Delegation
A nurse is busy passing morning meds and does not have time to listen to her patient's lung and heart sounds. Can the nurse delegate this task to a CNA/PCT while they are rounding to take vitals?
No, a nurse cannot delegate an assessment.
A nurse is hanging out in the break room with a fellow nurse telling jokes. The fellow nurse amid this conversation says "You know what's really funny, my nursing degree. I didn't have the patience to go to school for 4 years so I paid for a fake one ha ha." What is the responsibility of the nurse?
The responsibility of the nurse is to report their fellow nurse to a supervisor immediately. The nurse can be liable for actions of their fellow nurse if they know the fellow nurse is a fraud and does not report it
A nurse has a patient who is depressed and requires a sitter. The patient is not allowed to have any furniture or items in their rooms and all the doors must stay open at all times. The patient wants to shower and asks to close the bathroom door for privacy. What is the correct action of the nurse?
The nurse should not allow the patient to close the bathroom door. This paternalistic action will prevent harm to the patient, despite attempt to assert autonomy.
A nurse is caring for a patient with thyroid cancer who needs their teeth brushed and their blood glucose checked. Which task should the nurse do themself or can they delegate both of these tasks.
Both of these tasks can be delegated to a CNA/PCT. CNA/PCTs are able to assist with hygiene activities and can check blood glucose.
An ICU nurse comes into her patient's room to find his wife bent over her husband crying. When the nurse asks the wife what is wrong the wife blurts out, "He cheated on me and we were arguing. I just got so angry that I pushed him and he fell down the stairs. I'm so sorry I never meant to hurt him I love him. He may not even remember when he wakes up." What is the proper action of the nurse?
The nurse should report the wife's statement to their supervisor and/or security official immediately. The nurse should be careful not to spook the wife off before the proper authorities can come to deal with her.
A nurse is caring for a pregnant patient with gonorrhea who is refusing to take the ordered medication. The nurse informs the patient that she is putting her health and her babies health at risk by not taking this medication. What is the proper action of the nurse?
The nurse must hold the medication because it is within the patients right to refuse medication.
A nurse asks CNA Josh (who has a cast on his right arm) to assist her patient in room 222 with going to the bathroom. What has this nurse failed to consider and what could be the consequences of her actions?
The nurse failed to properly assess the functional ability of Josh when delegating this task. Although CNAs are within their scope of practice with ambulation assistance, it is not good practice to delegate this task to Josh since he has a broken arm. If Josh were unable to properly assist the patient to the bathroom because of his arm and the patient were to fall or be harmed, the nurse would be responsible. Nurses must considered competence when delegating tasks as well.
A nurse is precepting a new grad on the ICU floor who has to pass a trach cleaning skills test to be allowed off orientation. When performing her skills check off the new grad slightly turns her back on her sterile field but performs the skill flawlessly. The nurse passes the new grad since nothing happened to the sterile field while her back was turned. What error has the nurse made and what could the consequences of this action be?
The nurse has a responsibility to make sure the nurse she teaches/supervises is competent. As stated in provision 4.3 the nurse shares the responsibility with any nurse they teach, so if the new grad were to infect a patient from a broken sterile field, the teacher would also bear some responsibility for passing them when they shouldn't have.
A nurse is caring for a patient who just underwent abdominal surgery and is confused after surgery. The patient keeps attempting to get out of bed which can be very harmful for the patient and their incision. After performing necessary interventions first, the nurse obtains an order for soft arm restraints to enable to patient from getting out of bed while their incision is still fresh. The patient yells and demands that the restraints hurt his wrists and he be allowed to get out of bed. Why is it okay for the nurse to ignore the patient's wishes?
(Per our textbook)"The prevention of harm to the patient outweighs risks to the patient of the action taken." It would cause more harm to the patient if he is allowed to get out of bed right after abdominal surgery than keeping soft arm restraints. The nurse can further pad the restraints as well.