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Do you agree with their assignments? Provide a rationale for your decision.
What would you change about their assignment?
Client 1: Room 422 A: A 49-year-old male client admitted two days ago with hypertension and peripheral vascular disease. The client underwent a stenting procedure to the left popliteal artery one day ago. The client is expected to be discharged home later today. As the charge nurse, I would delegate this patient to an LPN. Rationale: The patient is stable post stent placement and is set to be discharged home. The LPN can also reinforce discharge teaching to the patient after the initial teaching from the RN.
Client 2: Room 423: A 70-year-old female admitted yesterday with a diagnosis of community acquired pneumonia. She is afebrile, with stable vital signs. She has a saline lock in place and is receiving IV antibiotics every 8 hours. She is on oxygen at 2L/minute; her oxygen saturations have been 93-95% on the previous shift. As the charge nurse, I would delegate this patient to the RN. Rationale: The RN can administer IV medications, the LPN and UAP cannot administer IV meds as ordered because the task is not within their scope of practice.
Client 3: Room 424: A 67-year-old female admitted with an exacerbation of COPD three days ago. The client is receiving IV solumedrol every 8 hours and is on oxygen at 2L/minute nasal cannula with oxygen saturations of 89%. As the charge nurse, I would delegate this patient to the RN. Rationale: The RN can administer IV medications to this patient, LPN and UAP cannot administer IV meds as ordered because the task is not within their scope of practice. The RN can also actively reassess the patient’s oxygen saturation and intervene if necessary.
Guidelines for Reviewing and Providing Feedback on Nursing Assignments
- Understand the Patient’s Condition
Begin by reviewing the patient’s condition carefully. Key factors to consider include:- Acute or chronic illness: Is the patient stable or at risk for complications?
- Medical interventions required: What specific treatments are needed, such as IV medications or frequent reassessments?
- Care complexity: Does the patient require advanced monitoring or intervention, or is the care routine?
- Scope of Practice for Each Nursing Role
Review the scope of practice for each role (RN, LPN, UAP) and match it to the patient’s care requirements:- Registered Nurse (RN): Can perform advanced interventions such as administering IV medications, evaluating patient status, and making clinical decisions.
- Licensed Practical Nurse (LPN): Can perform routine care tasks like medication administration (except IV medications), monitoring stable patients, and providing patient education under RN supervision.
- Unlicensed Assistive Personnel (UAP): Can assist with basic care such as taking vital signs, assisting with activities of daily living, and providing comfort measures.
- Determine Appropriateness of Delegation
Analyze if the delegation aligns with the patient’s care needs. Consider the following:- Patient’s stability: Stable patients may be assigned to LPNs or UAPs for routine tasks. Unstable or high-acuity patients require an RN’s direct involvement.
- Task complexity: Tasks that involve decision-making or clinical assessments should be performed by an RN.
- Interventions and treatments: Ensure the staff member has the skills to administer specific treatments (e.g., IV medications or oxygen therapy).
- Delegation Rationale
For each assignment:- Explain why a specific role was chosen for the patient: Provide a rationale based on the patient’s current condition, required treatments, and skill set needed for care.
- Consider risks: If a patient’s condition changes or worsens, reassess the delegation. Is the chosen nurse or staff member capable of handling potential complications?
- Considerations for Improvement
Reflect on the following areas for potential improvement:- Clear instructions for task performance: Are there specific tasks that need clarification? Should certain interventions be revisited to ensure the appropriate person is assigned?
- Communication between team members: Ensure communication is clear, especially when tasks are delegated to less experienced staff.
- Supervision and oversight: Does the RN need to supervise an LPN or UAP? What is the backup plan if complications arise?
- Final Evaluation
- Evaluate if the delegation was appropriate based on the patient’s condition and the nursing staff’s capabilities.
- Ensure that the reasoning for delegation reflects both patient safety and efficient workflow.
Conclusion
By using these guidelines, you can critically assess the assignments, ensuring that patient safety and care quality are prioritized while considering the scope of practice for each role.
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