delegation of tasks

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    I am having problems with the nursing staff in area of delegation. I know the rules of the NPA and They should know them as well, but we continually have issues with improper delegation. Mostly in the respect of our Nurse Techs or Externs (employees that are currently enrolled in a nursing, RN, program. We allow these employees to do skills that they have been checked off on at their school (with the exception of medication, they never do that) and of course we evaluate them for competency as well, i.e, foley catheter, NG tube, etc. But the nurses are asking them to things that they should not be doing, for example, calling the physician and taking verbal orders, hanging IV bags, etc. I have tried to address this from the NT point telling them not to do these things, but it seems to me it needs to be addressed from the nursing end in that they shouldn't be asking them to do it. Does anyone else have this problem and what have you done about it?
  2. 8 Comments so far...

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    Sounds like you need a clear written policy to cover what can and cannot be done with student nurses. If it is clear written policy and the nurses are choosing to ignore it, that is something I might bring to my management team. Then if the management team decides to turn a blind eye to it, you are covered.
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    Originally posted by camilleRN68
    with the exception of medication, they never do that

    hanging IV bags, etc.
    Just a thought, in the Uk, IV are classed as prescibed medication and hanging a bags would be the same as giving out medication.
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    You are right Mike. IV's are medications. They are NOT supposed to be doing that but the nurses continue to ask them to do it. I have done everything to let the NT know what they can and cannot do, yet, it is hard for them when seasoned respected nurses continue to ask them to do things which are not to be delegated.
    Camille
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    Our facility has a "hotline" to report things anonymously. Failing that, I would contact the Risk Manager. There is a huge lawsuit waiting to happen and someone will lose their license due to non-compliance with Nurse Practice Act. We have nurse extern program too. They are unlicensed personnel and cannot perform the tasks you outlined. Also, the facility is teaching these nurses-to-be that it is ok to fudge on the rules and put yourself at risk. Bad modeling. And if a policy exists in your facility prohibiting this action, I would write up both the extern and the nurse (both are employees).
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    We had somewhat of a problem with this, but it was because nobody was clear on what the techs could and couldn't do, because we had so many different levels of techs.... nurse techs, intensive care techs, patient care techs, etc.... and they each have a limit on what tasks they can perform.

    They are ALL given a check-off list, in our facility. Anything on their list, they can perform alone, if it has previously been checked off by another RN. And, they are supposed to keep the list readily available, and the RNs are also responsible for reviewing these lists so they will delegate tasks properly. And, of course, NO medication should be given to a patient by anyone but an RN/LPN or a student nurse who is under the supervision of an RN.

    Our manager had to bring it up in a staff meeting, to make everyone aware. Maybe that's what needs to be done in your case.
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    In my opion, if it was me being ask to do a procedure that by law of the nurses association I should have the comman sence to "JUST SAY NO." If anything happens, it would not only be the nurse giving me the order, the charge nurse responsible for the floor, but also mine. The fact that I would do something terrible wrong, and also by not being able to obtain that license when time comes. The nursing student would also loose any chance of becoming a LPN, or RN, and loose what ever license he/she holds. That includes the delegator.
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    I totally agree. I just don't know what else to do at this point. The techs have been brought in and signed papers if they do something else not on their list of duties it will be grounds for immediate termination. What I feel like is that it should be addressed more from the charge nurse or staff nurse point. Which makes it hard because I have no control over that realm. I am in charge of the NT program. Granted the techs should say no. But we can't seem to get the RN's to understand their delegation rules, which amazes me. The techs have a pathway which has the duties that they have been checked off on and the nurses should ask for it, which they don't. The techs have been instructed that if when they come to work and don't have that pathway of their check offs they will be sent home.
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    It takes just one mistake, and one person to stand up to the other nurses. Maybe some really dont understand, or maybe they do. Best thing to do is to have a mandatory meeting. Discuss the issues as your manager being the middle man/woman. Think of the pt's. Be their advocate. Would you want one of them doing these things to you? Better yet would you want them doing them to your child or mother? If no one else wants to be the advocate, and it sounds like you do, stand up for what you believe. You will be better respected for it, and the nurses doing these things will know better than to do them when your on as charge. Its a difficult thing to do, I know, Ive been charge for years. I never lost a friend ship for it, I only gained more respect.

    GOOD LUCK, KEEP US POSTED


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