Tell Me What You Think....

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we've been having debates in class over the topic of delegation and assigning. i would love to get your opinions on how you feel that these questions should be answered. we had alot of different views.

question is why not and why?

an rn robert, is working on a busy surgical unit in a local hospital when one of his patients mr. b. requires increasing care. mr. b. has an episode of incontinence and his b/p and o2 saturation simultaneously are falling dramatically. he requires one-on-one attention. decisions must be made regarding which of roberts other patient care duties could be delegated out to the team. select the answer that depicts the best example of appropriate delegation.

a.the charge nurse provides guidance to an lpn regarding hanging blood on another of robert’s patients.

b. robert tells the lpn on his team to assess his other patients while involved with mr. b.

c. the charge nurse reassigns a certified nursing assistant to work with robert.

d. robert transfers the responsiblitly of caring for one of his patients who requires a blood transfusion to another rn.

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Specializes in mental health, military nursing.

I'm not sure the question makes a lot of sense. Why does Robert have to stay with Mr. B, who is incontinent and has poor vitals? Sounds like Mr. B could be delegated to an LPN if needed, while you take care of the blood transfusion.

You can't do A or B, as they're outside of an LPN's scope of practice, you should already have a nursing assistant, so... D? However, you usually don't 'delegate' laterally...

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Specializes in Utilization Management.

I'd call a rapid response on Robert. Falling BP and falling sats w/ incontinence (translation--confusion, weakness) constitutes an emergent situation in my experience. :uhoh3:

Another RN might hang the blood for me (and I'd make sure to give her a kudos for helping). :yeah:

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Specializes in Med-Surg; Telemetry; School Nurse pk-8.

You need to think NCLEX style -- which means that NONE of the answers are perfect, or even perhaps what you would do in the real world. So, that being said:

A. Get rid of this choice, b/c a LPN can not transfuse blood (at least not in my state)

B. Get rid of this choice, b/c an assessment must be completed by an RN

C. Okay, a Nursing Assistant's extra set of hands would be helpful, but is it the BEST choice? Look at D.

D. Transferring care for the patient who requires a blood transfusion to another RN -- Think about all that is involved in transfusing blood...Yep. That would free up the most time to spend with your patient who is going downhill. So, "D" -- final answer. :nurse:

Okay, so you are asking, is it delegation? Eh, if the charge nurse makes the reassignment, then maybe... It's a stretch, and not a well worded question. You'll see lots of poorly written questions, just pick the best choice provided and keep going. :redpinkhe

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Thank you! I agree worded very weird!

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Specializes in Critical Care.
I'd call a rapid response on Robert. Falling BP and falling sats w/ incontinence (translation--confusion, weakness) constitutes an emergent situation in my experience. :uhoh3:

Another RN might hang the blood for me (and I'd make sure to give her a kudos for helping). :yeah:

Unfortunately not everyone has the luxury of being able to call a rapid response. If you have that option, then yes that would be best.

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Unfortunately not everyone has the luxury of being able to call a rapid response. If you have that option, then yes that would be best.

And rapid response was not one of the answers provided for the question.

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I'd say d.

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a.the charge nurse provides guidance to an lpn regarding hanging blood on another of robert's patients. a lpn can't hang blood.

b. robert tells the lpn on his team to assess his other patients while involved with mr. b. a lpn can't assess.

c. the charge nurse reassigns a certified nursing assistant to work with robert.

a cna wouldn't be qualified to care for a pt. with falling o2 sats and a falling b/p.

d. robert transfers the responsiblitly of caring for one of his patients who requires a blood transfusion to another rn. your answer.

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Specializes in critical care, home health.

I agree that A and B are out of the question, and D is a better answer than C. In real life, you'd call an RRT on this patient (and the patient would be transferred to critical care), or if you didn't have the RRT option, the patient would be transferred to critical care anyways.

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Specializes in med-surg,ortho,oncology,teaching.

It all depends on where you are. I live in Texas and LPN's at our hospital can hang the blood as long as two nurses have checked it and at least one of them is an RN. LPN's cannot do comprehensive assessments, which means here the initial admission assessment, but daily assessments are done by both LPN's and RN's. If you are in a state that doesn't LPN's to do the above then D would be the answer.

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Specializes in MSP, Informatics.

A and B are out. I need more info on Blood transfusion person.... what is the H&H? is this an emergent transfusion? we get people in all the time with chronic anemia, and the MD orders a blood transfusion a day for three days. Low H&H or active bleeding, that is a priority....but you treat the symptoms not the dr order. You might delegate that blood transfusion to the other RN, and it still may not be done by the time Mr B. is out of crisis.

and If I have a patient crashing (low BP, low sat as in Mr B) I don't have time to even give a quick hand off report on Mr blood guy.

Don't ya all hate questions like that. You never have enough info. Tell the charge nurse to get off her butt and help Robert!

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