Delegation Assignment HELP

[Kandyrain22]

I am presenting this tomorrow in class... It is a student lead discussion. I have been going back and forth with my answers to this assignment and i was just hoping to get some different point of views that maybe i could add to the discussion. Any feedback would be great!

James works at a large teaching hospital in a major metropolitan area. This institution services the entire geographical region, including indigent clients, and because of its renowned reputation also administers care to international clients and individuals who reside in other states. Like all health-care institutions, this one has been attempting to cut costs by using more UAP. Nurses are often floated to other units. Lately, the number of indigent and foreign clients on James's unit has increased. The acuity of these clients has been quite high, requiring a great deal of time from the nursing staff.

James arrived at work at 6:30 am, his usual time. He looked at the census board and discovered that the unit was filled,and bed control was calling all night to have clients discharged or transferred to make room for several clients who had been in the ED since the previous evening. He also discovered that the other RN assigned to this unit called in sick. His team consists of himself, two UAP, and an LPN who is shared by two teams. He has eight clients on his team:3 clients need to be ready for surgery, including pre-op and post-op teaching,1 of which is a 35 year old woman scheduled for a modified radical mastectomy for the treatment of invasive breast cancer; 3 clients are second day post-ops requiring IV antibiotics, dressing changes, NG suctioning, chest tubes, TPN and lipids, central line dressing changes, Foleys, and ambulation; 1 client needs transferred to the rehab unit with report called prior to the transfer and finally, 1 client is to be discharged home and requires discharge teaching on insulin and dressing changes.

1. How should James organize his day?

2. Which client is a priority?

3. Who do you assess first?

4. What type of client management approach should James consider in assigning the staff

5. If you were James, which clients and/or tasks would you assign to your staff?

6. Explain your rationale for this assignment.

[Double-Helix, BSN, RN]

What do you have so far? We will help you with your homework, but we won't do it for you. The format of your post (the way you copied the entire assignment but shared none of your own ideas or thoughts) suggests that you just want to "drop it off" and come back to get the answers. You said that you are going back and forth with the answers, so please share what you have come up with so far and we can help guide you. We won't give you the answers without first knowing that you have tried on your own. This is, after all, YOUR homework. Tell us what you think, and we will help.

[Kandyrain22]

I'm not asking for you to do my homework. If you do not want to give ideas, then don't.

[sjbrk]

But do you realize that you have given the homework question without even your own answer? If this is to be a discussion, tell us what you have first. No one will give you any ideas/answers when you haven't given any first. That is simply not how it is done.

[Kandyrain22]

Well I figured the first thing I would do is call staffing to replace the RN that called in sick. Obviously the tpn/lipids need to be hung by the RN.. Lpns can do things like dressing changes and ng suctioning... Pre and post op teaching.. Discharge teaching all need to be done by the RN... It's not like I could assign any 1 patient to the LPN bc there isn't one patient that can be cared for without an RN... Ambulation and transferring can be done by the aids...

[Kandyrain22]

Priority thing to do would be to get the patients that are to be discharged or transferred out of there to make room for new patients... Next I would check on my chest tubes..

[ADN2B]

Is this a case study assignment?

[Kandyrain22]

It's a class discussion.. I'm just the lead who presents the scenario to the class and gives suggestions.

[Esme12, ASN, BSN, RN]

I am late to the conversation........but,

Welcome to AN! The largest online nursing community!

We are happy to help with homework.......but we will not do it for you. It is our goal to make you the best nurse you can be. Asking for opinions the night before an assignment is due might indicate to some.....that you might not have planned your assignment in advance. Nursing is all about advanced planning. Getting that basic information needed to make those critical decisions when we need to.....but those decisions are based on some core education and planning. Ashley is a big contributor here to the students and will help you......once we know where to start.

We can't help you without know what your thoughts are first...to know how best to guide you.....there are five rights of delegation.

The five rights to Delegation.

Nursing assistants work under the direction/supervision of a licensed nurse. In order to receive delegation appropriately, a nursing assistant must be knowledgeable about the “Five Rights of Delegation”. These “Rights” guide effective delegation.

The Right Task:

The task delegated must be right for the client and for the

nursing assistants knowledge and experience. If the nursing

assistant has not performed the task before, it would not be

appropriate for the nurse to delegate the task or for the nursing

assistant to accept the task. Tasks that include assessment of the

patient, planning and evaluating patient care, and giving care that

requires ongoing nursing judgment cannot be delegated to or

accepted by nursing assistants.

Right Circumstances:

In determining whether delegation is appropriate,

several factors must be taken into consideration. These

include: type of setting, supervision offered, available

resources, and the condition of the client. Certain tasks

may not be appropriate in all healthcare settings and the

level of supervision varies.

The Right Person:

Ensures the right person is delegating the right task to the right

to be performed on the right person. The nurse is

responsible for determining whether a task for a specific

patient should be delegated to a specific nursing assistant. The

nursing assistant should have been taught to perform the task

and competency should be assessed. A nursing assistant cannot

delegate a task to another staff member. The nurse should not

delegate a task that is not within their scope of practice or a

task they are not familiar with.

The Right Direction and Communication:

In delegating a task, the nurse must give the nursing

assistant clear, concise information on which to perform the

task safely and effectively. The information should includes

what task is to be performed and for whom, when the task is

expected to be performed and concerns or conditions to

report to the nurse during the task once the task is

completed.

The Right Supervision:

The supervising nurse is responsible for supervision of the

nursing assistant performing the delegated task.

Supervision should include ensuring that the nursing

assistant is competent to perform the task and

the request of the task. Supervision also

includes assisting with problems /concerns during the

task and follow-up after to ensure the desired result and

documentation occur.

The Laws and rules that govern nursing practice vary from state to state and facility to facility. LPN', CNA's and Medical Assistants must be familiar with the laws and rules within the state in which they are working.

Communication: By working together and having open communication, the supervising nurse and the nursing assistant can achieve effective delegation and provide excellent patient care.

LPN', CNA's and Medical Assistants should not accept nursing tasks that they are not educated or competent to perform and should communicate this to the delegating nurse prior to accepting a delegated task.

[Esme12, ASN, BSN, RN]

Well I figured the first thing I would do is call staffing to replace the RN that called in sick. Obviously the tpn/lipids need to be hung by the RN.. Lpns can do things like dressing changes and ng suctioning... Pre and post op teaching.. Discharge teaching all need to be done by the RN... It's not like I could assign any 1 patient to the LPN bc there isn't one patient that can be cared for without an RN... Ambulation and transferring can be done by the aids...

What if no one can be called in.......I don't think the assignment is about calling someone to get you a nurse. What is the LPN allowed to do? What has your instructors told you about delegation? YOU can assign the LPN patient but have to account what tasks you need to oversee/perform for the LPN.

It's not as simple as you think......what research have you done about your states nurse practice act?

[Meriwhen, ASN, BSN, MSN, RN]

It's not as simple as you think......what research have you done about your states nurse practice act?

I agree...I see a at least one patient there (likely 2) that could be assigned to a LVN, at least in my state. Plus the LVN could perform some of the duties needed for the other patients.

[Double-Helix, BSN, RN]

Priority thing to do would be to get the patients that are to be discharged or transferred out of there to make room for new patients... Next I would check on my chest tubes..

This may be a priority for the hospital administration who want to make money, or the ED that wants to send up their patients, or the patient that wants to go home, but is it a priority for the nurse? Patients that are ready for discharge are generally stable. A new admission will likely require a lot of more work for the nurse- and has to be done by an RN (assessment). This busy RN may not have time if they have lots of other patients that need attention first.