Delegation/Priority setting

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  1. Key words
    • delegation
    • responsibility
    • authority
    • accoutability
    • supervision
  2. Delegation
    • assigning job activities/corresponding authority to specific individuals within an organizatio orĀ 
    • careful assessment of what work can be effectively completed by others
  3. delegation nursing
    • transferring to a competent individual the authority and responsibility to perform a selected nursing task in a selected situation
    • for certain situation ok, others may not be ok
  4. RN delegate 2 things
    • collection of some data ie amount urine in foley, vs etc
    • implementation of some tasks: feeding pt (who is stable), bed making
  5. responsibility and authority
    • responsibility: the obligation or requirement to complete the assigned work
    • authority: giving official approval
    • - you as a rn will have lpn or cna working with you
    • - can introduce cna to pt or write name on the board
  6. nurses retain accountability
    nurses are responsible for delegating the task and taking action if something goes wrong
  7. Supervision
    • provision of guidance by a qualified nurse for the accomplishment of nursing task or activity AND periodic inspection of the act of accomplishing the task of activity (national council of state BON
    • this organization is to protect the public/patient
    • gives you your license and can take it away
    • periodic inspection: check and ask questio
    • always talk to the cna to see what they understand and know
  8. Delegatig to CNA/UAP
    • repetitive, routine, predictable tasks are easiest to delegate
    • bed making, feeding a stable pt, bathing, VS, TWE* (tap water enemas), DSD (dry sterile dressing)
    • with TWE u have to inspect the results so u can tell cna to save
    • most RN's do the DSD bc u have to assess the wound- bc they cannot assess
  9. Bedmaking rn time gained
    • 8 beds per day- 1 hr per day
    • 7 hr per week
    • 365 hr per year
    • 45 days per yr
  10. Barriers to effective delegation
    Non productive leadership styles

    • manager as the sacrifical lamb: sees themselves as nobleperson who always stay overtime to finish things up. irritable personality and they think they are great
    • 2. manager as high priest/priestress: working for some higher authority, "keeping things to themselves"- if anything new comes it they won't share. hard to trust. easily threaten
    • 3. manager as mother: rn stepping in all the time. nurtuers but no constuctive feedback. usually liked bc they will jump in to help. not good for cna for learning purposes
    • not testing us on this
  11. Non productive follower styles
    • 1. appliance nurse: working till I get a new care. you hope that people are looking at it as a career. never sees the larger picture
    • 2. doomsayer: pessimist, everything is a problem. nothing will work out. never come up with a solution. not a problem solver
    • 3. subversite: takes pessism one step further. undermine nurse. will report u to the nurse manager. can't trust- dangerous
    • 4. accommodater: yes ma;am people could be dangerous. they will do what u ask but they will never speak up to tell u that they aren't comfortable.
  12. Additional barriers to effective delegation
    • 1. lack of experience
    • 2. preference to complete task alone- feeling in control
    • 3. not trusting others' skills- don't trust anyone
    • 4. fear of being rejected or not liked- dont want to tell people what to do cause person may not liked u
    • 5. unable to tolerate mistake- like little things
    • 6. desire to perfect and receive recognition
    • 7. believe too much time is required- like it is quicker for u to do it.
    • 8. legal ramification- like someone working under your license
  13. Requirements for delegating duties and task
    • 1. determine the extent and complexity of client needs or nature of work delegated. what do u need to do with/for this patient
    • 2. identify the employee to whom the taks or duties are to be delegated- team? who are u working with
    • 3. determine that the work is consistent with employees position description and normal duties as well as state BORN rules related to NP acys
    • 4. clearly communicate expectations and desired results using concrete, measurable, understandable, terms (time frame what to report)- ex give parameters, time frame, regarding bp values etc
    • NP act- nothing overrides this, ultimate authority
    • - state to state may vary
    • - regulate practice in nursing
    • - employee policy cannot override this
    • - improve school of nursing
  14. requirements for delegating duties and tasks
    • 5. obtain employee's voluntary acceptance of work- are u comfortable/do u want me to go with u
    • 6. keep communication open
    • 7. compare results with goals, provide constructive feedback and earned praise for a job well done
    • 8. say thank you
    • 9. practice practice practice
  15. 5 rights of delegation
    • right task- can this be delegated (know NP act, job description)
    • Right circumstance- can they feed pt? is pt stable?
    • right person- LPN CNA
    • Right direction/communication: when u need something parameters if needed
    • Right supervision/evaluation- if u are delegating an activity u should be available if needed
  16. do not delegate what u cannot EAT
    • E- evaluate
    • A- assess
    • T- teach
  17. LPNs should be assigned to stable patients with predictable outcomes
    • MA BORN regulates re LPN:
    • * assess an individual's basic health status, records ad related health data
    • * participate in analyzing and interpreting said recorded data and making informed judgements as to specific elements of nursing care mandated by a particular situation
  18. LPN role cont
    • participate in planning and implementing nursing intervention
    • incorporate the prescribed medical regimen into nursing plan of care
    • participate in health teaching
    • when approriate, evaluate basic nursing interventions, encourage change of plan of care
    • collaborate, cooperate and communicate with other health care providers
    • (work with pts)
  19. Stable v unstable patiet
    • look at clinical pictures represented by VS- HR, O2 stat, temp, CBG
    • look at clinical picture represented by signs ad symptoms such as LOC, RR, and character, skin color, skin temp, diaphoresis
  20. BH policy to LPN medication administration
    • may hang and monitor IV fluids
    • peripheral TPN (prepared by pharmacy or manufacturer, calculations done by RN)
    • not central line but picc line yes bc less concentracted
  21. LPNS may not
    • administer central line meds, IV push med, blood products or ay of the following IM/IV antineoplastics (cancer), oxytoxics, antiarrythmics, investigational, epidural, IV meds that alter BP, IV insulin, or Rh immune Glogulin
    • RN should supervise the 1st dose of any peripheral IV med
  22. Priority level for pt care
    • maslow's hierarchy
    • the bottom of the pyramid
    • physiologic needs: top priority
    • most critical
  23. Priority levels for pt care level 1
    • immediate airway and breathing problems
    • circulation problems
    • (ex pulmonary edema, hemorrhage)
  24. Priority level 2 and 3
    • level 2:
    • sudden changes in level of consciousness- could be due to oxygen
    • level 3:
    • new onset vital sign change: increases and decreasing
  25. Priority level 4
    • unstable metabolic disorder ex:
    • severe hypo/hyperglycemia
    • (unless mental status changes have already occured which moves pt to level 2)- pt is symptomatic
    • severe electrolyte abnormality
  26. Priority level 5 &6
    • level 5 complaints of pain especially post op (except chest pain- could be PE level 1)
    • Level 6: performance of complex treatment of techniques (tubes and dressings). making referrals to other HCP's
  27. Priority level 7
    family and significant other meetings, discharge teaching
  28. guidlines for answering priority questions
    • apply the nursing process
    • if priority question as which step to implement first, look for an answer that would ASSESS for the problem discussed in the stem of the question
    • numerous words can be used to indicate assessments
  29. priority questions that ask which action should the nurse take first
    • determine
    • which intervention should occur FIRST in a sequence of events
    • which intervention directly affects the situation
  30. priority questions that ask what should the nurse do next
    • determine from information given in the stem which steps of the P have been completed (assessment, dx, planning, implementation, evaluation)
    • choose an option that matches the next step in NP
    • if NP cannot help try maslow or priority levels.
  31. priority question that ask which client should the nurse assess first
    • look at each option and determine whether the s/s the pt is exhibiting are normal or expected for the disease process. if yes nurse usually doe ot need to assess that pt first
    • if 2 or more of the options state s/s that are not normal or expected for the disese process, then select option that is greatest potential for a poor outcome
  32. look at each option to determine priority by asking the following questions
    • 1. is the situation life threatening or life altering
    • 2. is the situation unexpected for the disease process
    • 3. are the lab data abnormal
    • 4. is the situation expected for the disease process
    • 5. is the situation or is the data normal?
Card Set:
Delegation/Priority setting
2015-09-12 19:42:14
del pri

how to delegate and prioritize
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