On returning from your tea break you are met by several staff members who relate the
following information to you concerning your patients.
i. Mrs Chew’s intravenous (IV) infusion has tissued, her IV fluids are running behind and
she has missed her 14.00 hrs IV antibiotic.
ii. Mr Smith’s visitor has fainted.
iii. One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly.
iv. Mr Esposito is scheduled to leave the ward now for his cardiac catheterisation and he
has still not received his preoperative medication.
v. One of the surgical consultants (VMO) is waiting to discuss a medication error that
happened last week.
vi. As you are taking this handover, an elderly female post-operative patient collapses to
the floor and is unconscious. She has had facial surgery.
The other RN is busy with NUM role. Staff currently available on the ward to assist you in
addressing these issues include: the ward clerk, an Enrolled Nurse who is currently
undertaking her IV cannulation certificate but is not yet competent, and an Assistant in
Nursing.
ACTIVITY
Using the above scenario:
1: In order of priority, identify which tasks you yourself will undertake and which tasks
you will delegate.
2: Document your rationales in detail.
3: Please follow the NMBA Registered Nurse Standard for Practice
Module 2
Delegation
Delegation in Nursing refers to assigning of nursing duties to a junior nursing staff or an
individual who has not undergone nursing training. It is an important aspect of nursing since it
enables patients to receive healthcare services any time they are required. It is important to note
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that the delegating nurse remains accountable for the activities delegated. Consequently, they are
as well responsible for the activities they delegate (Berman et al. 2012).
In delegation, there are some factors which the registered nurse should factor out. They
are referred to as the rights of delegation. To begin with, the RN should assess a situation and
make a decision on which activity can be delegated to another individual, that is, the right task
for the right patient (Dalton & Levett-Jones, 2015). The task to be delegated depends on the
staff’s level of competency and availability of supervision. Therefore, the registered nurse should
make judgment on the level of supervision which would fit the circumstance (Cowan, Brunero,
Lamont & Joyce, 2015). Also, the nurse should identify the healthcare needs to be addressed by
the delegated task and what will be the outcome.
Moreover, the RN takes into account the skills and capabilities of the delegatee to be in a
position to assign a given task. Finally, there should be clear communication on what, how and
when a particular task should be done. It involves the purpose, the goal and limitations. Finally,
it is the responsibility of the registered nurse to monitor and after that evaluate both the patient
and the performance of the staff for the delegated tasks (Dalton & Levett-Jones, 2015). The RN
intervenes for the patient and provides feedback so as to enhance improvement in case a similar
function is given out.
According to the Nursing and Midwifery Board of Australia, a registered nurse is usually
held accountable for direct supervision and delegated tasks. During a nurses period of practice,
there are so many issues that come up, and she is required to analyze and think critically
pertaining an issue and come up with an intervention (Nursing and Midwifery Board of
Australia, 2012). A registered nurse is also supposed to utilize delegation, supervision, and
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coordination to ensure the best outcome for the patients. The registered nurse delegates nursing
activities to enrolled nurses and others in line with their scope of practice or any other clinical or
non-clinical personnel (Patterson & McMurray, 2013). Also, the RN should ensure that the
delegated method is safe and right through provision of proper direction and supervision.
To begin with, I would attend to the collapsed post-operative patient who had collapsed.
This is an emergency and needs to be attended to immediately so as to offer resuscitation.
Meanwhile, I would delegate to the nurse assistant to attend to Mrs. Smith visitor, and clear
information would be given to her on the activities to carry out.
Also, I would delegate to the enrolled nurse to give medication to the patient awaiting
cardiac catheterization. Then, the enrolled nurse and I would attend to the patient with the
cannula that had tissued to ensure she receives her due medication. The registered nurse would
demonstrate to the enrolled nurse on how it is done since she has a responsibility to teach her
colleagues. I would then delegate the Clerk to liaise with the maintenance to attend to the
blocked toilet
Finally, I would go to discuss the medication error that had occurred the previous week
with the medical consultant The Registered Nurse remains accountable for all activities that take
place in her unit (Berman et al. 2012). Therefore, it is important to follow the rights of
delegation so as to ensure best patient care outcomes. Finally, the enrolled nurse would be
requested to administer medication to the patient who was supposed to be taken for cardiac
catheterization. It is important to note that, after delegation, a registered nurse should accept
accountability for decisions actions and responsibilities for the actions of the others whom she
has delegated responsibilities.
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References
Berman, A., Snyder, S.J., Kozier, B., Erb, G., Levett-Jones T., Dwyer, T., Hales, M., Harvey, N.,
& Stanley, D. (2012). Kozier and erb’s fundamentals of nursing (2nd ed.). Vol 2, NSW:
Pearson Sydney Australia.
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Cowan, D., Brunero, S., Lamont, S., & Joyce, M. (2015). Direct care activities for assistants in
nursing in inpatient mental health settings in Australia: A modified Delphi study. Collegian,
22(1), 53-60.
Cowen, P. S., & Moorhead, S. (2014). Current issues in nursing. Elsevier Health Sciences.
Dalton, L., Gee, T., & Levett-Jones, T. (2015). Using clinical reasoning and simulation-based
education to ‘flip’the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,
33(2), 29-35.
Duffield, C., Roche, M., Twigg, D., Williams, A., & Clarke, S. (2016). A protocol to assess the
impact of adding nursing support workers to ward staffing. Journal of advanced nursing.
Health Sciences.
Lee, C. Y., Beanland, C., Goeman, D., Johnson, A., Thorn, J., Koch, S., & Elliott, R. A. (2015).
Evaluation of a support worker role, within a nurse delegation and supervision model, for
provision of medicines support for older people living at home: the Workforce Innovation for
Safe and Effective (WISE) Medicines Care study. BMC health services research, 15(1), 460.
McCarthy, G., Cornally, N., O’Mahoney, C., White, G., & Weathers, E. (2013). Emergency
nurses: procedures performed and competence in practice. International Emergency Nursing,
21(1), 50-57.
Patterson, E., & McMurray, A. (2013). Collaborative practice between registered nurses and
medical practitioners in Australian general practice: moving from rhetoric to reality.
Australian Journal of Advanced Nursing, The, 20(4), 43.
Pfaff, K., Baxter, P., Jack, S., & Ploeg, J. (2014). An integrative review of the factors influencing
new graduate nurse engagement in interprofessional collaboration. Journal of advanced
nursing, 70(1), 4-20.
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Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing. Elsevier
Nursing and Midwifery Board of Australia. (2012). Nursing and national competency standards
for Registered nurse.