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Nurses have realized the need to focus on the outcomes the patients and their families want to achieve as this is the most successful method in approaching their practice. Nurses should understand the patient’s preferred results whenever they attempt to prioritize, delegate or assign care. The paper discusses the guidelines for prioritization, delegation and assignment decisions in health care that will make it possible to achieve the outcomes the patients and their families want to achieve.
Prioritization is the process of deciding on the problems or needs to be considered first and the ones to be considered later because they are not urgent. In order to plan the priorities, the patient’s care purpose, current clinical picture and the outcome should be known. Therefore picture, purpose, part and plan should be considered as guidelines when implementing the process. Some criteria are used when evaluating and weighing each competing process or task.
The first criterion to be used is whether it is life threatening or potentially life threatening if the task is not done. Would it endanger another patient? Secondly, is the process or task necessary for the safety of the staff or patient? Lastly, is the task is essential to medical or nursing plan of care. Priority setting has three levels. The first level is airway, breathing, cardiac status and circulation, and vital signs. The second level concerns mental status changes, acute pain, untreated medical issues, laboratory results, and risks. Lastly is the health problems.
Delegation refers to the transferring to an individual who is competent the authority to carry out the selected nursing task in a selected situation. In 2006, ANA and NCSBN altered the definition of assignment to mean the distribution of work that each member of staff is responsible for during a given work period. Delegation describes the process of working through others and assignment describes what a person is directed to perform
A nurse must supervise whenever he or she delegates work. Supervision is the provision of guidance or direction, guiding, and influencing the outcome of an individual performance of a task. However, statutes and rules have been generated by some states that list specific tasks that can or cannot be delegated. Nursing judgement is used in the delegation of tasks that fall within scope of practice of nurses in all states. RNs make their decisions based on the individual patient situation. The RN is responsible for the nursing process and the total nursing care of the patient regardless of who performs the care activities.
The process of assigning or creating a work plan is done on the basis of who is present, available, and accounted for and what their competencies and roles are for each shift. Creation of assignment is made with knowledge of the complexity of patient’s required care, dynamics of the patient’s status and their stability, complexity of the assessment and ongoing evaluation, necessary infection control necessary, availability of supervising RNs among others.
In delegation and assignment, ‘five’ rights are considered. The right task should be assigned to the right person in the right circumstances. The RN should then offers right direction and communication, and the right supervision. RN can ensure optimal performance from beginning the shifts by holding a short second report meeting with assistive personnel. RN gives the day’s plan and plan for each patient and the initial directions at that time.
Research evidences have proven that appropriate nursing judgement in prioritization, supervision and delegation save time thus improving health care, job satisfaction and clinical outcomes. Some of the principles considered for implementation of prioritization, delegation and assignment include, starting with the patient’s and family preferred outcomes, the RN should not delegate nursing process or clinical judgement to a non-RN among others.
In conclusion, prioritization, delegation and assignment should therefore be implemented because it enables the nurse to project into the future from the present state. They critically think of what might occur if competing decisions are chosen, weighing the options and making split-second decision.
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