30 hours ago a. assess patient b's respiratory status b. perform a. Question: You have just received report on Patient A and Patient B. Patient A is intubated, sedated, and on a vasoactive infusion to keep their BP greater than 110 mmHg systolic on an arterial line. Patient B was extubated an hour ago and has a scheduled glucose check due in 1 hour. >> Go To The Portal
The current position statement, “Rights of Registered Nurses When Considering a Patient Assignment,” (ANA, 2009) expressly states that nurses have “the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.
Identify the priority patient based on the following: patient’s age, day of admission/ surgery, or the number of body systems involved. Unlicensed assistive personnel (UAP) such as nurses’ aides, certified nursing assistants, attendants, health aides are not allowed to delegate.
Proper and appropriate assignments facilitate quality care. Improper and inappropriate assignments can lead to poor quality of care, disappointing outcomes of care, the jeopardization of client safety, and even legal consequences.
If you are a leader, do not punish the nurse objecting or refusing the assignment. This is retaliation and it is barred by law and professional practice rules. Listen carefully, consider all available options, and thank the nurse for having the courage to speak up.
For example, a significant change in a client's laboratory values requires that the registered nurse report this to the nurse's supervisor and doctor.
When an assignment is not done as expected, the delegating nurse should determine why this has occurred and they must take corrective actions to insure task completion.
When assignments are made, the registered nurse must insure that the staff member will have ample time during the shift to complete the assignment and , then, the registered nurse must monitor and measure the staff members' progress toward the completion of assigned tasks throughout the duration of the shift.
Evaluate the effectiveness of staff members' time management skills. The assignment of care to others, including nursing assistants, licensed practical nurses, and other registered nurses, is perhaps one of the most important daily decisions that nurses make. Proper and appropriate assignments facilitate quality care.
The "right" person. The "right" task. The "right" circumstances. The "right" directions and communication and. The "right" supervision and evaluation. In other words, the right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct ...
Appropriate decisions relating to the successful assignment of care are accurately based on the needs of the patient, the skills of the staff, the staffs' position description or job descriptions, the employing facility's policies and procedures, and legal aspects of care such as the states' legal scopes of practice for nurses, nursing assistants and other members of the nursing team.
Nurses violate scope of practice statutes, or laws, when they function in roles and aspects of care that are above, beyond and/or not included in their scope of practice. Permanent license revocation may occur when a nurse practices outside of the legally mandated scope of practice.
When you get to the unit, the charge nurse gives you a fast report on your assigned patients. Contrary to what the supervisor said, you have most of the sickest patients on the unit and it is a regular patient care assignment, including administration of chemotherapy for which you are not qualified. What do you do?
Even if you have never been in questionable situation, you should know your organization’s policies and your state’s laws and regulations regarding refusing an assignment. Objections must be in writing so check to see if your facility or state has a form and keep several blank copies in your locker or backpack.
Questions using keywords such as “ best ,” “ essential ,” “ highest priority ,” “ primary ,” “ immediate ,” “ first ,” or “ initial response ” are asking for your prioritizing skills.#N#Know the patient’s purpose of care, current clinical condition, and outcome of care in order to determine and plan priorities.#N#Identify the priority patient based on the following: patient’s age, day of admission/surgery, or the number of body systems involved.#N#Unlicensed assistive personnel (UAP) such as nurses’ aides, certified nursing assistants, attendants, health aides are not allowed to delegate. Only a registered nurse can delegate tasks.#N#In some states, Licensed Practical Nurses (LPN) may delegate to a UAP depending on the state nursing practice.#N#Ensure the appropriate knowledge, skills, and experience of personnel performing the delegated tasks.#N#Do not delegate teaching, assessment, planning, evaluating, and nursing judgment to an unlicensed nurse.#N#A client with an unstable and unpredictable condition cannot be delegated to a UAP’s or LPNs.#N#Delegate tasks that involve standard, simple procedures such as bathing, dressing, feeding, and transferring patients.#N#Student nurses, float nurses, personal assistants, and other personnel may require levels of guidance and supervision.
Some examples of physiological needs include oxygen, food, fluid, nutrition, shelter, sleep, clothing, and reproduction.
The “delegate” assumes responsibility for the actual performance of the task and procedure . The nurse (delegator) maintains accountability for the decision to delegate and for the appropriateness of nursing care rendered to the patient. The role of a registered nurse also includes delegating care, assigning tasks, organizing and managing care, supervising care delivered by other health care providers, while effectively managing time! The NCLEX includes questions related to this unique nursing role of delegation.
Prioritization is deciding which needs or problems require immediate action and which ones could be delayed until at a later time because they are not urgent. In the NCLEX, you will encounter questions that require you to use the skill of prioritizing nursing actions. These nursing prioritization questions are often presented using the multiple-choice format or via ordered-response format. For a review, in an ordered-response question format, you’ll be asked to use the computer mouse to drag and drop your nursing actions in order or priority. Based on the information presented, determine what you’ll do first, second, third, and so forth. Directions are provided with the question. To help you answer nursing prioritization questions, remember the three principles commonly used:
Throughout your nursing education, you learned that assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment, and professional knowledge are the responsibilities of the registered professional nurse. You cannot give these responsibilities to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides.
Do not make decisions concerning management of care issues based on resolutions you may have witnessed during your clinical experience in the hospital or clinic setting . As a student nurse, you are constantly reminded that NCLEX questions are to be solved and responded in the context of “Ivory Tower Nursing.” That is, if you only had one patient at a time, loads of assistive personnel, countless supplies, and equipment. This is what people mean when they refer to “ textbook nursing .” But when you’re in the real world without the time and resources, you adjust. Your clinical rotation in management may have been less than ideal but remember that in NCLEX, the answers to the questions are seen in nursing textbooks or journals. Always bear in mind, “Is this textbook nursing care?”
Only a registered nurse can delegate tasks. In some states, Licensed Practical Nurses ( LPN) may delegate to a UAP depending on the state nursing practice. Ensure the appropriate knowledge, skills, and experience of personnel performing the delegated tasks.