M7.5 Delegation in Nursing
In your own words, define the “Rights of Delegation” and give an example.
Right Task:
Right Circumstance:
Right Person:
Right Supervision:
Right Direction and Communication
Remember T-A-P-E, these are things only the RN can do:
Delegation Case Study
You (an RN) have just arrived for your shift on the cardiovascular unit. You will be working the 15002300 shift. You have been assigned 5 patients. You are responsible for the safe care of these 5 patients.
You will be working directly with the following individuals:
1 LPN- This individual will be working directly with you in caring for your 5 patients and will also be assisting one other RN with their nursing assignment.
1 Unlicensed assistive personnel (UAP)- this individual is responsible to assist with the care of 10 patients on the unit. Five of these patients are yours.
The following was given to you and your team during nursing report:
Prioritize the following patient in order of care with a short explanation as to why:
#1____________________
#2____________________
#3____________________
#4____________________
#5____________________
1. George Stanley – 70-year-old male who is 5 days post-op coronary bypass surgery x 5. Pacing wires were discontinued 4 hours ago with no problems noted at this time. Patient is ambulating
without O2 and has no cardiac arrhythmias. Patient still requiring oral pain medication every 6 hours. Discharge teaching is needed. Patient to be discharged in the morning.
2. John Richards – 62-year-old male who presented to the ER 22 hours ago with an ST elevated MI. Patient has had 2 coronary stents placed. Arterial femoral line is still in place and needs to be
removed within the next 2 hours. IV nitro has been discontinued and patient is not complaining of any chest pain.
3. Violet Smith – 40-year-old female admitted 3 hours ago with cardiac arrhythmias due to possible cocaine and alcohol consumption. Patient is currently stable with no signs of cardiac
arrhythmias. Vital signs and patient assessment are every 30 minutes for the next 4 hours and then every hour for the next 24 hours.
4. Diane Johnson – 65-year-old female who received a coronary angiogram 12 hours ago. No coronary artery disease was noted. Patient has had femoral lines removed and has ambulated
once. She still needs to ambulate one more time this evening. Discharge teaching has been completed but the patient has had multiple questions relating to heart disease. Patient is to be
discharged in the morning.
5. William Bowers – 72-year-old diabetic male. Patient presented to the ER by private vehicle 8 hours ago complaining of 7/10 chest pain and difficulty breathing. O2 and IV nitro is running.
Patient currently has had no ST elevation and rates his pain 2/10. Morphine IV push has been ordered. Bedrest has been ordered until coronary angiogram in the morning. Patient teaching for angiogram needs to be completed.
Which tasks can be delegatedd to and/or performed by which team
member? You can select more than one person for a task.
Vital Signs
Blood Glucose
ADLs
Applying Restraints if needed
Receiving med and IV fluids from the Pharmacy
Signing off doctor orders
Assist doctor with insertion of central line
Ambulate patient
Pain medication administration
IV monitoring and maintenance
Administer IV medications via central venous
catheter
Set up and maintaining skeletal traction
Administer oral meds, IM, or SQ
Reinforce patient teaching
Apply cold or warm moist packs
Suction trach
Patient shift assessment
Removal of femoral lines and the 15 minutes of
direct pressure over the femoral site
Monitoring for withdrawal and vital signs of
patient #3-Violet Smith
Wound care and sterile dressing change
Refilling water jugs
Removing warm or cold packs
Answering call lights
RN
LPN
CNA
Specific Delegation Questions:
A Registered Nurse is trying to coordinate care with a nursing team that includes a licensed practical
nurse (LPN) and an unlicensed assistive personnel (UAP). Which of these patients should be
assigned to the UAP under the supervision of the registered nurse (RN)?
A.
B.
C.
D.
A 62-year old patient with postoperative pain who needs pain medication
A 65-year old patient with a hip fracture who needs to use the bedpan
A 50-year old patient who needs an abdominal dressing change
A 75-year old patient who is going to be transferred to a nursing home and needs discharge
teaching.
An RN oversees a team with an LPN, and UAP. Which of the following should be cared for by
the RN?
A. A patient with pneumonia who is refusing antibiotics and is hypoxic
B. A patient with a chest tube that has been in place for 2 days, is stable, and wants to use the
commode
C. A patient with chronic renal failure who is being discharged in the morning with stable vital signs
D. A stable patient with an old stroke that needs help with bathing
An RN on a telemetry unit is falling behind while performing assessments and
administering medications. Which task can the nurse safely delegate to the UAP?
A. Assessing a patient who has just arrived on the unit
B. Helping a postoperative patient out of bed for the first time
C. Documenting a patient’s I & O in the electronic health record
D. Teaching a patient with newly diagnosed diabetes about foot care
As an RN, which task can you delegate to an experienced LPN? Which choices should only the RN
perform?
Check the appropriate choices and give rationales for the tasks an RN must do for the patient.
______Performing an assessment on a new admission
______Collecting a urine sample from an indwelling Foley catheter
______Developing a plan of care for a patient who is admitted with Guillain-Barre Syndrome
______Reinforce education on a patient about how to monitor for side effects associated with Warfarin
______Auscultating lung and bowel sounds on a stable patient.
______Reinforce a patient’s understanding on how to administer subcutaneous injections of
Enoxaparin Sodium
______Administering an influenza vaccine
Which of the following can the UAP perform? Select all that apply.
______Collect and record patient’s BP, HR, RR, O2sat, temp.
______Empty an ostomy appliance
______Assist patient with administering Fleet enema
______Apply hydrocortisone cream to eczema on skin after bath