Nursing priority and delegation

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Nursing priority and delegation
2011-01-28 11:57:29
priority delegation assignment decisions nursing

Prioritization, Delegation, and Assignment
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  1. Five Rights of Delegation
    Right task • Right circumstance • Right person • Right direction/communication • Right supervision/evaluation
  2. Avoid Crisis Management
    Gather materials • Cluster activities bath and dressing chg at the same time • Do not ignore your intuition • Clarify before beginning task • Stick to your schedule • Limit interruptions • Finding the fastest way
  3. Delegation
    Reassigning of responsibility for the performance of a job from one person to another (ANA, 1996) • Accountability remains with the delegator*** • The person to whom a task was delegated also have responsibility and accountability to accept the task and for their own action in carrying out the act.
  4. RN responsibilities that cannot be delegated: These are all Nx Process and remain our reponsibity
    Initial admission client assessment • Decisions & judgment on client outcomes • Formulation of client plan of care • Interventions requiring professional nursing judgment, decisions & skills • Evaluation of client care decisions & judgments
  5. Supervision
    the provision of guidance and direction, oversight, evaluation, and follow up by the licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel.
  6. Types of Delegation
    • Direct: A verbal direction regarding activity or task in a specific nursing scenario
    • Indirect: approved listing of activities or tasks established by policies and procedures this does not eliminate the responsibility of supervising
  7. Right Task Assigned to The Right Person
    The right task is one that in the RN’s best judgment can be safely delegated for this patient, given his current condition and future preferred outcomes, if there is a competent individual to perform it.
  8. Right Circumstance
    Know the rules and regulations of your practice area o Know the patient’s condition o Know the preferred patient results o Sometimes a best judgment must be made
  9. Maximize your time by:
    Set goals • Make a schedule • Write a to-do list Accucheck, Tx, Skin Checks (Things not routinely done, but are required that day) • Revise & modify the list keep list as a reference and to modify; also pass it on to next shift of not done • Identify time wasting behaviors
  10. Time Management
    What is the relative importance of each task? -How much time will each task require? Something may not be top priority but may only take a few min -When must the task be completed? Some things are non-negotiable meds -How much time & energy have to be devoted to these tasks?
  11. Maslow's Heirarchy of Needs
    • 1. Survival needs (air, food and water)
    • 2. Safety and security
    • 3. Affiliation (love, relationships)
    • 4. Self esteem
    • 5. Self-actualization
  12. Levels of priority setting:
    Airway, breathing, cardiac/circulation, vital signs (ABCs plus V) • Mental status changes, untreated medical issues, acute pain, acute elimination problems can lead to circulation or airway problems, abnormal lab results, and risk • Health problems other then what is found at the first two levels such as long term issues in health education, rest, coping and so on One issue is setting a schedule and then unanticipated events impacting that schedule. As a nurse you must adapt; Also personal time wasting issues. Identification of time management issues is critical to efficient care.
  13. What is prioritization?
    Deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent.  Organizing activities from the most important to the least important
  14. 5 Factors that indicate the right circumstance to delegate?
    • 1. Know potential for harm to pt
    • 2. Complexity of Nx activity
    • 3. Extent of problem solving and innovation required 4. Predictability of outcome
    • 5. Extent of Interaction
  15. Delegating to the right person
    • 1. RN must know the licensure, role, and preparation of each member of the team
    • 2. RN must know the job description of coworkers and scope of practice
    • 3. Identify strengths and weaknesses of team members
    • 4. Temporary staff
    • • Ask about previous experiences • Ask if they understand their work duties • Assign a resource person to assist them buddy them with someone
  16. What are the 4 C's of the Right Communication/direction?
    • 1. Clear you may need to ask that the direction be restated
    • 2. Concise no extraneous information that can confuse them
    • 3. Correct accuracy is key for beneficial outcomes 4. Complete incomplete instructions are a set-up for substandard care and ultimately you are responsible for the outcome
  17. The right supervision consists of?
    • The RN is accountable for the total care of the patients throughout the shift • RN may not actually perform the task but must oversee the ongoing progress and results obtained You cannot delegate and never follow up. YOU MUST FOLLOW UP. Task list is helpful to remember evaluation
  18. SBAR
    • • Situation-what is happening at the present time
    • • Background-What are the circumstances leading up to the situation
    • • Assessment-What do I think the problem is
    • • Recommendation-What should we do to correct the problem
  19. Benefits of SBAR?
    • • For GN’s- helps them get organized and know what to report
    • • For experienced RNs-allows them to make recommendations
    • • For physicians-nurses get right to the point/know what they are asking
  20. Making an assignment:
    • • The distribution of work that each staff member is to accomplish on a given shift or work period
    • • Does the person have the skill/experience to perform this specific task When a charge nurse is making an assignment, they are transferring responsibility.
    • This is different than delegation, which ultimately, the nurse is responsible for.
  21. What are the types of nursing care delivery systems?
    • 1. Team nursing-mix of staff that is responsible for providing care to a group of assigned patients during the shift
    • 2. Functional nursing-assembly line style of management that focuses on division of labor and tasks that need to be completed
    • 3. Primary care nursing-an RN is responsible for the care of the patient for 24 hours a day for the patient’s entire hospital stay with the aid of associate nurses and other staff members
  22. What are the criteria to take into account when creating an assignment?
    • • How complex is the patients’ required care?
    • • What are the dynamics of patients’ status and their stability?
    • • How complex is the assessment and ongoing evaluation?
    • • What kind of infection control is necessary?
    • • Are there any individual safety precautions?
    • • Is there special technology involved in the care and who is skilled in its use?
    • • How much supervision and oversight will be needed based on the staff’s numbers and expertise?
  23. Tasks that an RN cannot delegate are?
    Decisions and judgements about patient outcomes & initial assessments.
  24. An approved listing of activities or tasks that have been established
    in policies and procedures of the health-care institution or facility
    is an example of:
    Indirect delegation
  25. The reassigning of responsibilities for the performance of a job from one to another is called:
  26. Before a nurse decides who should care for a particular patient, the nurse must:
    Assess, plan, implement, and evaluate
  27. The Delegation Decision-Making Grid:
    Provides a scoring instrument for seven categories that assist an RN when making delegation decisions
  28. Health-care institutions often use unlicensed assistive personnel (UAP). UAPs function as:
    Assistive to the RN
  29. The purpose of delegation is so that the RN can:
    Have more time to perform tasks only a professional nurse is permitted to do
  30. hen all members of the team know their jobs and responsibilities and work together like gears in a well-built clock, this is called:
  31. According to the American Nurses Association (ANA), specific overlying principles remain firm regarding delegation. These principles include:
    The RN has the duty to be accountable for personal actions. The RN directs care. The RN accepts responsibility.
  32. Verbal direction by the RN delegator regarding an activity or task in a specific nursing care situation is referred to as:
    Direct Delegation
  33. The charge nurse and is setting up the day's assignments. A newly licensed RN has been floated to the unit. What is most important for
    the charge nurse to consider when making the assignment for this RN?
    The RN's Knowledge base and level of skill
  34. The RN has delegated the care of a fresh postoperative patient to the LPN on the team. The LPN notifies the RN that the patient's vital
    signs are elevated and that the patient is complaining of pain and dyspnea. Which is the most appropriate action to be taken by the RN?
    Assess the client and analyze the preoperative and perioperative data before calling the surgeon
  35. A patient recovering from CHF, is being discharged and needs teaching reinforced. Who is the appropriate caregiver to complete this
  36. A nurse for 10 years is precepting a new RN. The new RN is having difficulty prioritizing patient care. The preceptor explains that prioritizing patient care is based on what criteria?
    Maslow's Heirarchy
  37. A male is admitted through the emergency department after being involved in a motor vehicle accident. His airbag failed to deploy, and
    he was hit in the abdomen with the steering wheel. He has an IV of 0.9% NS @ 100 mL/hr, BP 92/58, and complains of weakness, fatigue, and
    abdominal pain. On assessment, the nurse discovers that he is nauseated and just vomited 560 mL. The nurse is quite busy and decides to
    delegate patient care activities to the nursing assistant. Which activity should the nurse keep?
    • A. Increase the IV rate to 250 mL/hr if the blood pressure drops to 85/50
    • B. Obtain a baseline weight to guide therapy
    • C. Taking and recording vital signs every 15 minutes
    • D. Recording accurate intake and output
  38. The nurse manager tells Luci, a RN, that the ICU needs more help and as she is the most experienced RN on this unit, she is being
    reassigned to work in the ICU for the day. Luci tells the nurse manager that although she is the most experienced, she has never worked in the
    ICU. She shares her concerns with the nurse manager regarding the lack of familiarity with the technical equipment and protocols of the ICU.
    The nurse manager states that she understands Luci's concern and reluctance; however, Luci is to go to the ICU. What is the most appropriate action Luci should take?
    • A. Refuse to go to the ICU
    • B. Go to the ICU and inform the charge nurse of the tasks she isable to perform and those tasks with which she feels she needs assistance
    • C. Go to the ICU and tell the charge nurse that she is ill and needs to go home
    • D. Call the nurse manager's supervisor and report her for unsafe delegation
  39. Which tasks could be delegated to a unlicensed assistive personnel (UAP)? (Select all that apply)
    • A. Vital signs every 2 hours on a patient with pancreatitis
    • B. Assisting a patient who is experiencing diarrhea with perineal care
    • C. Assessing a patient for perianal excoriation while performing perineal care
    • D. Reporting the quality & color of a patient's NG drainage
    • E. Transportation of a patient to radiology
  40. The associate nurse manager of a busy postpartum unit has a staff of both RNs and UAPs. What criteria is most important in determining each staff member’s assignment?
    • A. Scope of practice
    • B. Ability to perform the task
    • C. Length of service
    • D. Job Title
  41. The RN who is the team leader preparing to make assignments to the nursing team members. What criteria is most important in determining each staff member’s assignment?
    • A. The desires of the team members
    • B. The number of shifts the staff are scheduled for
    • C. The condition and needs of each patient
    • D. The physicians preference for who cares for their patients
  42. Which tasks are within a LPN's scope of practice? (Select all that apply)
    • A. Performing a complex dressing change
    • B. Giving IV push medications
    • C. Formulating a patient's plan of care
    • D. Hanging a blood transfusion
    • E. Administering IV piggybacks