The ability of an individual to perform defined behaviors proficiently by demonstrating the appropriate knowledge, skills, attitudes, and professional judgment required for a specific role or setting. Delegation Transferring to a competent staff member the authority and responsibility to perform a selected nursing task that the staff member would not normally be allowed to perform; the RN retains accountability for the delegated task (ANA and NCSBN, 2014). Supervision The active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity or task (ANA, 2012). Unlicensed assistive personnel (UAP) Individuals who have not received practice licenses but who are trained to function in an assistive role to the RN by performing patient care activities as delegated by the nurse; may include nursing assistants, clinical assistants, orderlies, health aides, and those with other titles designated within the work setting (NCSBN, 2016). Professional/ethical issue Nicole Adams, Registered Nurse (RN), has taken a position as the new charge nurse for a 24-bed medical-surgical unit at a long-term acute care and rehabilitation hospital. Nursing Five Rights of Delegation Discussion
Nicole is excited about this new opportunity but is apprehensive because this is her first position as a charge nurse. After completing the hospital’s orientation program, Nicole reports to her unit for her first official day as charge nurse. She is immediately approached by a licensed practical nurse (LPN), who says, “I’ve worked here for 8 years and I always can take care of everything. I’ll complete all patient assessments and let you know about anything you might need to follow up with.” Nicole is alarmed about this statement but knows she must handle the situation carefully to ensure she follows safe delegation practices while also developing a good working relationship with the LPN. Discuss what elements of delegation Nicole should consider in this situation and what the best approach with the LPN might be. Vignette Glenda Miller, BSN (Bachelor of Science in Nursing), RN, is the charge nurse on a medical-surgical floor of a hospital. She has just received report from the 7 pm to 7 am shift and is about to make assignments for the 7 AM to 7 PM shift. The philosophy of the unit is that the RN coordinates all patient care. Today on this 12-bed unit there are eight patients and four empty beds. The nursing staff consists of Ms. Miller, one RN, one LPN, one nursing assistant, and one unit secretary. The following interprofessional team members are available for specific patient care needs: respiratory therapist, physical therapist, occupational therapist, speech therapist, medical social worker, and chaplain. The patients are medically complex with extensive nursing care needs, including psychosocial and emotional support. The patients are described to Ms. Miller as follows: • 502: Mr. A. is ventilator dependent with an infection that requires intravenous (IV) antibiotics every 12 hours. He needs to be out of bed in a chair twice a day. He has a stage I sacral decubitus ulcer and a percutaneous endoscopic gastrostomy (PEG) tube with bolus feedings. He is very hard of hearing, tries to speak, and becomes very frustrated and uncooperative. • 503: Mrs. B., age 77, is on day 2 of 40 days of antibiotics for osteomyelitis. She is dehydrated with a central line in her right subclavian and on total parenteral nutrition (TPN). She needs to be out of bed and ambulated in the room. She receives a respiratory treatment every 4 hours and needs assistance with am care. Her daughter is at her bedside and is very upset that her mother may need to go to a nursing home. • 504: Mr. C., age 52, is to be discharged to a rehabilitation hospital today. Discharge records need to be prepared for the transfer. The family is at his bedside and is extremely anxious. • 507: Mr. D., age 64, has TPN infusing into a left subclavian catheter and is on multiple antibiotics. He has vancomycinresistant Enterococcus in his urine and a stasis ulcer on his left leg that requires Pulsavac treatment every day. • 508: Mr. E., age 72, is a ventilator-dependent patient who will start weaning this am. Nursing Five Rights of Delegation Discussion
He is on continuous tube feedings and IV antibiotics and needs to be assessed for a peripherally inserted central catheter (PICC) line. He is to begin ambulation in the hall twice a day per physician’s orders. He also needs to have a pharyngeal speech evaluation scheduled. • 509: Mrs. F., age 66, is 3 days post cerebrovascular accident (CVA) and unable to move her right extremities. She has an IV infusing via her left arm. Her blood pressure is 170/100. She needs total care with personal hygiene and feeding. The physician just ordered range-ofmotion exercises every day. Her husband is at her bedside crying continually and asking, “What am I going to do now?” • 510: Mr. G., age 52, has been off the ventilator for the past 24 hours and is doing very well. He continues on respiratory treatments every 4 hours. His TPN is being decreased, and his PEG feedings are increasing. Glucose monitoring has been ordered every 4 hours and IV antibiotics every 12 hours. He has an indwelling urinary catheter to gravity drainage. He needs to be out of bed, ambulating in the hall with assistance. If he stays off the ventilator, he will be discharged in 5 days. The family needs to find a nursing home for him; however, the family has not visited Mr. G. since his admission 18 days ago. • 511: Mr. H., age 49, is a new admission who will be coming from the intensive care unit (ICU) sometime during the shift. In addition to the tasks mentioned, routine activities of taking vital signs, giving scheduled medications, updating care plans, and answering call lights must be assigned. When reviewing the tasks to be accomplished, Ms. Miller must consider several issues to make safe and effective assignment and delegation decisions. Questions to consider while reading this chapter: 1. 1. Which of the tasks listed in the vignette must the RN perform as required by your state’s nurse practice act? 2. 2. Which of these tasks can be delegated to the nursing assistant? 3. 3. How can the training, skills, and competencies of the LPN or licensed vocational nurse (LVN) and nursing assistant be determined? 4. 4. How can other members of the interprofessional health care team contribute most effectively to meet patients’ needs? Chapter overview The safe and effective delivery of patient care is the fundamental goal of every health care organization. Nursing Five Rights of Delegation Discussion
To accomplish this goal cost effectively, teams of diverse professionals and assistants are used to deliver care. Because the RN is most often responsible for coordinating care provided by the various team members, he or she must clearly understand and be able to effectively use the management processes of delegation and supervision to ensure high-quality, safe patient care. This chapter highlights issues that influence staffing patterns and the delegation and supervision processes. The chapter also discusses the RN’s role and responsibility in delegating to and supervising staff members, including unlicensed assistive personnel (UAP) and LPNs or LVNs, and provides useful guidelines for establishing a safe and effective delegation and supervision practice. Delegation and supervision in the health care system In today’s complex health care environment, nursing must be knowledge-based, not task-based. Nurses are accountable to provide “culturally sensitive, safe, timely, efficient, patient-centered, equitable, and effective nursing care for consumers in a variety of settings across the continuum of health care” (ANA, 2012). Several factors influence staffing patterns and the provision of patient care across multiple health care settings from hospitals to home health. First, reduced reimbursement from Medicare, Medicaid, and private insurance companies has led to cost-cutting measures. Second, the Patient Protection and Affordable Care Act has allowed more people to have health insurance, so more people are seeking health care. Third, the consumer is now paying a higher co-pay for care and is demanding that care be provided in an effective and efficient manner. Fourth, the strong focus on safety and quality is requiring health care systems to make rapid changes for continual improvement. Fifth, advances in medical technology are causing a sharp increase in the cost of providing care. Finally, an increase in patient acuity (severity of illness) and complex treatments contribute to health care environments struggling to address multiple complex priorities with dwindling resources. Using unlicensed assistive personnel (UAP), such as nursing assistants and patient care technicians, is one strategy to increase the costeffectiveness of providing patient care. As the use of UAP increases, the RN is obligated to delegate more tasks to people who do not have clearly defined parameters for education, training, job responsibilities, and role limitations. The RN must know that the profession defines the scope and standards of practice, and that the state nurse practice acts define the legal parameters for nursing practice (NCSBN, 2016). It is important that the RN work closely with nonclinical administrators and managers to make sure they understand that the nursing process cannot be delegated to anybody other than the RN. In support of the role of UAP in delivering patient care, the Joint Statement on Delegation (ANA and NCSBN, 2014) states, “There is a need and a place for competent, appropriately supervised, unlicensed assistive personnel in the delivery of affordable, quality health care.” As health care facilities continue to seek more cost-effective ways to provide care, RNs must learn new ways of managing care and delegating tasks. What is delegation? Delegation is a legal and management concept that involves assessment, planning, intervention, and evaluation. Delegation, as defined by the American Nurses Association (ANA, 2015b), is “the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.” Although RNs can transfer the responsibility and authority for the performance of an activity, they remain accountable for the overall nursing care. When delegating tasks, the nurse should understand the delegatee’s competencies, communicate succinctly, offer clear guidelines in advance, monitor progress, and remain accountable for the final outcomes of care. Delegation is a two-way process in which the RN requests that a qualified staff member perform a specific task. When delegating, the RN delegator is accountable for (NCSBN, 2016): • • Determining patient needs and when to delegate. • • Being available to the delegatee. • • Assessment and follow-up evaluation. • • Any intervention or corrective actions that may be required to ensure safe and effective care. The delegatee is accountable for: • • His or her own actions. • • Accepting delegation within the parameters of his or her competency level. • • Communicating the appropriate information to the delegator Nursing Five Rights of Delegation Discussion