Delegation of Duties in Nursing
2022 Scenario case details
You are the recently graduated registered nurse working on a unit that practices patient-focused care. The particular unit practices a version of patient-focused care consisting of one registered nurse, one enrolled nurse, and one nursing assistant for a group of patients.
You as the registered nurse, delegate tasks to the nursing assistant and assigns care that the enrolled nurse is permitted to do according to the registering bodies in Australia. The nurse completes report at 0730. The nurse has the following assignment for the 0700 to 1530 hrs shift:
Bed 1: Mr L is a 70-year-old male, diagnosis: urinary tract infection. Mr L is alert but is experiencing some confusion. Vital signs are ordered every four hours. He is experiencing urinary frequency. He is a falls risk, and needs to be reminded to use the urinal rather than getting out of bed on his own to use the bathroom.
Bed 2: Mr P is an 88 year-old male, diagnosis: pneumonia). It has been handed over from the Night Shift nurse that assisted Mr P with his hygiene requirements in the bathroom at 0630hrs, that whilst removing Mr P’s anti-embolitic stockings, the nurse noticed a pressure injury on his leg, which Mr P stated it is very painful, then night nurse has left the area uncovered for review this morning.
Bed 3: Ms. N is 78 years of age and is a female patient diagnosed with new onset sinus bradycardia that is being monitored by remote telemetry. She is on an IV medication that requires titration. She also has Dementia and tends to fall and wander. She needs supervision with all ADLs.
Bed 4: Ms S is a 30 year old lady who is normally ambulate and self-caring however due to pain and limited range of movement, due to L) knee arthroscopy yesterday) needs assistance in the shower and is then to prepare for an 0930hrs discharge. She needs discharge teaching.
Bed 5: Mr. T is 68 years of age and is a male patient who is scheduled for a laparoscopic cholecystectomy at 1100 hrs. He needs preoperative teaching.
Bed 6: Ms. A is 55 years of age and is a female patient who is scheduled to go to the day oncology unit at 0800 hrs. Someone from the health care team will need to take her via wheelchair.
Bed 7: Mr W a 43-year-old male, new admit, diagnosis: suspected Crohn’s disease. Mr W has been having abdominal pain and severe bouts of diarrhoea for the past several months. He was admitted this morning. He is NBM to rest his bowels and to prepare for an upper gastrointestinal diagnostic series. He has been hypotensive and has IV fluids running and prn pain medications.
Bed 8: Mrs C is a 60-year-old female, diagnosis: congestive heart failure. Mrs C was transferred onto the ward overnight. She was admitted four days ago with acute pulmonary oedema. She has history of CHF and takes diuretics, digoxin, and an ACE inhibitor at home. She is alert and oriented. She is short of breath, on 2L of O2 with oxygen saturation at 93%. She has an IDC in situ and is on strict fluid balance. Copyright © Department of Health 2020
Before leaving the handover room, what tasks would you consider delegating to the nursing assistant?
Which patients should the registered nurse care for during the shift and which patients should be assigned to the enrolled nurse and why?
Using the 5 principles of delegation identify what tasks you might delegate to each staff member and why.
Your rationale should be supported by evidence, particularly relevant in Australia
Please note: The list of a health assistant’s (nursing) duties may vary from individual to individual. This is because an individual’s scope of activities will be influenced by a range of factors including:
• the context in which they are working
• their own level of competence, qualifications and experience
• the policies, qualities and risk management frameworks and culture of the organisation in which they work. © Copyright, State of Victoria, Department of Health and Human Services 2015
Therefore, here is a position description of a Nurse Assistant role at Cabrini Hospital, Victoria, as a guideline for this assessment task.
The essay should include headings Introduction, 5 principles of delegation, Tasks Delegated with evidence
Risks to delegation and actions to mitigate these
Conclusion
Delegation of Duties
Your Name
Department of ABC, University – Whitewater
ABC 101: Course Name
Professor (or Dr.) Firstname Lastname
Date
Delegation of Duties
According to the American Nurses Association (ANA), delegation is the transfer of responsibility for the performance of activities or tasks related to patient care to assistive personnel while retaining accountability for the outcomes (ANA, 2012). Registered nurses hold the responsibility delegation within healthcare organization settings based on the nurses working under them. Therefore, registered nurses arexpected to be knowledgeable about the principles of delegation, associated benefits & risks, and the state regulations and laws that govern the nursing practice (Hopkins, Itty, Pinon, & Nazario, 2012). In this regard, the purpose of the current paper is to outline a practical application of the delegation of duties by a registered nurse based on a case study.
Case Overview
The list of nursing duties may vary across individuals based on a range of factors, including the context of work, level of competence, qualification, experience, and internal policies & and risk management framework. Thus, the case involves the role of a Nurse Assistance at Cabrini Hospital, Victoria. The case involves eight different patients with different needs. The registered nurse is expected to delegate duties to an enrolled nurse and a nursing assistant based on these patients. Thus, the core objectives are to establish the tasks assigned to the nursing assistance, the patients to delegate to the enrolled nurse, and the patients under the care of the registered nurse from a 0700 to 1530 hrs shift based on the five principles of delegation.
5 Principles of Delegation
The five principles of the delegation are designed to guide the delegation of duties among nursing staff to enhance collaboration, distribute workload, and provide safe and quality care (Dudley, Miller, & Breslin, 2020). They are also called the five' rights of delegation': the right task, the right circumstances, the right person, the right communication, and the right supervision (Barrow & Sharma, 2021). Under the right tasks, some activities cannot be delegated. These include activities that require clinical reasoning, nursing judgment, and critical decision-making. However, many other nursing tasks like management of ADLs, medication administration, and patient mobility needs, among others, can be delegated.
Once the right tasks have been identified, it is vital to assess the circumstance. For instance, if the person to whom the tasks are delegated is available (Mueller & Vogelsmeier, 2013). This leads to choosing the right person who is the most appropriate to get the tasks done. This is because people have different skills and experience levels, strengths, and weaknesses (Mathebula & Barnard, 2020). Once the right person has been identified, instructions should be communicated effectively. Supervision, therefore, is done based on the instructions provided and the nurse's ability to solve problems that may arise during their performance of the assigned tasks. Understanding these principles is critical because it helps registered nurses inform their delegation decisions.
Tasks Delegated
Each of the 8 beds has patients that have unique needs based on which the registered nurse determines the shift tasks. Table 1 below is a summary of the task.
Table SEQ Table \* ARABIC 1: Tasks Summary
EDTASKS1Patient experiencing confusion, vital signs every four hours, fall risk, urinary frequency, reminder to use the urinal2Assistance with personal hygiene, review of pressure injury on the leg3Remote monitoring through telemetry, IV medication – titration, fall risk, patient may wander, help with ADLS4Showering assistance, to be discharged. 5Preoperative teaching 6Oncology schedule to be taken by a wheelchair7Pain management, NBM to rest his bowels, blood pressure monitoring, prn pain medication, and running IV fluids8Strict fluid balance, monitoring of breathing, assistance with prescriptions
Before leaving the handover room, what tasks would the registered nurse consider delegating to the nursing assistance?
Cabrini Hospital has established an elaborate position description for a Nurse Assistant. Based on the rules and laws of Victoria (Cabrini, n.d.). Accordingly, Nursing Assistants have the operational responsibilities of facilitating ADLs, skincare, cleaning and replacing wearables, helping patients walk, escorting patients to appointments, controlling infections, continuous observation of patients, and mortuary transfers, among others (Twigg et al., 2016). Thus, in the current settings, tasks to be delegated to the Nurse Assistance include helping Mr. L with urinary needs like reminding him to use the urinal, personal hygiene for Mr. P, showering assistance to Ms. S, escorting Ms. A to her oncology appointment and observing and reporting on beds 7 and 8. These tasks fall under the responsibilities of a nursing assistant as indicated under the hospital's HR department's position prescription. These are the right tasks, and the job description makes the nursing assistant the right person (Richmond, 2020). The circumstances are already established because the nursing assistant is already scheduled to be present du...