Question

Maxine Overland is an RN, working on a medical-surgical unit in a partnership model of primary nursing. She has been on vacation for 2 weeks, and when she returns, she finds that the unlicensed assistive personnel she typically worked with is not expected to be back at work for several months because of a family emergency. A new nursing assistant, John Maxwell, who had worked in the hospital for only 2 weeks, is assigned as her partner.

Maxine was pleased to learn that John had previous experience in another hospital and is a certified nurse aide. However, as she began to work with him, she realized that he does not understand the delegation rules established by the state Board of Nursing. For example, she entered a patient’s room to find that John was removing an IV from the patient’s arm because it had infiltrated. Maxine took over the task, noting that the IV was in fact infiltrated. After leaving the room, she asked John why he had begun to remove the IV instead of calling her. He indicated that he had been taught how to do this at his last place of employment. She indicated to him that this was not a delegated task in this hospital. He responded, “Why? I know how to do it.”

Later in the morning, Maxine was reviewing the vital signs of the patients to whom they were assigned. The values for all blood pressures, pulses, and respirations were numerically very close, despite the fact that the patients had previously had widely different vital signs results.

Question ( 4 pts)

1. If you were Maxine, what would you do? ( must relate your answer to the NCSBN delegation rules.)

Answer 1

ANSWER: Delegation is the very skillful responsibility in nursing. It is applicable for all level of nursing that is advanced practice registered nurse, registered nurse and licensed practical/ vocational nurse.

NCSBN DELEGATION has 5 rights:

• right task
• right person
• right circumstance
• right direction and communication
• right supervision or evaluation

Here are some responsibilities of practical/ vocational nurse with delegated responsibilities:

• must accept the delegated responsibilities thar are appropriate for him/ her, in which they are informed, trained or educated and have the confidence to perform it.
• maintain the competency while performing responsibilities
• must communicate with Registered nurse
• must complete task on timely, correctly and documented according to organizational policy.

In above case RN should do :

• Identify the task that should be delegated to LPN or that are not appropriate for her level
• Ensure that the LPN has adequate skills, training, knowledge and experience for the delegated task
• There should constant supervision and evaluation of task performed by other
• communicate the task and reports of client, or other personnel concern
• Report about LPN to ward incharge if breaking and not following any instruction or guideline of delegation.
• If LPN performs that task that is not for her level, She should be stop to perform and if LPN still not following guidelines should be reported to higher level.
• RN should utilize the five rights of Delgation guidelines appropriately.
• LPN violate the practice statues and laws if perfrom the roles that are beyond and above the scope of practice.
• permanent lisecence revocation may occur if performs practice beyond her level.
• state disciplinary action should be taken in this situation.   

Task that are approriate for LPN are:

• assist in ambulation of client
• feeding and meeting hygienic needs of client
• collecting and sending specimen for lab test like urine and stool specimen
• measuring and recording of vitals and intake output
• report changes in client's condition
• teach and perform non pharmalogical activities.
• transportation, range of motion, bed making