Problem
Applying the Five Rights of Delegation to work through these scenarios.
A. Alice is an LVN on the night shift, working on a med-surg unit. Tonight the unit is staffed with two RNs, one PCT, and Alice. Alice is assigned to care for Mr. Brown who is six hours post op. She notices that he is anxious, restless, and cannot settle down to sleep. After talking to him about his pain, which he denies, she asks one of the RNs if there is anything else she should do. The RN tells Alice to "just keep an eye on him".
After shift change the next morning, the oncoming RN finds Mr. Brown severely distressed with significantly low O2 sat, low BP, and tachycardia. What went wrong with delegation in this situation? Which right(s) of delegation were missing?
B. You asked student nurse Tim to remove Mr. Lane's peripheral IV prior to discharge. Tim is competent to do this task. Half an hour later Mr. Lane's doctor appears at the nurse's station. He is furious that somehow Mr. Lane's PICC line has been removed rather than the peripheral IV. Who is responsible? How are the rights of delegation applicable here?
C. Sara is a new PCT on your unit. You have not been assigned with her before. You have a new patient that needs a urinary catheter inserted. Catheters are on your unit's PCT skills checklist. What else need to know to make a delegation decision?
D. You ask a PCT to take and chart vital signs on your patients. The day has been very busy and you have not seen the PCT for most of the shift. As you make rounds near the end of your shift you note that one of your patients has had a very high blood pressure since early morning. Did you do anything wrong in this delegation? How should you delegate to the PCT?
E. You have been floated to a surgical unit. One of your patients needs a procedure done that is on the PCT checklist for that unit, but is a sterile invasive procedure. You don't know the tech or the patient and do not feel comfortable letting the PCT do the procedure. The charge nurse tells you "Go ahead. It will be fine. The techs do that all the time here." What should should be done? How do the rights of delegation apply here?