Need help with delegation question

Nesher, BSN, RN · Mar 5, 2005

Sounds like a regular day.

What are your thoughts on who should do what and when and where?

dbsn00 · Mar 5, 2005

OK, here it goes:

The breakfast trays should be given out by the NA - occupy other patients, get those call bells quiet!

While that's being done you can get to Mr. Johnson & his central line - this is a priority & your responsibility as the charge nurse.

The new grad RN can begin the insulin injections (with practice comes experience...), starting with the 6AM blood glucose of 400 (priority), & after the LPN calls Ms. Johnson's family regarding her change in condition she can assist the new grad RN. (since pt.'s change in condition was expected this could be done by the "very familiar to the unit" LPN, the LPN then can oversee the orientee with the other insulin injections & continue to monitor the patient with the blood glocose of 400 after their injection)

Meanwhile, the receptionist can call maintenance regarding the overflowing toilet. (the rationale should be obvious here)

After you've dealt with Mr. Johnson's central line (& making sure the above has been done) you can call the Medical Director & get chewed out! (since all of the above is being done simultaneously you will be able to respond to the Medical Director within a reasonable amount of time). Hope this helps!!!

nursepotter05, RN · Mar 5, 2005

I appreciate the help. I couldn't decide who to send to Mr. Johnson.I knew he was first priority. I knew that his condition warranted a RN, but I couldn't decide on me or the new grad. I REALLY appreciate the help :balloons:

happytobehere96 · Mar 5, 2005

Good response, the only one I disagree with is the LPN orienting the RN. Can't do.

OK, here it goes:
The breakfast trays should be given out by the NA - occupy other patients, get those call bells quiet!
While that's being done you can get to Mr. Johnson & his central line - this is a priority & your responsibility as the charge nurse.
The new grad RN can begin the insulin injections (with practice comes experience...), starting with the 6AM blood glucose of 400 (priority), & after the LPN calls Ms. Johnson's family regarding her change in condition she can assist the new grad RN. (since pt.'s change in condition was expected this could be done by the "very familiar to the unit" LPN, the LPN then can oversee the orientee with the other insulin injections & continue to monitor the patient with the blood glocose of 400 after their injection)
Meanwhile, the receptionist can call maintenance regarding the overflowing toilet. (the rationale should be obvious here)
After you've dealt with Mr. Johnson's central line (& making sure the above has been done) you can call the Medical Director & get chewed out! (since all of the above is being done simultaneously you will be able to respond to the Medical Director within a reasonable amount of time). Hope this helps!!!

BRANDY LPN · Mar 5, 2005

I have helped orient many new grad RNs. Why do you feel this is a can't do? This LPN has ten years experience and certainly has MUCH more experience with monitoring blood glucose and administering insulin than a brand new grad. (No offense to any new grads, but with experience comes knowledge.)

caroladybelle, BSN, RN · Mar 5, 2005

Good response, the only one I disagree with is the LPN orienting the RN. Can't do.

This RN must disagree. The LPN can provide plenty of assistance and orientation to a new grad....if the new grad is willing to learn.

I learned some of my best tricks of the trade from LPNs.

And if the facility is worried about legalistic definitions of supervision and orientation, they should have provided an RN to do so.

caroladybelle, BSN, RN · Mar 5, 2005

PS. Is the comatose patient a code or a no code?

nursepotter05, RN · Mar 5, 2005

PS. Is the comatose patient a code or a no code?

That is a good question. The scenerio does not say one way or another. Since it says that this was not unexpected, I assume she is a no code.

hcmanp, NP · Mar 5, 2005

the clue is in the statement, the lpn oversees the rn - legally this is not an option. Yes, the lpn can assist the new rn, yes, the lpn knows WAY more than the new rn (most likely given the experience in this case), but the RN oversees the LPN legally. It was a semantic problem.

LPN1974, LPN · Mar 5, 2005

Good response, the only one I disagree with is the LPN orienting the RN. Can't do.

I'd like to know why you think this.

My DON just hired a new RN for supervisor on my evening shift, and we are helping this new nurse orient to HER job.

She comes to us lowly LPNs for ADVICE. Imagine that.

Some of us have been there 28, 25, 20 years and she's coming to us for advice.

Don't you think that YEARS of experience counts for ANYthing?

This new nurse has never worked in this type of situation before, we work with MR/DD.

So I'd like to know why you think an LPN can't do anything to help a new RN orientate to her job?

:confused:

nurseinmilo · Mar 5, 2005

does sound like a typical day