Beruflich Dokumente
Kultur Dokumente
College of Nursing
Malaybalay City, Bukidnon
In Partial Fulfillment
of the Requirements for the Course
NCM 107-B
Nursing Leadership and Management
Submitted by:
Auguis, Fe
Cagulada, Lharra Mae
Casite, Nielmark
Doydora, Ma. Zusette
Gomez, Junfelm
Homamoy, Frances Joy
Palado, Marcher
Robosa, Joshua
Santillan, Cheerille
Telin, Marvin
Tortola, Loweelyn
Torayno, Imelda
Villamor, Rachelle
Submitted to:
Dr. Violeta B. Juan
TABLE OF CONTENTS
I.
II.
III.
INTRODUCTION
a. Objectives/Statement of the Problem
b. Theoretical Framework
c. Significance of the Study
d. Definition of Terms
REVIEW OF RELATED LITERATURE
CASE
IV.
V.
VI.
APPENDICES
I.
INTRODUCTION
A changing health care environment is impacting on the role of practice nurses. As a result of
fundamental changes taking place in both health care and nurse education, the clinical role of the
practice nurse will need to extend and expand (Paxton et al 1996). New knowledge and skills
will be a necessity. In the future, one of the greatest challenges to practice nurses will be the
attainment, maintenance and advancement of their professional development.
The importance of continuing professional development (CPD) for nurses has been
increasingly emphasized in the past few years. An Bord Altranais, in its Review of Scope of The
Commission on Nursing, saw the need to develop and strengthen the availability of professional
development for all nurses and suggested that it might be helpful to consider continuing
professional development three broad headings: in service training, continuing education and
specialist training (Commission on Nursing, 1998).CPD has been shown to improve job
performance, quality of care, organizational performance and service delivery across
employment sectors with consequential reduction in costs.
The symptoms of the dengue virus generally include mild, moderate, or high fever,
headaches, nausea, vomiting, pain in the muscles, bones, or joints, and rashes on the skin. In the
case of dengue hemorrhagic fever, other disturbing symptoms can develop. These may
include:restlessness, acute fever, bleeding or bruising under the skin, and cold or clammy skin.
Philippine Hemorrhagic Fever was first reported in 1953. In 1958, hemorrhagic fever
became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic
Fever. The morbidity rate of dengue fever in 2003 is much lower at 13 cases per 10,000
population compared to the highest ever recorded rate of 60.9 per 100,000 in 1998. The case
fatality ratio for dengue fever and dengue hemorrhagic fever in 2003 is also lower at 0.8%
compared to the highest recorded ratio of 2.6% in 1998.
A Dengue Hemorrhagic Fever patient, having a lethal disease must be strictly watched for
the signs and symptoms as this could turn to life-threatening situation.
The presenters being student nurses sought to know and understand delegation, tasks that
are not to be delegated, laws relating to improper delegation in relation to the case identified, and
professional development activities to improve knowledge on delegation.
B. Theoretical Framework
Theory
(1978)
addressed
workers.
Learning
Theory
is
registered
in
professional
Knowles
nurses.
Adult
Knowles
labeled the differences in adult learning andragogy. Andragogy deals with how science and art
assist adult learners in a special way. The goal of educators should be to guide adult learners to
meeting their learning needs and reaching their goals.
There are six basic assumptions of andragogy (Knowles, 1978). The first assumption is
called self-concept. This means that adults need to be self-directed. The second assumption
addresses the issue of experience. Adults bring their past experiences to the learning
environment. The third assumption is readiness to learn. Adults are ready to learn when they feel
that they need to know the information or when they feel the increase in knowledge will help
them accomplish a task more effectively. The fourth assumption is orientation to learning. As
adults mature, they apply knowledge learned immediately. Adults learn based on an immediate
problem or task, and this is related to the fifth assumptionmotivation. As adults mature, the
motivation to learn becomes intrinsic. The sixth assumption is the need to learn. To be motivated,
adults must know the reason why they should learn something. These six assumptions are
essential to the creation of the milestone pathway tool. They drive the creation of the tool that
helps facilitate forming professional development goals that are significant to the individual and
specific to the nursing unit. The tool encourages self-direction and takes into account experience
level. Understanding the assumptions allows creation of a tool that is appropriate for adult
learners.
Conceptual Framework
1. Selfconcept
2. Issue of
experience
KNOWLES ADULT
LEARNING
THEORY
3. Readiness
PROFESSIONAL
DEVELOPMENT
4.
Orientation
to learning
5. Motivation
The first assumption is called self-concept. This means that adults need to be selfdirected. As a Registered nurse you need to think first the welfare of others before yourself. To
6. Need
to you.
grow professionally this kind of attitude must
be within
The second assumption addresses the issue of experience. Adults bring their past
experiences to the learning environment. If you are an experienced nurse you already know if
how to assess your patients thoroughly. You know what are the task need to done and need to be
delegated. As a RN you learn based on an immediate problem or task and you will know what to
do. You already know how to weigh the situation to what will be prioritize.
The third assumption is readiness to learn. Adults are ready to learn when they feel
that they need to know the information or when they feel the increase in knowledge will help
them accomplish a task more effectively. For professional development, nurses need to have
continuing education to be updated and has an attitude to learn and accept opinions from others.
The fourth assumption is orientation to learning. As adults mature, they apply
knowledge learned immediately. When you are in this stage you will apply all your
learningsfrom the new updates that you learned.
The fifth assumption is motivation. As adults mature, the motivation to learn becomes
intrinsic. Registered nurses must have the motivation for continuing professional development as
this will help them enhance their knowledge, skills, and attitude towards nursing.
The sixth assumption is the need to learn. To be motivated, adults must know the
reason why they should learn something. T
These six assumptions are essential to the creation of the milestone pathway tool. They
drive the creation of the tool that helps facilitate forming professional development goals that are
significant to the individual and specific to the nursing unit. The tool encourages self-direction
and takes into account experience level. In order for you to be a competent nurse and to grow
professionally you should not stop learning. You should have continuing education. To be more
efficient and effective nurse, you should be updated to the new trends and development in
nursing profession so that you can provide quality care to your clients.
Staff Nurses and Nursing Attendants. The staff nurses and nursing attendants
will be presented and updated regarding their roles and responsibilities as a
nurse/nurse attendant, the tasks that are not to be delegated, and laws relating to
improper delegation;
Chief Nurses. The study will present the Chief Nurse the actual scenarios
observed by student nurses in the hospital, and will be able to further conduct
continuing professional development activities for the nurses and nurse
attendants.
D. Definition of Terms
Delegation is the assignment of responsibility or authority to another person to carry
learning.
Need to know: Adults need to know the reason for learning something.
Foundation: Experience (including error) provides the basis for learning activities.
Self-concept: Adults need to be responsible for their decisions on education;
II.
Nurses have authority to assign selected activities of care to other qualified and competent
helpers while protecting the health, safety, and welfare of every patient. Registered Nurses (RNs)
determine the tasks that can be delegated; they rely on other assistive caregivers as a necessary
component of safe staffing. Organizations rely on assistive workers to provide a cost-effective
skill mix. Threats of nursing shortages, mandates for reportable quality outcomes, and data
supporting greater RN presence as improving nurse-sensitive measures have increased the
urgency to ensure appropriate RN staffing inclusive of effective delegation.
Delegation unburdens the RN from unnecessary work others can do, while the RN retains
accountability for care and outcomes. With increased complexity of patients, nurses increasingly
must use critical thinking skills to evaluate the type of care, circumstances, and competence of
assistive caregivers prior to delegation. Delegation remains an underdeveloped skill among
nurses, and one that is difficult to measure. It relies on personality, communication style, and
cooperation. The success or failure of delegation depends on a positive two-way relationship of
mutual respect and trust between the RN and the helper who assumes responsibility for specific
tasks. This dynamic exchange between the RN and the helper requires constant evaluation,
feedback, and modification to achieve the results needed to meet patient care goals.
The six initial articles in this topic address a variety of considerations that are important in
successful delegation. These considerations include traditional and emerging thought about the
common skills necessary for delegation and the unique challenges across practice settings. A
number of common themes emerge in this topic. First is the importance of understanding the
legal authority to delegate to other qualified individuals. In the United States (US) each state
issues its own definitions and regulations regarding delegation, whereas there is no legal
definition of nursing in the United Kingdom (UK), making delegation even more challenging.
Additionally, in any practice setting, developing trust is a fundamental requirement for successful
delegation. Nurses delegation skills develop over time, building on critical thinking, and
growing from being uncomfortable delegating to others to being confident in this delegation
process. Competence in delegation is as important for the nurse as are other cognitive or
psychomotor skills. This competence requires ongoing education and development. The
influence of delegation on quality and safety outcomes should not be underestimated. Growing
sophistication in our ability to measure nurse-sensitive outcomes creates an imperative to assess
the contributions of all who contribute to care under the direction of the RN.
Building delegation skills starts with all nurses understanding the provisions of their nurse
practice acts, and also understanding of the concepts of responsibility, accountability, and
authority. In Developing Delegation Skills, Weydt walks the reader through the fundamental five
rights of delegation as articulated by the National Council of State Boards of Nursing (NCSBN).
These include the right task; circumstance; person; direction and communication; and
supervision and evaluation. She points out two major ways delegation occurs, by simple task
assignment based on job descriptions or matching a staff members expertise to a patients needs.
Weydt stresses the need for: (a) clarity in delegation, (b) ongoing development of delegation
skills, (c) assuring that the person to whom a task is delegated is qualified to perform the task,
and (d) assuring the RN retains final accountability.
Anthony and Vidal describe how the right communication, one of the five rights of
Delegation, influences effective delegation. In Mindful Communication: A Novel Approach to
Improving Delegation and Increasing Patient Safety, they explore mindful communication
which requires individuals to recognize the significance of facts and how the facts relate to a
current patient condition or situation. Scenarios amplify the relationship of delegation to safety
and quality outcomes. Some of the tasks typically delegated, for example turning, ambulating,
providing personal care, and/or glucose checking, are directly associated with nurse-sensitive
outcomes, such as preventing complications and maintaining physiologic balance. The right
communication transmitted via timely and clear messages makes communication meaningful.
Reflecting on the communication concepts of information decay and information saliency,
RNs must emphasize to the assisting caregiver what information is important and clarify any
information that can be interpreted in more than one way. Just as communication breakdown is
responsible for sentinel events, it also has a significant effect on effective delegation in our daily
practice.
In Delegation in the School Setting: Is it a Safe Practice?, Resha points out that school
nurses are providing more care than ever before, with limited numbers of providers. In many
locations the ratio of RN to students is five times the recommended 1 to 750 well students.
Nurses are called upon to perform health screenings, immunizations and reporting, health
teaching, case management, and management of medically fragile children with complex needs,
including ventilators, pacemakers, and insulin pumps. Safe delegation can occur for some of
these activities if there is adequate training of assistive personnel and close supervision.
However, for school nurses assigned to multiple buildings and locations, close supervision is a
myth. In some schools there is no support for a nurse helper. When the RN is not present, other
substitutes, for example administrators, teachers, and/or parents, may step in to provide care; this
presents a risk to safe patient care as well as to the school nurse. School nursing practice includes
playing a role in development of school policies, being competent in the five rights of delegation,
educating assistive personnel, and building relationships to ensure proper delegation.
Delegation is a universal nursing skill. With the looming world-wide nursing shortage, any
change in skill mix will undoubtedly lead to an increase in the amount of delegation of certain
aspects of care. In the UK delegation is recognized as an important skill at all levels of practice.
Gillen and Graffin describe the authority, accountability, and responsibility for delegation in the
UK, along with facilitators and barriers in their article Delegation in Nursing in the United
Kingdom. With no legal definition of a nurse in the UK it is imperative that there be clarity in
procedures for delegation as well as clarity between the RN and Health Care Assistant. Many
delegation similarities exist between the UK and the US. In both countries the RN retains
accountability and responsibility for care, but the person who accepts the assigned work also
accepts responsibility for performing the work. Appropriate delegation assumes that prior to
assignment of tasks, the RN uses judgment and demonstrates critical thinking to assess the skill,
competence, attitude, and experience of the helper, as well as the patient requirements and nature
of the circumstances. Building of trust, effective communication, and mutual support contribute
to success in the US and the UK, and around the world. (Delegation Dilemmas: Standards and
Skills for Practice by: Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN; Retrieved February 24,
2015)
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines
negligence as a "failure to use such care as a reasonably prudent and careful person would use
under similar circumstances." JCAHO defines malpractice as "improper or unethical conduct or
unreasonable lack of skill by a holder of a professional or official position; often applied to
physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of
duties when professional skills are obligatory. Malpractice is a cause of action for which
damages are allowed." Malpractice is defined variously under state nurse practice acts,
institutional policies, and federal guidelines such as JCAHO standards, all of which may be taken
into consideration in court.
Several factors have contributed to the increase in the number of malpractice cases
against nurses:
Early discharge. Patients are being discharged from hospitals at earlier stages of
recovery and with conditions requiring more acute and intensive nursing care.Nurses
may be sued for not providing care or not making referrals appropriate to the patient's
condition.
Republic Act 9173, also known as the Philippine Nursing Act of 2002 states in Article 6,
Section 28 that it shall be the duty of the nurse to undertake nursing and health human resource
development training and research, which shall include, but not limited to, the development of
advance nursing practice. Nurses really must continue professional development in accord to
the law, in order to provide the best possible care to patients.
IIII.
CASE
Nurse Z has been working at Bukidnon Hospital with competitive service of caring and
love for patients for almost five years. He is currently assigned as a charge nurse at the Pediatric
Ward, supervising three nurses under his shift. One fine day in the hospital, the ER staff was
extremely busy caring for urgent patients arriving. A male infant named BABY was brought to
the ER by his mother who is 14 months old with a high fever of 40.1C, and red patch rashes all
over the body. The mother said that it was the 6th day of his fever, he does not drink his milk, has
been having diarrhea, bleeding on gums, vomiting, epistaxis, swelling around the eyes, irritable
with a blood pressure of 80/60 mmHg, pulse pressure of 20 mmHg, PR-147bpm, RR-51cpm.
While in the ER, after the admitting physician examined the child, he diagnosed him of
having a Dengue Hemorrhagic Fever Degree III, the charge nurse carried out the order and asked
the nursing attendant Could you please start IVF on pt. BABY? Im very busy carrying out
orders here. The nursing attendant did insert the IV cannula but the first attempt was
unsuccessful. After several times of reinsertion of the IV cannula to the same vein, she finally
was able to insert it. She left the child and attended to next patients without informing the charge
nurse regarding the several attempts of IV cannula insertion. After a while, the mother
complained to the nurses and said,: Hey my babys hand is starting to swell and blood is coming
out from his nails!, but the nurses did not pay much attention not until the mother screamed for
help. Suddenly, all staff gave their attention and transferred the patient to the Pediatric Ward. The
patients mother told Nurse Z about the situation that have happened at the ER that her babys
IVF was not infusing well and that the site has become swollen. After a few hours, lab results
were in and the CBC showed thrombocytopenia (90,000mm3). Nurse Z knew that the patient
must be strictly watched for complications of Dengue Hemorrhagic Fever such as extensive
bleeding, LOC and pleural effusion. However, the bedside nurse delegated the task to the nursing
attendant to discontinue and reinsert a new IV cannula to another site because she was busy
attending other patients and carrying out doctors orders.
V.
At the Emergency Ward, the nursing attendant inserted the IV cannula but the first
attempt was unsuccessful. After several times of reinsertion of the IV cannula to the same vein,
she finally was able to insert it. She left the child and attended to next patients without informing
the charge nurse regarding the several attempts of IV cannula insertion. At the Pediatric Ward,
Nurse Z knew that the patient must be strictly watched for complications of Dengue
Hemorrhagic Fever such as extensive bleeding, LOC and pleural effusion. However, the nurse
delegated the task to the nursing attendant to discontinue and reinsert a new IV cannula to
another site because she was busy attending other patients and carrying out doctors orders. The
identified problem from the case was: Non-compliance to hospital protocol related to improper
delegation. Inserting an IV cannula is not in the job description of a nursing attendant, therefore,
the charge nurse, though she was busy carrying out the Doctor's Orders, should not have
delegated the task to the attendant. Only Registered Nurses who are trained for IVF insertion can
do the task.
Recommendation:
As aspiring future nurse staffs and nurse managers, we recommend the following:
1. The hospital must precisely formulate a comprehensive scope of practice for the
Registered Nurse and Nursing Attendants, including the specific tasks which are
delegable.
2. Registered Nurses must consider the set of tasks he/she would delegate, that fit with the
nursing assistants skill and are in accord to the hospital protocols.
3. Advance Life Support and knowledge updates through seminars on delegation.
Although it is costly, these activities will help not just the staff nurses but also the nurse
managers to enhance their management skills.
2. Seminar on Philippine Nursing Act of 2002.
Republic Act 9173 encompasses the Scope of Nursing Practice on Article VI. It must be
presented to all the Registered Nurses as well to remind them of their legal tasks, and
their duty of continuing professional development.
ASSESSMENT
Subjective data:
gamayrakaayoiyanggakaihi. Ga whole day
nalangiyang diaper,
gamayragyudangbasadayun nay
dugogapanggawassaiyangtudlouglagus. as
verbalized by the mother
Objective data:
Tachycardia (PR-147bpm)
Tachypnea (RR-51cpm)
Hypotension (80/60 mmHg)
Decreased urine output
Bleeding on gums
Delayed clotting time
Thrombocytopenia Platelet count
90,000mm3
NURSEING
DIAGNOSIS
Deficient fluid
volume r/t
hemorrhage
OBJECTIVES
INTERVENTION
Nursing Outcome
Classification
(Expected
Outcomes)
Independent Nursing
Intervention
Classifications:
Short term:
At the end of 30
minutes of several
interventions, the
patients vital signs
will be stable and
bleeding will be
minimal.
Long term:
At the end of few
hours of
interventions, the
patients platelet
count will improve.
Bedside Nurse
1. Asses initial vital
signs
2. Monitor vital signs
every 15-30
minutes.
3. Put pressure on the
bleeding areas
Dependent Nursing
Intervention
Classifications:
Medication Nurse
4. Start IVF PNSS 1
L upon doctors
order.
5. Blood transfusion
(platelet)
Charge Nurse
6. Monitor platelet
count together
with the med tech.
7. Refer the pt. to the
physician.
R
-
T
v
T
n
d
T
th
a
T
p
T
b
T
p
re
o
ASSESSMENT
Subjective cues:
Could you please
start IVF on pt.
BABY? Im very busy
carrying out orders
here. As verbalized
by the charge nurse to
the nursing attendant.
Objective cues:
The nursing attendant
inserted the IV
cannula but the first
attempt was
unsuccessful. After
several times of
reinsertion of the IV
cannula to the same
vein, she finally was
able to insert it. She
left the child and
attended to next
patients without
informing the charge
nurse regarding the
several attempts of IV
cannula insertion.
IV.
PROBLEM
Improper
Delegation
OBJECTIVES
Nursing Outcome
Classifications
(Expected Outcomes)
At the end of nurse
managers action, the
staff nurse and
nursing attendant will
comply with hospital
protocols.
ACTION
1. Call the attention
of the staffs on
duty and the
nursing attendant
on that shift.
2. Have them make
incident report.
3. Review to them
the consequences
and sanctions of
their action.
4. Evaluate their
previous
performances
whether they
have committed
the same action
on their previous
duties.
5. Decide whether
to give them a
second chance or
terminate them
immediately.
RATIONALE
To have them
explain their side
of the issue.
For
documentation
To remind them
of the hospital
protocols.
Definition: HYPERTHERMIA the body temperature rises above the normal range.
ASSESSMENT
PROBLEM
OBJECTIVES
ACTION
Subjective cues:
Nursing Outcome
Independent Nursing
He has been feverish for
Hyperthermia related Classifications:
Interventions
RATI
to the process of
dengue virus infection
(Expected Outcomes)
Classification:
Short term:
That during 30mins1hour of nursing
interventions, patient
will experience
normothermia with a
temperature of 3637C.
Charge Nurse:
1.Carry-out Doctors
orders
2. Make and follow-up
laboratory results (e.g
WBC- 15/L
3.Assess possible
etiology of increased
temperature
Long term:
At the end of our duty,
patient will be able to
maintain a core body
Bedside Nurse:
temperature of 36-37C 1. Provide/ encourage
even without RTC
patient to drink
antipyretic.
plenty of fluid as
tolerated (colostrum)
2.Instruct the significant
other to let the
patient wear
clothing that is thin
and not the cotton
and silk ones.
Medication Nurse:
1.Inform patient
regarding the side
effects of the drugs to
be administered
2.Considers the nursing
precautions in drugs to
be given
Nursing Aide:
1.Monitor V/S every
30mins.
2.Provide and increase
air circulation
Bedside Nurse:
1.Intake and output
1.To facilitat
of care
2.To determi
regimen. To
and other me
3.To monitor
causes of the
condition
1.To replace
evap
2.To provide
comfort and
clothing abso
does not stim
increase in bo
1.To educate
effects and le
2.To prevent
upon adminis
Nursing Aide
1.Vital signs
determine the
general cond
2. Serves as a
measure to lo
heat
Bedside Nurs
1.Detecting e
dehydration a
balance of flu
ASSESSMENT
Subjective cues:
There was blood coming
out from his gums since
this morning, as
verbalized by the
patients mother.
Objective cues:
PROBLEM
OBJECTIVES
Risk for
hemorrhage related
to altered clotting
factor
Nursing Outcome
Classification:
After 3 hours of
nursing
interventions, the
client will be able
to demonstrate
behaviors which
reduce the risk of
bleeding.
ACTION
Independent NIC:
Charge Nurse:
1.Carry-out Doctors orders
2. Make and follow-up
laboratory results (e.g Platelet
Ct: 90,000mm3)
Bedside Nurse:
1. Assess the signs and
1.
symptoms of GI bleeding.
Check for secretions.
Observe color and
consistency of stools or
vomitus.
2. Observe for presence of
petechiae, ecchymosis,
bleeding from one more
sites.
electrolytes i
1.To enhance
evaporation a
2.Removing
cooling meas
providing of
promotes hea
1.To lower d
temperature.
RATIO
1.To facilitate c
care
2.To determine
regimen
1.The GI tract i
source of bleed
mucosal fragili
2.Sub-acute dis
intravascular co
develop second
clotting factor.
mmHg, pulse
pressure of 20
mmHg, PR147bpm, RR51cpm
Nursing Aides:
3. Monitor vital signs hourly
or more often.
Medication Nurse:
4. Use small needles for
injections. Apply pressure
to venipuncture sites for
longer than usual.
Collaborative:
1. Administration of
PNSS 1L 50cc/hr as
per Physicians order
3.An increase in
decrease BP can
of circulating bl
4. Minimize dam
reduce risk for b
hematoma.
1. To repla
can go
transfus
isotonic
VI.
APPENDICES
b. She will keep all articles well-arranged and maintain the inventory.
c. She will take the report, make bed to bed round at the time of changing of the shift of the
unit.
d. She will orient the new patient with ward.
e. She will help the ward sister for supervision of work of Group D allotted in the ward for
maintenance of cleanliness and sanitation.
f. She will make list of patients belongings and keep in safe custody, according to laid down
policy of the hospital.
g. She will keep a sub stock of drugs, linen and other supplies for ward maintenance.
h. She will maintain poisonous drugs registered.
i. She will sterilize all articles; maintain all equipments, gadgets, electrical connections
Sight, fan etc.
j. She will indent drugs, diet, and other supplies if necessary.
k. She will vigilant to protect the patient from injury or accident by providing side rail.
l. She will write report of each shift and sign the report after checking properly.
m. She will assist the ward sister in orientation programme of new staff and students.
n. She will make round with doctors and senior nursing officers.
o. She will help ward sister in indenting and checking of drugs, supplies and maintaining
inventories.
p. She will be deputed for the ward sister during her absent.
q. She will keep herself up to date with nursing knowledge by taking part in -service
education programme.
Medical Duties
In addition to helping patients care for themselves, nursing aides provide very basic medical
care.
a. They monitor vital signs, such as blood pressure, pulse and temperature. Nursing aides
report any irregularities in vital signs or health concerns expressed by patients to
supervising nurses or doctors.
b. In some states, nursing aides who have been specially trained and certified are
responsible for administering medication to patients and residents.
Cleaning Responsibilities
a. While hospitals and nursing homes almost always employ a custodial staff for the big
jobs, nursing aides are expected to maintain cleanliness to a certain extent while on the
job.
b. For instance, it is often the responsibility of the nursing aide to clear the dishes and
silverware of residents after meals.
c. Nursing aides also may remove soiled bedpans; sweep and wipe down furniture; and
change bedding.
Take and record blood pressure, respirations, temperature, and pulse rate
Obtain daily weight
Apply leads and connect to cardiac monitor
Obtain 12-lead ECG
Perform chest compressions in life support situations
Nutrition
Feed patient
Calculate and record calorie count
Skin Care
Perform back care
Prepare skin for procedure
Perform skin prep for operative procedure
Respiratory Support
Set up oxygen
Assist patient with using an incentive spirometer
Assist patient with coughing and deep breathing exercises
Perform oral suctioning using an oral suction device
Procedures
Set up patient room (suction canisters, cables for continuous cardiac monitoring, tubing
for chest tubes)
Orient patient to room environment
Set up and calibrate hemodynamic monitoring equipment
Obtain necessary supplies for sterile procedure
Discontinue peripheral intravenous catheter
Perform postmortem care
Indirect Patient Care Activities
Cleaning
Errands
Deliver meal trays
Obtain and deliver supplies
Clerical Tasks
Place pages
Place and answer phone calls
Assemble, disassemble, and maintain patient chart
Transcribe physician and nursing patient care orders
Schedule diagnostic tests and procedures
Order necessary office supplies and forms
Sort and deliver mail
Assist with unit orientation for float and registry ancillary personnel
Prepare charges for unit-based billing
Problem solve and locate lost charges
Keep unit log books up to date with patient admissions, transfers, and discharges
Maintain awareness of nursing bed assignments
Update and retrieve information systems data
Delegable task. The nurse first should determine if the task is properly delegable. For
example, giving medications or interpreting clinical data cannot be delegated because
these are licensed functions. However, it is generally agreed that routine tasks (e.g..,
taking vital signs) or personal care activities (e.g.., bathing) for stable patients with
predictable outcomes can be assigned to UAP
Patients needs. The nurse is responsible for individual patient assessment and
determination of nursing care needs. Therefore, even though an intervention such as
giving a bath may be a routine, the nurse may need to complete this task for certain
patients if further assessment or health teaching is needed. The nurse should refuse to
delegate any task that would jeopardize patient safety.
Competency of UAP. Job description for UAP should have clearly specify their
responsibilities. UAP should have a record of documented competencies to perform tasks
and should have participated in a formalized educational program that provided
instruction. However, it is the duty of the nurse to ensure that UAP are competent in
particular situations (e.g.., they may not be able to measure blood pressure properly even
though there is documentation that they can). It is the nurses responsibility to determine
ability and provide proper instruction for UAP or complete the task himself or herself.
The nurse must provide supervision for UAP and serve as a resource. The sole criterion
for determining who should complete a task in a particular situation in patient safety, as
determined by the nurse.
Communication. Clear directions must be given to UAP so that the task can be completed
properly. For example, the nurse should say, I need a finger stick done on Mr. Jones. A
better instruction would indicate the immediate need for blood glucose measure and to
report the value to the nurse immediately, who will determine if insulin is needed. It is
suggested that the nurse obtain minireports throughout the shift, to clarify data obtained
and to provide any supervision necessary for UAP.
Evaluation. As part of the nurses duty to supervise UAP, the nurse is responsible for
evaluating their performance. This is an opportunity to provide positive and negative
feedback as well as supervised practice of a skill if needed. The ability to set priorities for
completion of task is an essential skill needed by UAP and often requires guidance by the
nurse.
Improper Delegation and Nurse Liability. The nurse can be liable for improper
delegation in several circumstances. One example is when a task should not be delegated
(e.g.., medication administration) assigned to UAP. Another example is when the nurse
delegates a task to UAP who are not competent to perform the task. While nurses can
generally rely on documented competencies of UAP, there may be information that the
nurse knows or should have known to indicate UAP are not competent in a particular
situation. Another example of improper delegation occurs when the nurse does not
provide the required supervision for UAP. The nurse should always be available foe
questions or further instruction.
Proper Delegation without Nurse liability. If the has delegated properly, UAP can be
individually liable for this actions. One example is when UAP do not inform the nurse of
an liability to perform a task or when UAP perform a task incorrectly, even after
instruction and supervision. UAP who perform tasks that are beyond those delegated o re
outside their competencies are liable for their own actions and for mistakes or adverse
patient outcomes
as a result of their actions. The liability of UAP is generally shifted to the situation, as
the employer.
Staffing Issues. Inadequate staffing is not a rationale for delegating tasks. In such an
instance the nurse needs to documents him or her refusal to delegate a tasks as based on
concern for patient safety and its effect on patient care. This should be forwarded to a
supervisor who has the power to correct the staffing .by taking these steps, the nurse is
shifting the liability to the institution for any outward outcomes resulting from the
situation..
Proper Delegation. Proper Delegation involves (1) the right task, (2) the right
circumstances, (3) the right person, (4) the right direction/communication, and (5) the
right supervision. In all situations, the nurses professional judgment determines what can
be delegated safely to UAP. (Retrieved: February 22, 2015)