Delegating

i'm actually a first year student. this is my first time here so i wasn't sure if i had to start a new thread. my question is regarding a case study and im trying my best to answer them without having taken to courses yet. (im trying to be advanced ) my scenario is as follows on a unit, there is a staff nurse, a lpn and a uap. the lpn is iv certified which i know means she is able to main and start ivs but cannot hang piggybacks or give iv push meds. she is able to give all other medications except iv meds. the rn can obviously give all meds. the uap can generally bath, feed and provide other care that does not require a license.

ok the rn, the team leader, divides the workload at the start of the shift, between 3 members (yourself, the lpn and the upa). there are 13 patients.

some facts before we start:
the lpn is 26, mother of 4 preschoolers and her husband is a city bus driver.

the uap is 53, a grandmother with no children living with her at home, a widow and states her works keeps her "happy".

ok now here are the patients assigned to us... and i will try to explain assessments, procedures and basic care needs to the best of my ability.

room, name, age, diagnosis and condition (and some additional information):

401. mrs. jones, age 33, mastectomy for ca and 2 days post op/ fair. mrs. jones needs instructions regarding her post op activities and has begun to talk about her prognosis. the nurse would take this patient and tell her about post-mastecomy exercises preformed 3 times days for 20 minutes a time until full range of motion is restored (usually taking 4-6 weeks). these exercises may include wall hand climbing, rod or broomstick lifting, rope turning or pulley tugging. ongoing assessment of the patients concerns related to the diagnosis of cancer, the consequences of surgical treatment, and the fear of death is important in determining her progress in adjusting and effectiveness of her coping strategies. you should encourage questions, provide information of postoperaterive care and promote a sense of control. exercises are initiated on the second post op day to increase circulationa dn muscle strength, prevent joint stiffness and contractures and restore full rom.

402. mrs. redford, 55, back pain, pelvic tract/ good. this can be given to the lpn since he has already been assessed thus "pelvic tract good". the lpn can provide the analgesics, promote rest, and stress reduction by possibly providing a massage and relaxation. relieving pain by reducing stresson the back muscles and have him change positions ffrequently. diaphramatic breathing may also help by reducing muscle tension. guided imagery (which i just used in clinicals) allows them to "focus on a happy place" . aid in phycial mobility and in using proper body mechanics.

403- mrs. worley, 46, cholecystectomy, 2 days post op/ good. mrs. worley requires frequent changes (every 2-3 hrs) of her laproscopic site dressing due to a high volume of serious drainage. this can be assigned to the lpn since many lpn's at my clinical change the dressing and it's the 2 day. would this be correct?


404-1 mrs. smith, 83, parkinson's/cvd/htn, fair. mrs. smith requires assistance with feeding at mealtime. this would be assigned to the uap since it is only assistance with feeding.

404-2 mrs. dewey, 26, pid, good with d/c today. the nurse would take this patient.
i know that pid is pelvic inflammatory disease but i am not able to find anything in that chapter with d/c what is that?

405-1 mr. arthur, 71, metastic ca, poor/ semicoma/ iv. mr. arthur is no longer able to turn himself in bed. the lpn should take this patient since she is lv certified and know which position to turn the patient.

405-2 mr. vines, 34, r/o peptic ulcer, good/ ugi today. mr. vines states that being in the same room with a critically ill patient makes him upset and he has asked to move to a new room. the patient would be transported to the vacant room and take care of by the uap.

406-1 vacant
406- 2 ms brown, 24, d&c, to or this am. i don't know what d&c means but since the patient is going to be taken to the or this should be assigned to the nurse.

407-1 mrs. west, 41, mi, fair with heplock telem and is 1 day out of icu. the nurse should take this patient since the lpn is not about to give meds iv push.

408-1 mr. niles, 21, open redct femur from auto accident, 3 days post op/ fair. mr. niles is depressed because he feels his football career is over. the uap can take care of this client since it 3 days post op and fair condition.

408-2 mr. ford, 44, gastrectomy, 1day post op/ iv/ fair. there have been problems with mr. ford's iv and nasogastric tube. both will need to be replaced today. the patient's status is fair therefore the rn should take care of this client. although the lpn is certified to place the iv she is not for the ng tube placement.

409-1, mrs. land, 42, depression, fair with ba enema today. mrs. land began to talk with you today about her husband's recent death. the prep for the barium enema will result in mrs. land having frequent toileting needs today. the nurse it to administer the enema. she would prepare the patient by emptying and cleansing and advise the patient to increase her fluid intake to assist in eliminating the barium.

would these assessments, procedures and basic care be correct?

blue breeze. j
D/C generally means dischargeI think you are on the right track. I am thinking this is team nursing. SO the RN will be ultimately over all the patients. THe patients that you assigned to UAP, they have to have a nurse as well. UAP don't give meds, some treatments, and can't use judgments.a thought RN is responsible for all patients, she does all assessments and IV meds.Then you assign the LPN to do dressing changes and oral meds. Education can be done by either RN or LPN so that can be assigned to either. UAP is assigned to bed, baths, vitals, and feeding the patient.Turning the patients will take two persons. can be done by LPN and UAP.Does this help?

Just fyi, in most states, if an LPN is IV certified, she can not only start and maintain IVs, but she can also hang piggybacks and give IV push meds.

The RN cannot delegate away the responsibility of teaching, assessment or professional nursing judgment. Therefore, the RN must do the discharge teaching. The LVN can do sterile dressing changes but an unlicensed person cannot.As for IV's - in "NCLEX-RN" world the various state's laws are not considered. NCLEX will question you as if everyone was living in NCLEX-land and all the laws are generic. So, LVN's are not certified in anything. They are licensed to provide care as a vocational nurse, but not as a professional nurse (according to the ANA Standards definition). This way a new RN, or one who is new to that state, will always delegate safely. Exceptions can be learned after you are licensed.

? In several places of your post, you state "the nurse will take this patient and the lpn can do this/that". Do you not consider lpn's to be actual nurses? Or is it just a typing error?In our hospital, we do team nursing: rn, lpn and cna together. Each team of 3 is assigned so many patients to care for. rn's do the assessments and open charts while the lpn's do med passes (including iv meds) and med audits while the cna's start vital signs, bed baths and routine patient care. It is common for the rn's to do the dressing changes so they can assess the wounds. All cna's on the floor assist each other with turning and bathing patients. At our 6am v/s, the rn does the I&O's and the lpn does the v/s while the cna's complete their rounds for turns, bed checks and daily weights. Any time we are available to help turn or help do anything, we do it...regardless of our titles. Of course, not all shift rotations work the way we do, either! There are some wonderful nurses in our town.

of course LVN/LPN's are nurses. You are reacting emotionally. What I said was that, according to NCLEX-RN, the LVN is not the professional nurse. They are vocational nurses. There is a difference in licensure and in expectations and each state's NPA spells out the authority, responsibility and accountability for each type of nurse. So while they are different, they are also both nurses. Remember, the NCLEX-RN is testing the student who will be an RN.

Although LPNs are a dying breed at my hospital, we do team nursing. LPNs give all the non-IVP meds and RNs do the assessments.

Hi I am an RPN in On. Canada and I think that is equal to LPN we have gotten away from team nursing and I miss it we now do total pt. care and as an RPN we do all types of drsg except if there is deep ulceration with undermining and also meds, IVs,hang peggy back meds check Blood, do blood sugars, receive back OR pts and assess,chart and call doctors and process orders for our assigned Pts usually 4-5 we dont do TPN central lines blood transfusions although we can set up the lines we do discharge instructions and admissions, insert and discontinue foley cath. etc. and for most of the older nurses we were educated for the added skills through our college and the Hospital to be cert. and recert.yearly we do not have UAP or as we call them PCW as yet but I feel they are going to be to help save money.We have a ratio of RNs ro RPNs depending on condition of pts and numbers and still find ourselves working at 120-150% and big time overtime.