As a new nurse, you cannot provide safe care to your clients if you don't know how to
-manage care
-assign care
-supervise care
-prioritize
... [Show More] care
The judgments you make in management situations have to be based on
med-surg knowledge
If you don't understand disease processes, you cannot
set priorities of care or determine which staff member would be best to take care of the client
You MUST know your _______________________, and then you can move on to ________________________
core content; management decisions
Assignments include
the routine care, activities, and procedures that are within the authorized scope of practice of the RN, LPN/LVN, or part of the routine functions of the UAP
Assignment is the sharing of
routine work that each staff member is responsible for during a given shift or work period
The assigned tasks should be part of
the course work taught in the basic educational program of the staff member
Delegation is
allowing a specific task to be performed that is not routinely performed and is BEYOND the traditional role of the individual to which the nursing activity skill, or procedure is delegated
The key is that the staff member who is delegated the task has
received additional training or education and has validated competency to perform the delegated task
You can delegate the responsibility of the task, but you cannot
delegate the ultimate accountability
The RN is accountable for
ALL aspects of nursing care that are being provided including the choices you make about who is considered competent to perform each task
What are the 5 rights of delegation?
1. right person
2. right circumstances
3. right task
4. right direction/communication
5. right supervision and evaluation/feedback
The Right Task: What is the traditional role of the UAP?
UAP is an umbrella term that NCSBN defines as any unlicensed personnel trained to function in a supportive nursing role, regardless of the title
The Right Task: What type of clients can the RN delegate to the UAP?
-perform tasks on STABLE clients in uncomplicated
situations
-routine, simple, repetitive, common activites that do NOT require nursing judgment
The Right Task: Examples of tasks that the UAP can perform?
-hygiene
-feeding
-I&O
-routine vital signs
-ambulation
EVERYDAY THINGS!
The Right Task: Can a UAP take VS ona client receiving IV Dopamine?
no, because it requires nursing judgment
The Right Task: Can the UAP provide a total bed bath and dress the client?
yes
The Right Task: Can the UAP serve meals and assist with eating?
yes
The Right Task: Can the UAP obtain a urine specimen from a catheter?
no, this is a sterile procedure
The Right Task: Can the UAP turn the client every 2 hours and provide skin care?
yes
The Right Task: Can the UAP assist the client to the bathroom with a walker?
yes
The Right Task: Can the UAP perform a fleet enema?
no, because this is a medicated procedure
The Right Task: Can the UAP answer the client's call light?
yes
The Right Task: Can the UAP clean and sanitize the client's room?
yes
The Right Task: Can the UAP change the linen on a totally bedridden client?
yes
The Right Task: Can the UAP provide mouth care and denture cleansing?
yes
The Right Task: UAPs CAN'T do
medications
The Right Task: What tasks can the LPN perform?
-data collection
-NO assessment
-updating client data
-NO evaluation (involves assessment)
-NO admission hx
The Right Task: The RN NEVER delegates or assigns tasks that involve
assessment
The Right Task: The LPN can assist the RN in data collection, but that is NOT
assessment in the NCLEX world
The Right Task: After the initial assessment, the LPN
updates client data
The Right Task: Can the LPN evaluate the client to determine if a goal has been met?
no
The Right Task: The LPN cannot do any form of _____________________, because _________________________________
evaluation; evaluation involves assessment, and we NEVER assign or delegate assessment or judgment
The Right Task: Who must do the admission history?
the RN
The Right Task: If someone else, such as an LPN, collects the admission data for you, NEVER
sign off on the form until you have validated the data
The Right Task: Can the LPN implement tasks on the plan of care?
yes
The Right Task: Can a LPN devise a teaching plan for a newly diagnosed diabetic?
no, ONLY the RN can plan care
The Right Task: LPNs can do teaching, but
it's basic standardized teaching or reinforcing teaching
The Right Task: Can the LPN data collect, monitor and observe?
yes
The Right Task: Can the LPN reinforce teaching from plan of care?
yes
The Right Task: Can the LPN administer IVPB medication?
yes
The Right Task: Can the LPN administer IVP pain medications?
NO
The Right Task: Can the LPN initiate transfusion of blood products?
NO
The Right Task: Can the LPN monitor transfusion of blood products?
yes
The Right Task: Can the LPN administer meds & nutrition via NG tube, G-tube or button, J-tube?
yes
The Right Task: Can the LPN insert, maintain and remove urinary catheters?
yes
The Right Task: Can the LPN maintain and remove peripheral IV catheters?
yes
The Right Task: Can the LPN calculate and monitor IV flow rate?
yes
The Right Task: What type of clients can the RN assign to the LPN?
stable clients
The Right Task: An unstable client is
medically fragile and requires an increased level of care
The Right Task: A client can be
complex and stable at the same time
The Right Task: DON'T let a complex, chronic diagnosis make you think the client is
unstable and has to be seen only by the RN
The Right Task: Always consider a new admit
unstable
The Right Task: The RN should assess the newly admitted client ____________. The new admission is your __________________________
FIRST; responsibility or priority
The Right Task: Is the diabetic client with low blood sugar stable or unstable?
unstable
The Right Task: Is the client returning from an invasive procedure stable or unstable?
unstable
The Right Task: Is the client with neurological problems, stable VS, no change in LOC/neuro checks stable or unstable?
stable
The Right Task: Is the client with acid-base imbalance and respiratory distress with unstable VS stable or unstable?
unstable
The Right Task: Is the client with chronic HTN, hx of angina controlled with meds and living alone stable or unstable?
stable
The Right Task: Is the client with HIV+, medication compliance and working full time stable or unstable?
stable
The Right Task: Acid-base imbalance makes a client
unstable 99% of the time
The Right Task: Can the LPN perform any tasks in an unstable situation?
yes! they can help the RN by taking BP, getting a crash cart, etc
The Right Circumstance: First, the right circumstance could be influenced by the
work setting
The Right Circumstance: LPNs and RNs function in different roles depending on
the work place
The Right Circumstance: Another factor that influences the right circumstance is
a change in the client status from stable to unstable
The Right Circumstance: Client conditions can change and the LPN or UAP must
report this to the RN (RN should reassess right away)
The Right Circumstance: If you're unsure if the UAP can perform a procedure,
go with them yourself and make sure no harm is done
The Right Circumstance: When staff members are pulled to a new floor, you should
pretend they are a brand new nurse all over again
The Right Circumstance: Do not give a nurse from another floor any clients requiring
specialized care
The Right Circumstance: Routine task assignments can change based on
the circumstance
The Right Circumstance: The same activity may
differ in each situation
The Right Circumstance: We know that feeding a healthy client who has 2 broken arms is different than
feeding a client who has dysphagia
The Right Circumstance: Bathing a weak client is not the same as
bathing a client who is severely burned
The Right Circumstance: If there is ever a degree of potential harm, the RN
must retain the task, no matter how routine it is
The Right Person: Know the scope of practice as defined by
your state (read the Nurse Practice Act)
The Right Person: Know the job descriptions of
the staff that work with you
The Right Person: Don't assume someone is competent to do something just because
of their job description
The Right Person: It is the RN's responsibility to figure out the staff's _______________________. Know their ______________________________
strength and weaknesses; knowledge level and skills
The Right Person: What should you do about a hospice or grieving client?
send your most compassionate nurse
The Right Person: What should you do about the child who needs an IV started?
choose the most experienced IV nurse and send the new RN with them to be mentored
Right Direction and Communication: The RN is responsible for providing
clear, concise, correct, and complete communication to nursing staff at the time of delegation, as well as providing continued direction on an ongoing basis
Right Direction and Communication: You must communicate a __________________ and the ______________________
time frame; priority of the task
Right Direction and Communication: Tell what you want done ___________, and what you want done in a __________________________
first; particular time frame
Right Direction and Communication: Provide specific directions and expectations of how you want the task to be performed and
describe the findings you want to be reported
Right Supervision and Evaluation or Feedback: You must _____________, ____________, and ____________________ the carrying out of any delegated task
guide; supervise; evaluate
Right Supervision and Evaluation or Feedback: You must follow up to
see that the nursing tasks that you delegated are done properly
Right Supervision and Evaluation or Feedback: We need to ask these 3 questions after a delegated task is completed
1. was the task done properly & in a safe manner?
2. was the task done in the proper time frame?
3. were the client's needs met?
Right Supervision and Evaluation or Feedback: When a task is performed and you identify a weakness, you are supposed to
teach, teach, teach
Transferring Care Between RNs: RN to RN transfer of care is called
a handoff and transfers BOTH responsibility and accountability
Priorities of Care: Priority questions are considered
management of care
Priorities of Care: You will go see all of the clients, but you have to
set priorities and go see the one who has the most life-threatening condition first
Privacy: We are responsible for keeping all client information
confidential
Privacy: You CANNOT post pictures of your client on
social media
Privacy: Social media posts violate the clients'
right to privacy
Privacy: Violations infringe on ____________________________ and could lead to _______________________________________
federal privacy laws; job loss, action by the board of nursing, or even the loss of your license
Privacy: You are the client ________________ and are responsible for _________________________________________
advocate; making sure that client privacy and confidentiality are maintained
Privacy: Confidentiality and privacy should be maintained with
conversations, electronic records, or any sources of client information
Privacy: You can NOT access a client's record that
you are not responsible for providing care to
Organ Donation: Organ donation decision made by a minor can be
refused by the family, regardless of presence of documentation of organ donation wishes by the client
Organ Donation: Laws impacting the rights of the family to overturn documented wishes for organ donation in non-minors can
vary from state to state [Show Less]