Online Companion: Fundamentals of Nursing Standards and Practice 2E
How does the nurse
maintain responsibility for nursing care implementation when some care tasks
are delegated to other staff?
The nurse begins by carefully selecting the tasks to be delegated. The level
of preparation and experience of the staff member is evaluated and the nurse
ascertains that the staff member is able to safely perform the care task being
delegated. The nurse also is aware of the legal aspects of delegation that includes
the definitions of scope of practice from the state's nurse practice act. The
nurse uses assessment data from the client to make a decision about what aspects
of the client's care are suitable for delegation. Complex care and technical
care that requires high degree of expertise cannot be delegated to personnel
who are not registered nurses. When the tasks are delegated, the nurse clearly
states the expectations or standards of care for the task to the staff member
and seeks verification that there is clear understanding about the care to be
given. The nurse makes pertinent observations of the client during the period
of care to determine responses to care and to identify any change in the client's
condition. Finally, the nurse provides opportunities for communication from
the staff member about the client's condition and responses.
How does the beginning
nurse know what and how frequently to communicate with the supervising nurse?
The beginning nurse uses critical thinking skills to determine the urgency to
communicate with the supervising nurse. Some guidelines can be outlined. At
the beginning and end of a period of care, nurses exchange information about
the client's current condition. During the period of care, any changes in the
client's condition, such as onset of new pain, variation from previous vital
sign parameters, are reported. Any new concerns of the client or questions the
client or family has about the care should also be followed up; the beginning
nurse must use judgment about the urgency of the need to report this. Can this
data wait to be reported at then end of the care period or does the family need
a response immediately? The nurse's observations and interventions are documented
in writing in addition to verbal reporting.