To delegate or not to delegate?

[beaverlakefarm]

How would you handle this scenario?

It's change of shift. A nurse assistant approaches you that a patient is asking for oral pain medication. It is not your patient, but the nurse whom you work with everyday, is obviously busy. You have taken care of this patient before. You need to give an IM pain medication to one of your own patients, so to foster teamwork, you obtain the oral pain medication for this patient also.

****NOTE: The nurse assistant is in school to become a CMT. It is common practice on this unit that other nurses have delegated to nurse assistants to give medications.******

Do you delegate to this nurse assistant to give the oral pain medication?

[PPL, BSN, RN]

Hi. This practice is not acceptable at our facility. I would do it or ask the other nurse. Almost always, I try to find the other nurse, offer to give the med for him/her. This isn't always possible, but the best choice, just in case they've given something and forgot to document it. Something funny? A TV ad just came on for my facility, advertising how you can improve your career by working there. Just thought I'd mention it. I wonder how much marketing spends on these things!

[Jenny P]

The patient isn't your patient; the nurse caring for the patient may have given something and not signed it out yet. You should find the first nurse and ask if the pt. is due for some pain meds and if you could help by giving it to the pt. for her. I would never delegate giving meds that I'd signed out. It's my name and license that are on the line again.

[Doey, BSN, RN]

Absolutely not. First off this goes against my facility's policy. Second, even if I knew this patient and knew what kind of pain they were probably having, I would go to them to assess them in case this was a new pain. Then I would inform the nurse assigned to this pt. of my assessment and would ask if he/she would like me to medicate the pt. This is the ideal but as mentioned before this isn't always possible. If that's the case, I would check in pxys to see when the last pain med was taken out for this pt. and the nurse's notes as well as MAR. Of course I would ask the pt. also if they were alert and oriented. But I would always check with the pts primary nurse. I can always assess the pt. when I get there with the pain med and change my course of action if it is a new pain, at that time.

[OC_An Khe]

No way would I do or condone what was descibed in the original post. Its poor and unsafe practise on many levels.

[hollykate]

Just because someone is in school to become a med tech does not make them a Med Tech. They were not hired to be a Med Tech in their current position, so delegation in this case is wrong. Legally, I don't think there is any ground to stand on for delegating a task to an NA which is not in their scope of practice. Personally, I would give the IM, check with the Primary RN and then give the PO stuff.

[Charles S. Smith, RN, MS]

Originally posted by beaverlakefarm:

How would you handle this scenario?

What does the Missouri Nurse Practice Act state concerning delegation to unlicensed assistive personnel? What does your facility policy state concerning delegation to unlicensed assistive personnel? Giving pain medication requires assessment (not within the scope of responsibilities for a UAP) and evaluation. If you follow both guidelines you will remain within the scope of your responsibilities and the law. Also, you definitely should confer with the nurse responsible for the patient to see if she has previously given meds that are undocumented (i hope not) or if there is a difference in the pain level of the patient over the course of the shift. Giving a pain med is a usual, routine procedure, but has many levels of accountability for the nurse.

[beaverlakefarm]

Thanks to all who responded. It was very insightful to hear from others about this scenario. Thank you for taking your time to post a response.

[mustangsheba]

Beaver: Sorry such a late reply. My personal choice no matter what the regs are is to administer pain medication myself. I assess, maybe even do vitals, and reassess for effectiveness. And I would not give pain meds to a patient without first consulting with his nurse. This is one area that is so touchy, I just am not comfortable delegating.