Having a hard time with delegation

NICUmiiki, DNP, NP · Feb 3, 2014

The LPNs in my state cannot administer IV push medications, but they can hang fluids and piggybacks. Maybe that's the same for your state. I agree that "skills" is a really broad term.

THELIVINGWORST, ASN, RN · Feb 3, 2014

NCLEX is based on national scopes of practice. You can't delegate what you can EAT, evaluate assess and teach. I think there is another acronym out there. But unchanging skills only for CNAs. Think about your answer choices and eliminate the ones you know you can't delegate instead of the other way around. It will help prevent confusion of the different scopes.

nurseprnRN, BSN, RN · Feb 3, 2014

Many students think "skills" are the manipulative actions they practice for check-off in learning lab. Therefore they don't realize that the number one RN skill is using all parts of the nursing process: assessment, analysis, planning, and delegating/implementing. You can't delegate something to caregivers with a lower level of licensure than you have unless their licensure permits them to do it. Therefore you must know your state nurse practice act, not just for yourself but for those you might supervise. For example, one task that any level can perform is taking VS. However, only licensed nurses (RN, LPN) can give meds (in most jurisdictions), and only RNs can analyze that assessment data to develop a plan of nursing care to deliver / delegate. A really good reference for you in this is the ANA Scope and Standards of Nursing Practice, a fairly small but powerful book, largely cut-and-pasted into many states' NPAs.

If the question in your study guide is in error, then be sure you know why and can defend your answer. There is no list of tasks per se in most nurse practice acts about what the different levels "can do."

Nolli · Feb 3, 2014

Thank you! I've been looking at it from the perspective of what each person can do vs what to not delegate and thus can eliminate. I thought maybe there was some list that dictated everything. I also didn't think about the ANA when I looked for resources. You were all very helpful.

Esme12, ASN, BSN, RN · Feb 4, 2014

Unfortunately the PA BON has not addressed delegation in regards to the LPN so your practice act will be of little help

049 Pa. Code Â 21.145.Â Functions of the LPN.

For the ANA correct delegation contains 5 rights....

The 5 ‘Rights’ of Teamwork
Once the decision to delegate a nursing activity has been made, the nurse must still safeguard the
patient. The 5 rights of teamwork define the essential responsibilities and techniques to ensure
that the patient receives the appropriate care and consideration.
Right Task—Is the task being delegated appropriately:
Within the caregiver’s scope of practice?
Compliant with the caregiver’s job description?
Based upon desired patient outcomes?
A task that is only delegated for a specific patient at a specific time?
Right Person—To perform the delegated activity, does the assigned caregiver possess:
The knowledge and skill required? Appropriate certification and licensure? An appropriate job description?
Documented and/or validated knowledge?
Demonstrated competency or skills?
Right Direction—Has the caregiver been provided with: Initial directions that
meet the 4Cs criteria?
o Clear direction
o Concise description of the activity to be performed
o Complete information including objectives
o Correct limits and expectations
Right Feedback—Is the caregiver provided the opportunity to participate in:
A reciprocal (mutual) process of information flow?
Providing input to the process?
Communication that recognizes his/her efforts?
Determining an alternative solution to problems that may arise?
Right Supervision—Is supervision forthe delegated activity provided by:
Determining the appropriate intervention to be delegated?
Monitoring of the delegated activity?
Ensuring that a follow-up evaluation of the delegated activity takes place

Lev, MSN, RN, NP · Feb 9, 2014

This was big question for me in nursing school and when studying for NCLEX. I used the Lacharity Prioritization, Delegation, and Assignment book (3rd ed.), which I highly recommend. I went through the entire book and whenever it mentioned RN or LPN or physical therapist etc I would jot down the task they were rightfully going to perform. I'm attaching the sheet I typed up for your use.

Other tips I wrote down related to delegation (also on attached sheet):

Delegation – Who can do what? REMEMBER: RN cannot delegate nursing process

In general, if there is something that both an LPN or RN and UAP can do, and both are available, the UAP should be assigned the task. The same for an RN and LPN.

Who can't do what:

LPN

NO blood products, NO IV push meds, NO arterial sticks, NO assessment, NO case management, NO evaluation, NO consultation, and NO education. In some states cannot insert IVs or give IV drugs

CNA

NO blood draws, NO IVs, NO glucose checks, NO Foleys.

Care based on level of experience:

Nursing student – meds, simple treatments

New Nurse – predictable needs, routine care, meds, non-complex care, do not assign overly anxious or fearful patients

Experienced RN – complex needs, complex assessments, discharge with detailed instructions

Do not assign the following nurses to a critical patient:

LPN

Agency nurse (even experienced nurse) who is new to the unit – do not know where supplies are, unit policies, or how to communicate with other departments

Floating nurse – not familiar with the type of patient and/or environment

New Grad RN- lack experience

TIPS_FOR_DELEGATION_AND_PRIORITIZATION.doc

diamond_girl, BSN, RN · Feb 9, 2014

Everyone gave you a lot of great advice here. I had trouble with this as well, until I practiced using PDA by Lacharity. I highly recommend it. After going through the chapters, priority, delegation, and assignments became much easier for me. My local library had a couple copies, so I would check yours out. Or you can buy on Amazon. It took me about 2-3 days to get through the 17 chapters (make sure you read the rationales!!!). After finishing, I felt confident and it finally just clicked.