Stability

beth66335, BSN, RN · Oct 23, 2007

I always get this type of question wrong on a test. Does anyone know how I would approach answering "which patient would a nurse keep for herself?" (instead of delegating). The scenarios are always different with someone having a headache or someone in a cast etc. How do I determine which patient is more stable?

Why would the nurse necessarily give away a less stable pt? I probably wouldn't because I like a challenge and I wouldn't feel right burdening another nurse with the harder, more time consuming pt.

Daytonite, BSN, RN · Oct 23, 2007

this has to do with determining which tasks are going to be more complicated or require more critical thinking (there's that problem solving stuff again!). delegation requires knowledge of a few principles. you can't just delegate off tasks willy nilly to another person.

the general guidelines of delegation are:

primary concern is to make sure that the patient is safe
you must know the job descriptions and abilities of the healthcare personnel and subordinates who you supervise
you must delegate tasks to those who you know are capable of performing what you are assigning them to do
you base tasks that you delegate to others on your knowledge of the state nurse practice act, facility policies and facility job descriptions.
give directions for the task that are clear in order to avoid misunderstandings
give a deadline when you expect the task to be completed
ask the person to repeat back instructions to verify they have the directions correct if you suspect they do not understand what you are asking them to do
follow-up to make sure the task was completed correctly and by the deadline in order to evaluate the performance of the task (this is your supervision function)
provide praise when tasks are done well and within deadlines; provide feedback and criticism when necessary
assign same tasks to the same individuals if possible

there are also five rights of delegation:

right task for a specific patient. for instance, it should be a task that recurs frequently in the day-to-day care of a patient, it doesn't require nursing assessment or judgment, it doesn't require complex or multidimensional application of the nursing process, the results are predictable, the potential risk is minimal, and a standard, unchanging procedure is used.
right circumstances , considering factors such as appropriateness of patient setting and available resources.
right person is delegated for the task; that is, one who has the appropriate skill set
right communication , which includes a clear, concise description of the task, including objective limits and expectations
right supervision , with appropriate monitoring, evaluating, and intervening, as needed."

please note the information in the five rights because it applies to what you are asking. remember that as the delegator you are ultimately accountable, so if you fail to follow or do any of the above in a responsible way, you've failed in delegating a task correctly.

the above is a lot of stuff to know and normally these are guidelines that i give to rn students. however, as an lpn you will still do some delegation to caregivers that you will have some supervision over. the same set of rules still apply.

for a patient with a headache or a cast you have to think about the potential problems the patient is likely to have and which you and the subordinate caregiver are going to be able to handle. i would take the person with the cast because they will require assessment of the limb upon which the cast is applied. patients with casts can develop compartment syndrome, paresthesias, ischemias and pressure sores. subordinate staff (cnas) are not trained or licensed to be assessing for these things, but you are and you are responsible for doing that and it would be inappropriate (and bordering on malpractice) to delegate this duty to a cna. worse yet, would be to assign the patient to a cna and never think about assessing the patient for evidence of compartment syndrome, paresthesias, ischemias or pressure sores. a patient with a headache can report it to any caregiver who can report that to you. you can easily give pain medication for the headache if there is no other information about the underlying cause of the headache. while giving the pain medication you can do a quick assessment of the patient's pain. now, if the patient were a head injury patient i might take that patient myself because they would require a more thorough and ongoing assessment of their condition.

is this making sense to you?