trying to learn delegation, please help???

[anangelsmommy, ADN, BSN, RN]

Hi,

I am an RN student in my final weeks and I have a project on delegation. and guess what, they never really taught us delegation! I did post this in the student section but I didnt really get any feedback, I would love some help from some seasoned RN's. When I started this, I was really thinking like an LPN, I didnt even realize that I am delegating to and LPN AND a UAP. I have 3 patients. I have done most of the project. Where I am getting stuck is what parts to delegate and what to keep. I dont know if I just do each of do appropriate work - I mean realistically you wouldnt have 2 nurses and a UAP with 3 patients. But here goes. I have a cardiac patient that has not yet ruled out MI - having an echo today, not a lot of meds, no ivs, is on anticoagulant. Have a lung cancer pt in for fever considered immunocompromised because of chemo. recieving iv antibiotics lots of meds, pain meds, she is on bleeding precautions due to the chemo. then I have a post stroke gentleman with a small bowel obstruction having an xray today to see if has resolved, he is eating normally now but needs help with adl's because of the stroke and also has pneumonia, he is fairly stable. has iv antibiotics and quite a few meds, including anticoagulant as well. so I listed all my nursing interventions. Now I have to list what out of all of this I would delegate. I said that the uap could do the vitals on all patients and do the am care on the stroke pt and if the cancer pt need help with am care could assist there as well. also the uap could turn the stroke pt every 2 hrs to prevent skin break down.

as for the lpn....this is where I get stuck...probably still thinking like an lpn...I have to do the IV's, right? and assessment and teaching, there is a lot of teaching - teach the cardiac about diet, smoking cessation, calm environment, teach the cancer pt and family about how to prevent transmission of disease, prevention of nauseau, bleeding precautions, etc. would it be fair to have the lpn then do the medications for two of the other patients so that I can do the one with less meds, then do the iv's, and the teaching....what else would she be doing? patient care of course...but details? 2 pts with pneumonia but we have respiratory doing treatments and chest pt right? I normall work home care. I am not sure how this works in a hospital. my only patient without iv meds is the cardiac patient, if I assessed him and felt he was stable, could I give her the cardiac patient? He said he had a 10 out of 10 pain but was laughing and talking?

angels mommy

[jfriend]

when studying for the nclex remember RN has to do all the teaching and assessments (this always includes new admissions, discharges, and transfers). You can delegate tasks like trach care, dressing changes yada yada to an LPN if they know and understand what there doing and/or you can tell him or show them a policy or protocol that lists out step by step. Then the NA can do vitals (but they have to report them to the nurse so the nurse can assess them) and they do bathing feeding pts (unless the patient has a internal chemo device then the nurse usually does everything cause you have to limit the time and exposure). As far as meds. i think LPNs can do them all except pain meds (i dont think they can get into the pixis) and giving pain meds include assessment of pain. idk if that helps but i hope a lil. As far and the pts with pneumo the RN can teach cough and deep breathing exercises and then the LPN can encourage it after its initailly taught. then the ADLs and vitals go to the NA.

[filipina in Australi]

Delegation.......

Skill mix.. for example, the most senior and the incharged, the new RN, and 3rd nurse not RN

Give the patients need help with ADLS to 3rd nurse. the incharged nurse hould have no patient or may have lighter patient so that she can help to other nurses, give the new RN more patient with less complication.

More on capabilities and ability to handle the patients...............

[anangelsmommy, ADN, BSN, RN]

the thing is , I am the new nurse and supposed to be in charge. I am the RN. it is just for practice but I am the charge nurse, then I have an LPN- less abilities and then a UAP/CNA- unlicensed - they are not nurses. am more stuck on how much to give the LPN and how much to keep myself? the problem is that they dont really teach this, we are just given this as a project. I dont want to keep too much and give too much. I dont know how it is done in the real world because I work home care. I dont currently work in a hospital except to do clinical, and that I do as an RN, we dont have lpn's so I am kind of stuck. do nurses that work on floors with both, split patients up?

I guess I was really looking for an answer from some people that are working in hospitals that have both, and can tell me how they really do it?

angelsmommy????

[CuriousMe]

Also a student here, so take this with a grain of salt :)

I know in some states LPN's are automatically qualified to hang IV meds and in some they aren't. So, I'd find out how your state looks at LPN's and IV meds to make your decisions.

Good luck!!

Peace,

CuriousMe