Nursing Assignment: Rights of Delegation for Registered Nurse

Question

Task

Scenario 1 Case details for nursing assignment
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. R is 42 years of age and is a male patient who is legally blind. He is S/P (status post) lithotripsy for renal calculi. He is ambulatory with assistance. He needs to strain his urine when he voids, and he needs to drink 2 to 3 litres of non-caffeinated liquids during the shift. He also needs ice packs applied to his right flank. The next ice pack is due at 0730 hrs.

Bed 2: Ms. M is 85 years of age and is a female patient diagnosed with new onset atrial fibrillation (AF) that is being monitored by remote telemetry. She is on an IV medication that requires titration. She also has Alzheimer’s disease and has a tendency to wander off. She needs constant direction during bathing and needs to be reminded to eat during meals.

Bed 3: Ms. S is 65 years of age and is a female patient who is S/P abdominal hysterectomy who needs a blood transfusion. The blood bank called and stated that the first unit of packed red blood cells will be sent at 8 AM. She has an initial dressing change that will need changed when the surgeon rounds at 8 AM. She currently has an IV of NS at 125 ml per hour via an infusion pump. She has multiple IV medications ordered. She has a 20-gauge IVC site on her right forearm that is flushed and capped and available for the blood transfusion. She has just called to the nursing station that she is nauseated and in severe pain.

Bed 4: Mr. J is 70 years of age and is a male patient who is S/P transurethral resection of the prostate (TURP), done yesterday. He is going to be discharged home at 1000 hrs. He needs discharge teaching.

Bed 5: Mr. T is 72 years of age and is a male patient who is scheduled for a transurethral resection of the prostate at 1100 hrs. He needs preoperative teaching.

Bed 6: Ms. A is 50 years of age and is a female patient who is scheduled to go to the hemodialysis unit at 0800 hrs. Someone from the health care team will need to take her via wheelchair.

Bed 7: Ms. B is 55 years of age and is a female patient who is scheduled to go to the OR at 1400hrs for a vaginal hysterectomy. She should return from the post anaesthesia care unit at 1700 hrs. She has received patient teaching.

Bed 8: Mr. H is 60 years of age and is a male patient who is going to be discharged home at 0800 hrs after a 23-hour hold for pain management related to renal calculi. He passed the two calculi seen on diagnostic testing. He has received his discharge instructions.

Answer

Introduction
It is evident herein nursing assignment that in patient-focused care, the patient is provided with more control over the other related care decisions. The nurse does not only assist the doctors in the provision of patient-centred care but also discusses the issue with the patient or his/her carers which is deemed appropriate. It is the responsibility of the graduate nurse to support and assist the nursing personnel in the delivery of patient care through compassion (Elliott et al., 2017). The graduate nurse must also coordinate with the registered nurse, the nursing assistants and the enrolled nurse to monitor the condition of the patient. As different Governments have different rules and regulations to care for the patients, the same also exists in the case of nurses practicing in Australia. This study will highlight the delegations that are to be made to the nursing assistant before leaving the room of the registered nurse. It will also discuss which patients the registered nurse cares for during the shift and which are assigned to the enrolled nurse as per the given case study. Further, the five principles of delegation used by the registered nurse in identifying and delegating the tasks to other staff members have been discussed in the study.

Principles of Delegation
The registered nurses are responsible to the public for the provision of culturally competent, safe as well as effective nursing for the patients in varied settings across the different continuum of care. The five principles of delegation of a nursing assistant, and an enrolled nurse include the right task, the right circumstances, the right person, the right direction, and the right supervision.

In case of the right task, it is the responsibility of the enrolled nurse to tackle appropriate activities for consideration following the delegation decisions. The varied types of organizational policies, standards, and procedures describe the limits and the expectation of different activities (Barrow & Sharma, 2020). On the other hand, the nursing assistant must also tackle and identify appropriate delegation activities for the patients as per the needs and the requirement.

According to the right circumstances, the registered nurse must try to assess the health status of the patient, adopt appropriate steps for analysis of the data, carry out collective nursing practices and needs. There should also be appropriate attempts taken to tackle the skill mix and the staffing, identify the proper lines of reporting and authority to fulfill the collective nursing needs (Leslie, 2017). It is also important for the registered nurse to make appropriate preparations for management techniques thereby delegating and delivering appropriate care. On the other hand, the nursing assistant must monitor the health status of the patient, tackle the complex tasks with appropriate supervision, and thus carry out the improved level of monitoring and guidance.

In the case of the right person, the enrolled nurse must try to adhere to the organizational standards that are consistent with the laws and the rules identifying the training and the educational requirement. There should also be proper steps taken to incorporate the competence standards and the institutional policies, evaluate the performance of the other nursing assistants who are working under the registered nurse (Anderson, Moxham & Broadbent, 2018). The nursing assistant must verify and identify the competencies of the client or the individual thereby implementing professional development activities based on the assessed needs.

The right direction principle states that the registered nurse must only communicate those acceptable activities that are following the nursing delivery service model. The nursing assistant on the contrary must communicate the delegations as per the requirement of the client. The methods and the details of the communication process vary from one individual to another (Duffield et al., 2018). The communication activities include management of the potential complications as well as the timelines linked with communication.

In case of the right supervision, the enrolled nurse must assure that there are adequate human resources for the sufficient supervision and the management of nursing care. There should also be the identification of the improved level of licenses for managing the title, position, and delineation. It is also necessary to evaluate the outcomes of the patient through the development of quality assurance and the contribution to risk management plans (Poulos et al., 2020). However, on the other hand, the nursing assistant must also carry out the nursing activities under the supervision of the graduate nurse. The enrolled nurse must also teach the nursing assistant to monitor the performance, obtain the feedback and thus ensure an appropriate level of care and performance activity.

Scope of Practice of an Enrolled Nurse, Registered Nurse and a Nurse Assistant
The patients of bed 3 and 7 will be under the care of a registered nurse. As it has been found that the registered nurse reports the changes in the patient’s body to the other healthcare practitioners immediately (Endacott et al., 2018). In the case of the patient of bed 3, the enrolled nurse upon the advice of the registered nurse must inform the latter about the blood transfusion of the patient. This is to be done and the advice of the registered nurse is to be followed for the recovery of the patient. Further, the patient of bed 7 who has been operated on for vaginal hysterectomy also needs to be taken care of by the registered nurse post-operation. The registered nurse must keep an eye on the patient continuously and thus guide her on the steps that are to be followed for a quick recovery (Elliott et al., 2017).

The patient of bed 5 and 6 are to be taken care of by the enrolled nurse. The nursing assistant must also assist the patient of bed 5 who is admitted to the hospital for the transurethral resection of the prostate. The nursing assistant must provide the appropriate level of guidance of the do and the don’ts of the patient in this particular stage (Anderson, Moxham & Broadbent, 2018). For the patient in bed 6, it has been found that the patient is advised to go for haemodialysis and the enrolled nurse must take appropriate care of the patient. The enrolled nurse must also carry out a holistic assessment of the patient in the provision of care and thus this is considered to play a crucial role in the quick recovery of the patient (Sutton, 2020).

The patients of bed 1, 2, 4 and 8 will be under the care of the nursing assistant. In the case of the patient from bed 1, it has been found that the patient is blind and also suffering from renal calculi. The nursing assistant must take the necessary steps to look after the patient. On the other hand, the patient in bed 2 has also been diagnosed with atrial fibrillation and thus requires constant monitoring to assist her. As she is also a patient of Alzheimer’s. the nursing assistant must take the required level of care and thus help her recover within a scheduled time frame. Further, it has been found that the patient of bed 4 has also undergone the transurethral resection of the prostate and thus requires a proper level of care to make him understand the steps or the medicines that are to be taken after the discharge from the hospital. This will help the nursing assistant to understand how the patients are to be advised and made understand the importance of care during the period of discharge from the hospital (Duffield, 2019). In the case of the patient in bed 8, it has been found that the patient has been discharged from the hospital after providing him the related care of pain management and the renal calculi. In such a case, the nursing assistant must explain to the patient or the carers about the related level of care so that it becomes easier for the patient and his carers to undertake the correct level of treatment when at home.

Task Delegated with Evidence
The patient of bed 3 and 7 will be taken care of by the registered nurse. Under the delegation principle of right supervision, the registered nurse will find it easier to handle the patient of bed 3. The registered nurse must understand the critical care that is to be taken for Ms. S who needs care in the dressing and the blood transfusion. Further, the patient of bed 7 falls under the registered nurse right circumstances principle of delegation. As the patient has returned from post-anesthesia care, she must be provided with an adequate level of patient teaching (Endacott et al., 2018).

The patient of bed 5 and 6 is to be taken care of by the enrolled nurse. The patient of bed 5 under the right circumstance principle of delegation must be provided with pre-operative teaching guidelines for the proper recovery of the patient. It has been found that the patient of bed 6 falls under the right task principle of delegation as the patient is to be taken to haemodialysis and thus must be provided with the correct level of teaching (Sutton, 2020).

Under the care of the nursing assistant, the patient of bed 1, 2, 4 and 8 can be provided with adequate treatment. The right person principle of the delegation will assist the nursing assistant to provide the appropriate care to the patient of bed 1. The nursing assistant must provide the ice pack to Mr. R on his right flank. Further, the patient of bed 2 under the principle of delegation of the right direction by the nursing assistant can be guided correctly. As Ms. M is a patient of Alzheimer's, the nursing assistant must provide her the correct therapy and care through communicating with her in a friendly manner. On the other hand, the patient of bed 4 under the right supervision of the principle of delegation can be provided with an appropriate level of care. The patient requires adequate supervision before discharging him from the hospital. Moreover, the patient of bed 8 as per the right task principle of delegation must be provided with proper care for handling pain management. The discharge instructions are to be provided accordingly to the patient only when the nursing assistant follows this delegation principle.

Risks to delegation and actions to mitigate these
In case of the right task, the nursing personnel faces the risk to understand whether the state rules and the regulations support the principle of delegation. Moreover, problems are also faced if the delegation of the task is not based on the policies and the procedures. On the other hand, in the case of the right circumstance, the risk faced by the nursing personal includes the availability of the correct resources to accomplish the task because in some cases, the situation cannot be considered to be favorable for the delegation process (Anderson, Moxham & Broadbent, 2018). For the right person principle of delegation, the risk faced includes the lack of experience and knowledge to carry out the task safely. Moreover, the nurse might also face challenges to foresee the harm that is to be faced by the patient before the delegation of the task. Further, in the case of the right supervision, the nurses might also experience challenges in the intervention, evaluation, and the appropriate level of monitoring of the patient. In the case of right direction and communication, the nurse might fail to provide a clear description of the task including the objectives, expectations, and the limit even though the nurse possesses an adequate level of experience (Leslie, 2017).

The actions that are to be taken to overcome the different risks encountered by the nurse in adhering to the five principles of delegation includes the creation of an environment of co-operation and trust in the healthcare sector so that it becomes easier for the nurse to know their colleagues and the patient (Leslie, 2017). It is also important for the nurses to know about the different tasks that are to be delegated and thus expect the responsible actions from the delegates to promote improved level of client satisfaction.

Conclusion
Thus, it can be said that the nurses must complete their education diligently to manage the task as well as supervise other colleagues who are enrolled under them. It is the mission of every healthcare organisation to execute and coordinate the efforts of their employees. However, this should be done keeping into consideration the feedback and the satisfaction level of the patient. Therefore, an appropriate level of delegation is essential for the fulfilment of the desired objective with responsibility.

Reference List
Anderson, C., Moxham, L., & Broadbent, M. (2018). Teaching and supporting nursing students on clinical placements: Doing the right thing. Collegian, 25(2), 231-235.

Barrow, J. M., & Sharma, S. (2020). Five Rights of Nursing Delegation. In StatPearls [Internet]. StatPearls Publishing.

Duffield, C., Roche, M., Twigg, D., Williams, A., Rowbotham, S., & Clarke, S. (2018). Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment. Journal of clinical nursing, 27(19-20), 3768-3779.

Duffield, C., Twigg, D., Roche, M., Williams, A., & Wise, S. (2019). Uncovering the disconnect between nursing workforce policy intentions, implementation, and outcomes: Lessons learned from the addition of a nursing assistant role. Policy, Politics, & Nursing Practice, 20(4), 228-238.

Elliott, R. A., Lee, C. Y., Beanland, C., Goeman, D. P., Petrie, N., Petrie, B., ... & Gray, J. (2017). Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: the Visiting Pharmacist (ViP) study. BMJ open, 7(11).

Leslie, K., Moore, J., Robertson, C., Bilton, D., Hirschkorn, K., Langelier, M. H., & Bourgeault, I. L. (2021). Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK. Human Resources for Health, 19(1), 1-12.

Poulos, R. G., Boon, M. Y., George, A., Liu, K. P., Mak, M., Maurice, C., ... & Parker, D. (2020). Preparing for an aging Australia: The development of multidisciplinary core competencies for the Australian health and aged care workforce. Gerontology & geriatrics education, 1-24.

Endacott, R., O'Connor, M., Williams, A., Wood, P., McKenna, L., Griffiths, D., ... & Cross, W. (2018). Roles and functions of enrolled nurses in Australia: Perspectives of enrolled nurses and registered nurses. Journal of clinical nursing, 27(5-6), e913-e920.

Sutton, S (2020). Training.com.au. Retrieved 02 May 2021, from https://www.training.com.au/ed/enrolled-nurse-vs-registered-nurse/