Attachment EP23g Excerpt slides 1-23 Department of Nursing Orientation. Amy Stafford MSN, RN, CMSRN Professional Nursing Practice

Transcription

1 Amy Stafford MSN, RN, CMSRN Professional Nursing Practice 1

2 For Staff Nurses and Nursing Technicians 2

3 Webster: The act of empowering to act for another. MD Nurse Practice Act: The act of assigning or authorizing an unlicensed individual to perform acts of registered nursing or licensed practical nursing. 3

4 The art of delegation has to do with the delivery The science of delegation has to do with the legal and licensing issues 4

5 Consider how you like to be told you have to do something? You probably want to know the who, what, when and how behind it Give the same consideration to the person to which you are delegating a task 5

6 Do you like to be delegated to by someone who is not currently doing anything? Consider your workload and the workload of others before delegating a task that you are capable of performing yourself 6

7 Considerations to make prior to delegating a task Does the potential for harm exist? What is the nature of the task? What is the degree of critical thinking involved? Are the outcomes predictable 7

8 Your new admission, an 85 y/o male is admitted for a UTI r/t urinary retention from BPH (benign prostatic hypertrophy). The physician has ordered a foley catheter be placed. Should this task be delegated to an UAP (unlicensed assistive personnel aka Nurse Tech)? 8

9 NO!!! Does the potential for harm exist? Yes, damage to the already enlarged prostate What is the nature of the task? Foley placement, which is within the scope of the nurse tech What is the degree of critical thinking involved? Possibly high- the UTI is caused by retention from an enlarged prostate. If urine is unable to flow out, inserting a large catheter could be difficult. A coudee catheter might be needed Are the outcomes predictable? No, you may get the foley in easily, may need to insert a coudee, or may not be able to place one at all due to his current medical condition 9

10 Your patient, a 75 y/o female has a red, yeasty rash in her skin folds. The physician has ordered Nystatin cream to be applied QID. The Nurse Tech is about to bathe the patient, do you ask the NT to apply the 1000 dose of Nystatin cream? 10

11 NO! Does the potential for harm exist? No What is the nature of the task? Routine medication administration is NOT within the scope of practice for a NT What is the degree of critical thinking involved? Minimal Are the outcomes predictable? Yes 11

12 Your patient, a 55 y/o male, was admitted to your unit after a debridement of a necrotic toe. Barbara Todd has ordered wet-dry dressing changes BID with sterile water. Can the NT assigned to this patient perform the dressing change? 12

13 YES!!! Does the potential for harm exist? No What is the nature of the task? Routine dressing change, non-medicated. This is appropriate for a NT. What is the degree of critical thinking? Minimal Are the outcomes predictable? Yes 13

14 It requires specialized knowledge or skill It is not within one s scope of practice You are unsure of the competency level of others It is a task specific to the position of authority It involves a high level of confidentiality The task demands close supervision and there is not enough staff available 14

15 Right task Right circumstance Right person Right direction/communication Right supervision 15

16 All of the NTs at SHS are also Certified Nursing Assistants. They have been trained to perform the following tasks: Bed baths/hygiene Feeding patients (including those on aspiration precautions and thickening of liquids) Physical Transfers and ambulation 16

17 Administration of soap suds enemas only! Foley catheter placement Ostomy care, including appliance changes Emptying surgical drains Setting up sterile fields Assisting with lumbar puncture positioning Wet to dry and Dry to dry, non-medicated dressing changes 17

18 Finger sticks Providing continuous 1:1 observation Restraint application and removal Vital signs, including pulse oximetry Application and removal of SCDs and TED hose 18

19 Some nursing technicians assigned to the Emergency Department may: Start peripheral IVs and draw blood This is only after completing a 4 hour course offered by SHS 19

20 You can delegate authority, but not responsibility. - Stephen W. Comiskey, leadership author When you delegate to an UAP, you hold the ultimate responsibility and accountability for the nursing act being delegated 20

21 Remember- delegation is the act of authorizing an UAP to perform an act of registered nursing Assigning is the transfer of responsibility from one nurse to another nurse 21

22 Therefore, when you are the Charge Nurse and you make a patient assignment or assign a new admission, once the RN accepts that assignment, it is the accepting nurse that is then responsible and accountable for the care of that patient for the day. 22

23 Routine tasks may be delegated if The task if performed frequently enough to ensure competency The task has an inherently low risk to the patient There is written documentation that the delegatee is competent to complete that task 23