What tasks can an RN Delegate?

1. Safe and Effective Care/Disaster: Cultural Diversity, Ethical/Legal Delegation & Disaster Issues in NursingCreated by Professor Jill RayRevised by Professor Brenda Rowe

2. What tasks can an RN Delegate? • Who is she delegating the task to? • What type education/experience does that individual have? • Is there something about the task that requires the skill/knowledge of an RN? • Is there something about the task that requires the skill/knowledge of a specialized RN?

3. The person to whom the task is delegated must have the education and the experience required to complete the task safely and effectively.

4. When would a task be considered routine… when should a “routine” task be completed by an RN?

6. 1. The nursing team consists of 2 RNs and 1 LPN. The assignments would be considered appropriate if the LPN were assigned to which of the following patients? • A 3 year old who had an open reduction of a fractured radius performed yesterday. • A 5 year old who had a tonsillectomy yesterday. • A 7 year old who is being monitored for a seizure disorder. • A 2 year old who is receiving a tube feeding via a gastrostomy tube.

7. 1. The nursing team consists of 2 RNs and 1 LPN. The assignments would be considered appropriate if the LPN were assigned to which of the following patients? • A 3 year old who had an open reduction of a fractured radius performed yesterday. • A 5 year old who had a tonsillectomy yesterday. • A 7 year old who is being monitored for a seizure disorder. • A 2 year old who is receiving a tube feeding via a gastrostomy tube. …Routine task…within her scope of practice.

8. Tasks that can be delegated to an LPN/LVN • Any “regular” procedure that does not require assessment , teaching, or nursing judgment. • The technical “doer” • Physical care of clients with more complex conditions, selected treatments. • Must be supervised by an RN. • Saunders (2008) p.76…dressing changes, suctioning, urinary catheterization, medication administration (oral, sq, IM…)

9. 2. A client is admitted to room 703 with a diagnosis of acute GI bleed. Which of the following actions is BEST for the RN to take? • Ask the UAP to obtain v/s while the RN obtains orders from the MD. • Ask the LPN to start an IV while the RN assesses breath sounds. • Ask the UAP to obtain equipment needed for the patient’s care while the RN assesses the patient. • Ask the LPN to assess the patient while the RN reviews orders with the MD.

10. 2. A client is admitted to room 703 with a diagnosis of acute GI bleed. Which of the following actions is BEST for the RN to take? • Ask the UAP to obtain v/s while the RN obtains orders from the MD. Initial v/s • Ask the LPN to start an IV while the RN assesses breath sounds. LPN can do aseptic technique…but IV is very invasive and this task would be hospital specific if OK. • Ask the UAP to obtain equipment needed for the patient’s care while the RN assesses the patient. • Ask the LPN to assess the patient while the RN reviews orders with the MD. Assessment

11. What can be delegated to a nursing assistant or a UAP? • Routine, unchanging procedures • Assist with direct patient care activities under the supervision of an RN • Scope of nursing practice is limited.

12. How do we prioritize tasks? • Maslow’s Hierarchy of Needs • Basic needs must be met first • Pain is considered a psychosocial need • Deal with most acute actual need first…

13. 3. The RN who is caring for clients in the oncology clinic, receives four phone messages. Which call should she return first? • A client who is 5 days postop prostatectomy who complains of chills and a burning sensation with urination. • A client who is receiving chemotherapy who is experiencing fatigue. • A client newly diagnosed with colon cancer whose stool specimen tested positive for blood. • A client receiving chemotherapy for lung cancer who is experiencing a loss of appetite.

14. 3. The RN who is caring for clients in the oncology clinic, receives four phone messages. Which call should she return first? • A client who is 5 days postop prostatectomy who complains of chills and a burning sensation with urination. …Most acute… • A client who is receiving chemotherapy who is experiencing fatigue. • A client newly diagnosed with colon cancer whose stool specimen tested positive for blood. • A client receiving chemotherapy for lung cancer who is experiencing a loss of appetite.

15. 4. A nurse from the oncology unit has been pulled to the pediatric unit. Which of the following patient assignments would be BEST for this RN? • A newborn newly admitted with fever of unknown origin. • A 10-year old who 4 days post operative appendectomy. • A 5-year old newly diagnosed with diabetes. • A 12-year old newly diagnosed with a seizure disorder.

16. 4. A nurse from the oncology unit has been pulled to the pediatric unit. Which of the following patient assignments would be BEST for this RN? • A newborn newly admitted with fever of unknown origin. …Ped. specialty… • A 10-year old who 4 days post operative appendectomy. • A 5-year old newly diagnosed with diabetes. ..teaching… • A 12-year old newly diagnosed with a seizure disorder. ..teaching…

17. 5. The RN cares for patients on a medical-surgical nursing unit. Which of the following patients should the RN see FIRST? • A 91-year old patient who is 72 hours postop colon resection who has a temperature of 100 degrees F. • A 24-year old patient admitted to rule out ectopic pregnancy, whose BP is 90/58, HR 101. • A 45-year old patient who was admitted 24 hours ago with a diagnosis of r/o MI whose HR is 72, BP is 145/80. • A 50-year old male patient admitted with the diagnosis: “high blood pressure” who is complaining of back pain.

18. 5. The RN cares for patients on a medical-surgical nursing unit. Which of the following patients should the RN see FIRST? • A 91-year old patient who is 72 hours postop colon resection who has a temperature of 100 degrees F. • A 24-year old patient admitted to rule out ectopic pregnancy, whose BP is 90/58, HR 101….most acute… • A 45-year old patient who was admitted 24 hours ago with a diagnosis of r/o MI whose HR is 72, BP is 145/80. • A 50-year old male patient admitted with the diagnosis: “high blood pressure” who is complaining of back pain.

19. 6. An adult has been pre-medicated for her surgery. The operating room (OR) nurse, when going through the client’s chart, realizes that the consent form has not been signed. Which of the following is the BEST action for the nurse to take? • Assume it is emergency surgery and the consent is implied. • Get the consent form and have the client sign it. • Tell the MD that the consent form is not signed. • Have a family member sign the consent form.

20. 6. An adult has been pre-medicated for her surgery. The operating room (OR) nurse, when going through the client’s chart, realizes that the consent form has not been signed. Which of the following is the BEST action for the nurse to take? • Assume it is emergency surgery and the consent is implied. • Get the consent form and have the client sign it. • Tell the MD that the consent form is not signed. • Have a family member sign the consent form.

21. 7. Which of the following tasks could not be delegated to a UAP? • A patient with a fractured wrist who needs assistance completing her menu for the next day. • A patient with left-sided weakness who needs assistance to get out of bed to the bedside commode. • A preop patient who needs assistance learning to use the incentive Spiro meter. • A patient who is being started on Aldomet and needs his blood pressure checked every 4 hours.

22. 7. Which of the following tasks could not be delegated to a UAP? • A patient with a fractured wrist who needs assistance completing her menu for the next day. • A patient with left-sided weakness who needs assistance to get out of bed to the bedside commode. • A preop patient who needs assistance learning to use the incentive Spiro meter….teaching… • A patient who is being started on Aldomet and needs his blood pressure checked every 4 hours. …not the baseline BP – this is just routine monitoring…pts are started on Aldomet at the MD’s office and allowed to go home to monitor BP…

23. 8. Which of the following clients should the nurse deal with first? • A client who needs her dressing changed. • A client who needs his endotracheal tube suctioned. • A client who needs to be medicated for postoperative pain. • A client who is incontinent and needs to be cleaned.

24. 8. Which of the following clients should the nurse deal with first? • A client who needs her dressing changed. • A client who needs his endotracheal tube suctioned….ABC’s… • A client who needs to be medicated for postoperative pain. • A client who is incontinent and needs to be cleaned.

25. 9. Which of the following clients should the nurse observe first? • A client who has just returned from the OR • A client whose call light is not working • A client with Alzheimer’s disease • A client who is receiving a heating pad treatment.

26. 9. Which of the following clients should the nurse observe first? • A client who has just returned from the OR…most acute, requires assessment… • A client whose call light is not working • A client with Alzheimer’s disease • A client who is receiving a heating pad treatment.

27. 10. Four clients have signaled with their call bells for the nurse. Who should be seen first? • A client who needs to use the toilet. • A client who does not have his glasses or hearing aid. • A client who has just been given morphine. • A client in a Geri chair with a restraint vest on.

28. 10. Four clients have signaled with their call bells for the nurse. Who should be seen first? • A client who needs to use the toilet. • A client who does not have his glasses or hearing aid. • A client who has just been given morphine… most acute • A client in a Geri chair with a restraint vest on.

29. 11. A nursing team consists of an RN, two LPNs, and an UAP. Which of the following patients should be assigned to the RN? • A 3 year old recovering from a gunshot wound to the abdomen that requires a dressing change. • A 1 year old who is receiving tube feedings via a nasogastric tube. • A 6 year old with cystic fibrosis who requires chest physiotherapy qid. • A 5 year who has been newly diagnosed with diabetes.

30. 11. A nursing team consists of an RN, two LPNs, and an UAP. Which of the following patients should be assigned to the RN? • A 3 year old recovering from a gunshot wound to the abdomen that requires a dressing change. • A 1 year old who is receiving tube feedings via a nasogastric tube. • A 6 year old with cystic fibrosis who requires chest physiotherapy qid. • A 5 year who has been newly diagnosed with diabetes. …teaching…

31. Don’t forget the basic principles of safety…

32. 12. The nurse enters the dayroom and finds a fire. Which is the best initial action? • Evacuate any people in the room, beginning with the most ambulatory and ending with the least mobile. • Activate the fire alarm or call the operator, depending on the institution’s system. • Get a fire extinguisher and put out the fire. • Close all the windows and doors, and turn off any oxygen or electrical appliances.

33. 12. The nurse enters the dayroom and finds a fire. Which is the best initial action? • Evacuate any people in the room, beginning with the most ambulatory and ending with the least mobile….Rescue, Activate, Confine, Extinguish … • Activate the fire alarm or call the operator, depending on the institution’s system. • Get a fire extinguisher and put out the fire. • Close all the windows and doors, and turn off any oxygen or electrical appliances.

34. 13. The patient reports to you that he noticed that $20.00 was missing from his bedside table after the Respiratory Therapist finished his treatment. What action should you take? • Ask the Respiratory Therapist if he knows anything about the missing money. • Report the missing money to the head of the Respiratory Therapy department. • Report the missing money to your immediate supervisor. • Record the missing money in the nurses’ notes – the MD will follow up when he reads your note later in the day.

35. 13. The patient reports to you that he noticed that $20.00 was missing from his bedside table after the Respiratory Therapist finished his treatment. What action should you take? • Ask the Respiratory Therapist if he knows anything about the missing money. • Report the missing money to the head of the Respiratory Therapy department. • Report the missing money to your immediate supervisor… chain of command … • Record the missing money in the nurses’ notes – the MD will follow up when he reads your note later in the day.

36. Chain of Command • Always report to the RN in the scenario’s immediate supervisor.

37. 14. An adult has just arrived on the unit after surgery. Which of the following is the most appropriate task for the nurse to delegate to the certified nursing assistant (CNA)? • Assessment of the vital signs while the RN watches. • Suctioning the tracheotomy and reporting back to the nurse. • Changing the client’s postoperative dressing and then describing it to the RN. • Measure the amount of urine in the Urinary Drainage Bag.

38. 14. An adult has just arrived on the unit after surgery. Which of the following is the most appropriate task for the nurse to delegate to the certified nursing assistant (CNA)? • Assessment of the vital signs while the RN watches. • Suctioning the tracheotomy and reporting back to the nurse. • Changing the client’s postoperative dressing and then describing it to the RN. • Measure the amount of urine in the Urinary Drainage Bag.

39. 15. The nurse is making the assignment for the floor. There is one LPN and three RNs. Which of the following clients should the LPN be assigned to care for? • A client who is intubated and a newly diagnosed diabetic. • A recent ICU transfer and a person with AIDS. • A client awaiting a nursing home bed and a client one day post-hernia repair. • A new admission for cholecystectomy and a client one day post-op mastectomy.

40. 15. The nurse is making the assignment for the floor. There is one LPN and three RNs. Which of the following clients should the LPN be assigned to care for? • A client who is intubated and a newly diagnosed diabetic. • A recent ICU transfer and a person with AIDS. • A client awaiting a nursing home bed and a client one day post-hernia repair. … least acute… • A new admission for cholecystectomy and a client one day post-op mastectomy.

41. 16. The nurse is unfamiliar with a new piece of OR equipment that is scheduled to be used today. What is the best course of action? • Ask another nurse for instructions on how to use it. • Wait until she has attended a class on using the equipment before using it. • Get another nurse who is familiar with the equipment to operate it. • Read the instructions provided with the equipment.

42. The nurse is unfamiliar with a new piece of OR equipment that is scheduled to be used today. What is the best course of action? • Ask another nurse for instructions on how to use it. • Wait until she has attended a class on using the equipment before using it… ideally… • Get another nurse who is familiar with the equipment to operate it. • Read the instructions provided with the equipment.

43. Confused • Unsure of how to do something • Unsure of how something works

44. Never attempt a task you have not been trained to do • Always follow manufacturer's guidelines

45. 17. An adult has developed a stage II pressure ulcer. He is scheduled to receive wet to dry dressings every shift. Which of the following team members would be the BEST choice to perform this task? • An LPN who has worked on the nursing unit for 6 months. • A UAP who will graduate from a baccalaureate nursing program in 10 days. • A nursing assistant with 10 years experience on this nursing unit. • An LPN from the Surgical ICU who has been pulled to the nursing unit to help out today.

46. 17. An adult has developed a stage II pressure ulcer. He is scheduled to receive wet to dry dressings every shift. Which of the following team members would be the BEST choice to perform this task? • An LPN who has worked on the nursing unit for 6 months. • A UAP who will graduate from a baccalaureate nursing program in 10 days. • A nursing assistant with 10 years experience on this nursing unit. • An LPN who has been pulled to the nursing unit to help out today.

47. The nurse is about to administer the premedication prescribed for a woman scheduled for a lumpectomy. The client says, “I’ll be glad when the surgery is over. It will eliminate all the cancer from my body.” Which of the following is the BEST action for the nurse to take? • Medicate the client and tell the MD. • Correct the client’s misconceptions. • Call the MD without medicating the client. • Give the medications to the client and note her comment in the chart

48. The nurse is about to administer the premedication prescribed for a woman scheduled for a lumpectomy. The client says, “I’ll be glad when the surgery is over. It will eliminate all the cancer from my body.” Which of the following is the BEST action for the nurse to take? • Medicate the client and tell the MD. • Correct the client’s misconceptions. • Call the MD without medicating the client. • Give the medications to the client and note her comment in the chart

49. The nursing team, consisting of one RN, one LPN, and one nursing assistant has just received report from the previous shift. At the completion of the report, what action should the RN take FIRST? • Make assignments for the members of the nursing team. • Assess each patient that will be cared for by the nursing team. • Assess a patient who complains that the PCA has suddenly stopped controlling his postop pain. • Assess a patient who is requesting his prescribed prn for pain.

50. The nursing team, consisting of one RN, one LPN, and one nursing assistant has just received report from the previous shift. At the completion of the report, what action should the RN take FIRST? • Make assignments for the members of the nursing team. • Assess each patient that will be cared for by the nursing team. • Assess a patient who complains that the PCA has suddenly stopped controlling his postop pain. • Assess a patient who is requesting his prescribed prn for pain.