Prioritization and Delegation
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What is Nursing?
“Nursing is the diagnosis and treatment of human responses to actual and potential health problems.”
Cues for Setting Priorities
The RN must decide the priorities of care
Maslow’s Heirarchy of Needs
Acute vs Chronic
Patient safety is always a first priority
Maslow’s Hierarchy of Needs
Self Confidence, Achievement, Self Worth
Love & Belonging, Friendship, Love, Social Relationships
Safety & Security Needs
Air, Water, Food
those client needs with highest priority
Basic survival needs
Life-threatening client problems
Safety of client and/or nurse
focus on medium and low priorities. These are problems that do not impede medical treatment but require early resolution and have potential to impair functioning or normal growth and development.
client problem does not need immediate attention
An illness with an abrupt onset and usually a short course.
An illness that persists for a long period of time. It is a continuing disease process.
Delegation according to the ANA
According to the American Nurses’ Association (ANA):
The reassigning of responsibility for the performance of a job from one person to another
a process that transfers to a competent individual the authority to perform a selected nursing task in a specific situation.
The responsibility for the task is transferred.
Accountability remains with the person who is delegating tasks
means that the nurse is legally liable for her actions and is answerable for the overall nursing care of her patients.
involves reliability, dependability, and the obligation to accomplish work. Responsibility also includes each person’s obligation to perform at an acceptable level.
Usually verbal direction
The registered nurse (RN) decides which staff member is capable of performing a specific task
Lpn and assistance do not delegate
Usually in a nursing home lpns can delegate
Assign staff members who have the appropriate level of expertise that is necessary to deliver the patient care and perform the activities.
The RN may assign a more skilled individual to perform specific tasks.
- The RN may not assign an individual to perform a task that is outside that individual’s job
- description or scope of practice.
5 Rights of Delegation
Directions for Delegation
Priority of activity
Guidelines for reporting task completion
Use of written and visual resources may be used to reinforce direction
Delegation Red Flags
Refusal to accept delegation
Failure to confirm expectations
Failure to communicate
** Your delegation may be inappropriate
Take a step back and see what is wrong did you say things correctly do they understand is there a problem and is it you before it is them for delegation
The LPN/LVN can…
Perform routine assessments and skills
Deliver basic care
Perform routine tasks with predictable outcomes
Perform routine wound care/dressing changes
Perform uncomplicated sterile procedures (wound dressing, foleys etc)
Perform specialized “skills” with proper training in stable situations
Observe & report
LPN/LVN Cannot Administer
Administer Blood products
Total parenteral nutrition
IV push (except heparin and NSS flushes)
LON can administer O2 and put them on it but pt getting off O2 they need to b weend down and is much difficult which means a nurse needs to do so
Provide Basic care/ ADL
Routine clinical tasks
Vital signs; collecting urine & stool samples; I & O
Patient ambulation & transport
Must be stable situations with predictable outcomes
Must have been trained and deemed “competent” to perform these tasks
Feed, wash, ambulate, collect vitals, stool and urine specimens can do clean catch with urine but not foley because it is sterile, make beds, transport but pt needs to be competent
Requirements within caregivers job description & legal constraints
Adequate supervision available
Within skill & competencies of individual caregiver
Minimal potential for harm
Unstable patient with unpredictable outcome
Condition requires complex assessment
Problem Solving & critical thinking required
Nursing judgment required
Potential for harm exists
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