CONSIDERING DELEGATION AND NURSING MANAGEMENT OF PERSONNEL

Points to Ponder
TEST POINT 1:
DECIDE ON PRIORITIES OF CARE.
APPLY THE ABCS THEORY OF PRACTICE
LOOK for situations which have a Life Threatening Potential
(These are associated with RN actions)
The RN must see and work with patients who
 have any type of reaction to medications, tests or treatments
 require complex treatment via tubes such as CT, or penrose (but not feeding via ng tube)
 experience fluctuations in their vital signs (recovery type issues)
 present with any new onset problem (such as confusion)
 need to have any emergency medications administered
 are having a blood or other type of transfusion?
 in a complex precaution situation such as for severe burns or neutropenia
LOOK for situations which require Patient Safety
(PN/VN and UAP (unlicensed assistive personnel) activities)
The PN/VN and UAP can work with patients being placed in a simple precaution situation (contact
precautions)
 who will need to have vital signs monitored frequently, as long as they have been trained to report
any changes based on parameters provided by the RN
 experiencing some sensory deficits such as hemianopsia, and dementia
 who may be confused or are a safety risk that may require restraints or side rails
LOOK for situations that can be handled at the least trained level
The UAP can be involved in care associated with (as long as they are supervised) patients who require
 personal care such as bathing and dressing
 assistance with feeding; even if confused
 support in ambulating as part of a routine treatment (not first time)
 dietary monitoring for intake and output information
TEST POINT 2:
KNOW WHAT DIFFERENT WORKERS DO.
HERE ARE A FEW TASKS/ABILITIES TO REMEMBER
The Registered Nurse will
 Perform all complex assessments.
 Do all analysis; planning of patient care can be done with LPN/VN; coordinate all patient care; and act
as liaison with all health care team
 Direct, delegate and supervise the care provided by LPN/VNs and UAPs
 Directly manage patients who have intravenous medications; central line care; TPN; lipids; CVP
measurements; PCWP measurements; Central Line dressings; blood transfusions; extensive
dressing/wound care; and surgical drains
 Determine who should be seen in what order during emergencies
 Develop assignments for float nurses that will match their expertise and area of practice
The Practical/Vocational Nurse will
 Perform any simple admission assessments such as obtaining simple admission history and measuring
vital signs
 Measure and record intake and outputs; vital signs; collection of specimens
 Deliver all forms of basic care to all kinds of patients
 Participate in, assist in, and direct patient care such as feeding patients, obtaining weights, can oral
suction patients, change simple dressings, and start IV's if trained
 Be able to assist in teaching patients in areas of diabetes, bowel and bladder issues, simple wound
care, and dressing changes
 Assist in developing the nursing care plans
 Be able to assist in OR sponge counts
 Will be able to work with ostomy patients
The Unlicensed Assistive Personnel (UAP) or Nursing Assistant (NA) will
(When trained and supervised)
 Be able to provide basic care for patients including performing ADLs; collecting specimens of urine
and stool; obtain vital signs gather initial admission information
 Be able to test urine and stool for S&A and OB
 Be able to apply and monitor protective restraints
TEST POINT 3:
MOST OPPORTUNITIES FOR DELEGATION WILL BE IN THE AREA OF ASSESSMENT OR IMPLEMENTATION.
Simple assessment and reporting of vital signs, and collecting and recording I&Os is reserved for the
UAP. They may also provide basic care. They should not be used to answer complex assessment and
analysis questions. Implementation (interventions) include providing basic ADL care and feeding of
patients. Any problems anticipated in patients would not be delegated by the RN.
TEST POINT 4:
DISCHARGE PLANNING, AND ALL COMPLEX TEACHING OF FAMILIES AND PATIENTS WILL BE PERFORMED BY THE RN.
The LPN/VN can do noncomplex teaching All complex teaching about Central lines; PICC lines; TPN;
lipids; Central Line dressings; extensive dressing/wound care; and surgical drains must be done by the
RN LPN/VN can do simple diabetic teaching, reinforce colostomy care, and can teach about simple
dressing changes. The UAP is not involved in teaching in any of these areas.
TEST POINT 5:
WHEN MAKING ASSIGNMENTS CONSIDER THE FOLLOWING:
How often does the delegatee perform the assigned task?
What is the level of complexity of the care?
What type of technology is involved in the care?
Who can perform the care responsibly?
How will the delegatee be properly supervised?

Using the Test Points

"Don's Delegation Decision Path"
Step 1
WHICH PATIENT IS MOST STABLE?
(Look at Test Point Number 1)
Step 2
WHAT TYPE OF ACTIVITIES ARE GOING TO BE PERFORMED?
(Look at Test Points Number 2, 3, & 4)
Step 3
WHICH PATIENT WOULD THE DELEGATEE BE LEAST LIKELY TO HURT BASED ON THE ACTIVITY THAT IS TO BE DONE FOR THE
PATIENT?
(Based on the NSCBN decision tree for delegating activities, 1977)
Priority Levels for care in the Hospital and Community Setting

Use this guide to select who you need to see in which order

Criticality Level Assessed Problems

Level 1 Immediate Airway and Breathing and Circulation Problems*

*The problem needs to be occurring at this time (i.e.

Pulmonary edema or hemorrhage)

Level 2 Sudden changes in the mental status or level of consciousness (from

baseline)

Level 3 New onset vital signs changes especially pulse, blood pressure,
respiratory rate, or oxygen saturation if these are specifically
mentioned

Level 4 Unstable metabolic disorders and diagnostic test results.

Conditions would include severe hypo- hyper- glycemic conditions

(providing mental status changes have not already occurred which
moves that problem to level 2)

CBC results without description of problems or complaints

Severe electrolyte abnormalities with no additional information

provided regarding the findings

Level 5 Complaints of pain especially post-operative pain (exception: If pain

is described as cardiac in origin, move that complaint to a level one
response)