Scenario

You are assigned to six patients on the medical surgical unit working with a LPN/LVN and share a CNA with another RN. You are receiving report for your patients and need to identify what activities you will be assigning, delegating, supervising, and prioritizing for the shift.

Instructions

• Client number 1: 50-year old male who had a heart attack and stent placed with normal vital signs
• Client number 2: 46-year-old female with full-thickness burns to the leg who needs to have dressings changed
• Client number 3: 33-year-old male firefighter who has fallen and broken his right femur after surgery with pain in his leg
• Client number 4: 18-year-old male with wheezing and labored respirations unrelieved by an inhaler
• Client number 5: 74-year-old female with new onset dementia awaiting lab results
• Client number 6: 52-year-old female who has been recently diagnoses with diabetes type 2 and is getting discharged

Assignment

1. Describe the patients you will be assigning to the LPN
2. Describe the care that you will be delegating to the LPN and CNA
3. List the clients and care from the highest to lowest priority

Delegating, Supervising, and Prioritizing Care

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Delegating, Supervising, and Prioritizing Care

Integrate Leadership and Management Principles and Attributes in Nursing Practice

“If you really want to grow as an entrepreneur, you have got to learn to delegate.” (Richard Branson). Delegation, in general involves assigning activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. The national council of state boards of nursing and the American Nurses Association defines delegation as the process by which a nurse directs another person to perform a nursing task and activities (Haugen & Galura, 2019). The nurse responsible for delegation must be aware of variables besides the client’s conditions. The nurse is responsible for prioritizing and individualizing a client’s care plan. Prioritization can be termed as deciding which needs or problems require immediate action and which could tolerate a delayed response until a later time as they are not urgent. Supervision can help create a more supportive, caring and positive working environment by providing a space for regular communication, problem-solving, and increased team working. Supervision helps in planning the daily work schedule of the workers by guiding them on the nature of their work and dividing the work amongst the workers according to their interests, aptitudes, skills and interests. This essay will first describe the patient assigned to the licensed practical nurse (LPN), describe the care to delegate to the LPN and certified nursing assistant (CNA), the interventions to take for the supervision of the LPN and CNA, and lastly, look at the clients and care from the highest to lowest priority.

The Patients to Assign to the Licensed Practical Nurse (LPN)

While performing delegation, I would assign client number 2, the 46-year-old female with full-thickness burns and client number 3, the 33-year-old male firefighter with a broken right femur, to the LPN.  The two clients are the most medically stable, and their care needs do not immediately require the presence of an RN. For a patient whose condition is stable and predictable, and rapid change is not anticipated, the supervisor may provide supervision of the LPN without being physically present (LOGO, 2022). Client number 2 requires dressing changes as the task is not difficult, and the outcome is predictable. Client number 3 reports pain, most likely related to his surgical procedure. Decisions to delegate nursing tasks, functions, and activities are based on the needs of the clients, the stability of the client’s conditions, the complexity of the task, the predictability of the outcome, and the available resources to meet those needs and the judgment of the nurse.

The Care to Delegate to the Licensed Practical Nurse (LPN) and Certified Nursing Assistant (CNA)

For the CNA, it would be essential for them to provide care to client number 5, a 74-year-old female with new-onset dementia, toileting, assistance with bathing, eating, and hygiene, among others. Common tasks delegated to nurse assistants involve most daily living activities: bathing, feeding, ambulating, taking vital signs, and performing skincare. Additionally, the CNA is expected to continue receiving call lights as long as the situation is safe and allows them to do so. The LPN could be delegated to care involving measurements of physiologic function, observation of a client’s subjective and objective signs and symptoms, and performing assessments under the supervision of an RN (Connor et al., 2021). It would be ensured that the LPN competently performs the dressing change to the burns if there are signs and symptoms of infection or necrosis in the affected areas. If the LPN is unsure, they will inform me or the RN on shift. Lastly, the stability of both the clients’ verses, alertness and orientation, respiratory status, and pain in their patients would be ensured and let me know or another RN on a shift of any changes.

The Clients Care from the Highest to Lowest Priority

When prioritizing patient care, it requires classifying patient conditions into high, intermediate, or low priority. The high-priority conditions or life-threatening ones include airway, breathing, and circulation. Intermediate needs are non-life-threatening and non-emergent, and low-priority needs are those unrelated to the patient’s illness (Eissa, 2022). To follow this logic, it is clear that the client in respiratory distress needs to be seen immediately, followed by the client with the broken femur who is stable but requires care for pain management and in addition to being observed for apparent signs or symptoms or trauma, infection, or circulatory issues potentially related to the broken femur. In the case of infection control, addressing the client who needs their burn dressings changed would be essential. From the information provided, the client is stable, and one would anticipate administering pain medication before the dressing change. The administration of the medication would allow time for efficacy before dressing change which would be used to set eyes upon the remaining three patients. It would be essential to ensure that the recent onset dementia client is safe and comfortable with the CNA. When the aide reports no issues and does not require a break, one would obtain VS PRN and move on to look at the last client. The last client requires discharge planning and education; the RN may only complete it. When the client is safe to get a discharge, it is within reason to believe that they are the most medically healthy and stable patient and therefore, the lowest priority of care is required at the time.

Conclusion

Delegation is assigning activities or tasks related to patient care to unlicensed assistant personnel while retaining accountability for the outcome, and also termed as the process where a nurse directs another person to perform a nursing task and activities. Prioritization can be understood as deciding which problem or issue requires more immediate action and which can tolerate a delayed response until they are no more urgent. For the LPN assigning client number 2, the-46-year-old female with full-thickness burns and client number 3, the 33-year-old male firefighter with a broken right femur, would be appropriate. When prioritizing patient care requires classifying patient conditions into high, intermediate, or low priority where the high-priority conditions or life-threatening ones include airway, breathing, and circulation and intermediate needs are non-life-threatening and non-emergent, and low-priority needs are those unrelated to the patient’s illness

References

Connor, N., McArthur, D., & Camargo Plazas, P. (2021). Reflections on vital sign measurement in nursing practice. Nursing Philosophy, 22(1), e12326. https://doi.org/10.1111/nup.12326

Eissa, A. I. (2022). Common Troubleshooting in Daily Practice. In Personalized Mechanical Ventilation: Improving Quality of Care (pp. 351-366). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-14138-6_26

Haugen, N., & Galura, S. J. (2019). Ulrich & Canale’s Nursing Care Planning Guides E-Book: Prioritization, Delegation, and Clinical Reasoning. Elsevier Health Sciences.

LOGO, N. (2022). KBN CONNECTION.