Position statements are a means of providing direction for nurses on issues relevant to nursing practice and consumer safety. Position statements do not have the force of law, but are designed to act as education resources that help licensed nurses and other interested persons in determining safe, appropriate, Delegation Delegating patient-care responsibilities to another RN, LPN/ LVN, or unlicensed assistive personnel such as nursing assistants often triggers legal and ethical questions among those nurses doing the delegating. Delegation is an important responsibility. To properly delegate a task, the nurse must know the skills and knowledge level of the delegatee and that the task being delegated falls within the delegatee’s scope of practice (National Council of State Board of Nursing and American Nurses Association, 2019.). Even though the RN may delegate a task, they retain responsibility for the conduct and actions of delegatees. RNs cannot delegate their own accountability. They retain responsibility for the patient care delivered by the LPNs and nursing assistants (National Council of State Board of Nursing and American Nurses Association, 2019). However, this does not mean that delegatees do not have responsibility and accountability for their own actions. It is important to remember that delegatees still maintain responsibility and accountability for their own actions. Nursing consideration: It is the RNs responsibility to check the NPA in their states to determine which tasks may and may not be delegated. The “Rights” of delegation Safe and appropriate delegation of tasks requires that the RN adhere to “rights” of delegation. The American Nurses Association and the National Council of State Boards of Nursing have published guidelines for delegation (American Nurses Association & National Council of State Boards of Nursing, 2019): ● Right task : “The activity falls within the delegatee’s job description or is included as part of the established written policies and procedures of the nursing practice setting. The facility needs to ensure the policies and procedures describe Case study #2 Charlotte is a newly licensed RN. One of the LPNs under her supervision has many years of nursing experience and is quite resentful: “Why do I have to take orders from this new kid? I’ve been a nurse longer than she’s been alive!” Charlotte does her best to not only be friendly, but also to adhere to the scope and standards of practice for both RNs and LPNs. On one particularly busy day, the LPN insists that she can handle the arrival of a postoperative patient without any help. The patient is young and healthy and underwent surgical intervention for a compound fracture of the left femur. Charlotte knows that it is her responsibility to conduct assessments, but she is especially busy with several patients whose conditions are deteriorating. At the end of their shift, the LPN remarks, “That guy with the compound fracture sure is a whiner. He’s complaining about a cough and chest pain. He had a bad cold before surgery, so what does he expect!” Alarmed, Charlotte and the charge nurse for the oncoming shift rush to check on the patient, who is found to be cyanotic and unresponsive. He is rushed to the critical care unit with a diagnosis of fat embolism. Nursing consideration: Nurses who practice in more than one state should know the scope of practice and the NPA in each state in which they practice or hold licensure. Questions 1. Who is accountable for this lack of proper patient care? 2. How could this have been avoided?
and legal practice (Texas Board of Nursing, 2022). Examples of position statements include death pronouncements, carrying out orders from physician assistants, and performance of laser therapy by RNs. Position statements are generally posted on the BON website for review by nurses and the public. the expectations and limits of the activity and provide any necessary competency training.” ● Right circumstance : “The health condition of the patient must be stable. If the patient’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.” ● Right person : “The licensed nurse, along with the employer and the delegatee, is responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.” ● Right directions and communication : “Each delegation situation should be specific to the patient, the licensed nurse, and the delegatee. The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee, as part of two-way communication, should ask any clarifying questions. This communication includes any data that need to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation. The delegatee must understand the terms of the delegation and must agree to accept the delegated activity. The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.” ● Right supervision and evaluation : “The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary. The licensed nurse should ensure appropriate documentation of the activity is completed.” 3. Which of the “rights” of delegation were violated? Discussion Both Charlotte and the LPN are accountable for the lack of proper patient care. As the RN, Charlotte is the person who needs to conduct the assessment. If she was “too busy” because her other patients were deteriorating, she should have gone to the charge nurse and either asked for another RN to be assigned to the new patient, or ask the charge nurse to assess the patient, which could have prevented the patient from deteriorating. The LPN, while experienced, does not have the authority to conduct an assessment on a patient. The LPN should have not offered to assess the patient, as she should have known this was not part of her scope of practice. The LPN should have let Charlotte know the patient was experiencing signs and symptoms that were not associated with a normal post-operative course (chest pain and short of breath), no matter who did the assessment. LPNs are required to report to the supervising RN any changes in a patient’s vital signs. The principles of delegation that were violated were all of them. Charlotte delegated a task (assessment) that was not in the scope of practice of the LPN. Because of this Charlotte did not know if the patient was stable, and the principles state that only stable patients may be delegated to LPNs. There also seemed to be a breakdown in communication from Charlotte’s part in what to delegate. Finally, there was no supervision on Charlotte’s part. The LPN also has not followed the rights of delegation. The LPN accepted an assignment for which she may not have been qualified for and
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