Delegate to PCT

[Bekster]

Does anyone have a list of what a nurse can delegate to a PCT? I would appreciate a general list. I know most hospitals have specific criteria.

Also, can someone give me an idea of what a nursing student does on her clinical day. I am in nursing school and my teacher never checks on me to make sure I know what I am doing and I don't know if I am doing everything right. Too many students per teacher is the problem.

Thanks.

[TrudyRN]

Delegation is governed by state law. Read your state's Nurse Practice Act to learn what are acceptable things for each classification to do in your state.

The employer also has a say in who is allowed to do what in its facility.

RN's can do just about everything but some things require advanced training/education/certification - like running codes for cardiac and/or respiratory arrest. There might be some things that even RN's can't do and which a physician or advanced practice nurse must do (midwives, anesthetists, and nurse practitioners). It used to be RN's could not push IV meds where I worked, but that was back in the dark ages.

Also, certain procedures must only be done in ICU or in OR or Recovery Room.

LPN's can do everything an RN can do except IV push meds. Yet, where I work, they are not allowed even to call a doctor to report a client's change in condition and take phone orders. Yet, in local nursing homes here, they are often the only licensed nurse in the whole place. They are not allowed to do the initial history and physical assessment on a new admit. An RN must do it.

Aides are allowed to give meds in nursing homes and long-term care facilities if they've had the extra training. But they are not allowed to have anything to do with meds in the acute hospitals.

If trained and their employer approves them, they generally do vital signs, feed, bathe, turn, clean, get in and out of bed and chair, weights, accuchecks, collect urine specimens, and sometimes draw blood. They are not allowed to change dressings or do physical assessments, although they are usually excellent about notifying the nurse of rashes, scratches, bruises, diarrhea, emesis, appetite or lack of it, abnormal vitals, patients' complaints of pain, constipation, being cold, hot, dizzy, weak, etc. Don't count on them to notify you of abnormal vitals or blood sugars or other problems. They often/usually do but you also must be proactive. You must see your patients early in the shift and about every hour thereafter, you must check on results of accuchecks and vitals, weights, how much and what was eaten, etc.

Your Instructor needs to teach you what is permissible for delegation in your state and in your facility. If she doesn't seek you out, go find her. She needs to do her job. I know she's busy but you need her attention, too - although most of us were thrilled to be left alone and just learn from the staff nurses, LOL.

But do get in the habit early on of learning what the Policy and Procedure Manual says about every topic it covers, such as delegation, also get familiar with what your state NPA says. Best wishes.

[TrudyRN]

Oh, as to what a clinical day is like -

We always met for pre-clinical conference first. We each had to tell about our patient(s) - Diagnosis, History, Labs, our plan of care, our goals for the day, and tell about the illness/surgery/tests/labs/radiology studies, etc. that the patient had or would be having.

Then we'd go to the floor and get report on our patient(s) from the appropriate nurse. Then we'd go see our patient. (We had met them the night before and had read their chart and spend hours studying to learn the aforementioned and be prepared for Clinical.) We'd do Vitals, just for practice. We'd accompany them to wherever they might be going - surgery, Radiology, GI lab, wherever. We'd pour and pass meds if we had advanced to that point. Our instructor would have quizzed us up 1 side and down the other about the meds before we gave them and she'd have checked to be sure we were giving the right stuff. We charted our meds.

We did dressings, suctioned, bathed, turned, etc. We often rounded with the docs and med students, we went to physical and occupational therapy with the patients, we went to Central Supply for supplies, to Pharmacy, we just learned the building, all its nooks and crannies, names, faces, routines, phone numbers, doctors' handwriting.

We did as much as we could. We sought out the nurses to teach us whatever they were doing and to let us observe or do, under their supervision, as much as possible, we sought out aides to let us help them make beds, feed, and whatever else they were doing. We then wrote our notes and our instructors approved them BEFORE we charted them. We charted our vitals, etc. We gave report to the patients' nurses before we left the floor for a break or at the end of our tour. We bade farewell to the patients and staff and made sure they knew we were leaving and would not be responsible for any further care that day. We did NOT sit at the Nurses' Station, we did NOT get in the way of staff and doctors, we kept busy and out of view, truthfully, of our Instructor as much as we could.

Then, we met for post-clinical conference. We reviewed everyone's experiences and tidbits of information they'd picked up, we shared any sadness we'd experienced, any happiness, questions, etc.

Then we had to write up our day's experiences and turn it in by the next morning.

Hope this helps.

I think it's a lot different today. Many patients who are here today are gone tomorrow so there isn't a whole lot of point to meeting them the night before. Also, most students seem to live other than in the dorm at the hospital where they do their clinicals. Therefore, it is harder to get there the night before to read the chart, look up all the diagnoses, tests, meds, etc. As an Instructor a few years back, it was very hard for me to adjust to students not preparing for clinicals the way I was familiar with. I also was told I had to be forgiving and accommodating to commuter students who were ALWAYS late. When I finally lowered the boom one day, after warning the class that their next tardy would result in them being not allowed to do Clinical that day, the student went to the Director of the school, gave a sob story of how her period had ruined her pants and she'd had to go back home to change clothes, so was late. How convenient. The Director asked me to reconsider and I did relent - out of fear for my job, not wanting to cross my boss. It was not fair to other students, made me look ineffectual and foolish, and short-changed the student as well, who now figured she could always go over the head of anyone giving her an unhappy answer.

What have your teachers told you about clinicals so far? When do you start?