What aspects of delegation must the RN take into account as the delegator?
The registered nurse (RN) has delegated the intraoperative care of a patient to the enrolled nurse (EN) instrument nurse. During the procedure, another EN enters the theatre to relieve the RN for a meal break.
What will be an ideal response?
Answer:
The RN must always monitor and evaluate the performance of the person to whom the activities were delegated to ensure that the recipient performs the activity safely (NMBA, 2013). Other aspects the RN should take into account are outlined in the Decision Making Framework (DMF) Statements of Principles (NMBA, 2013):
the level of education, knowledge, experience, skill and assessed competence of the person who will perform an activity that has been delegated to them by a registered nurse from a nursing plan of care has been ascertained by a registered nurse
the person is competent, confident of their ability to perform the activity safely, or is ready to accept the delegation, and understands their level of accountability for performing the activity
the appropriate level of clinically-focused supervision can be provided by a registered nurse for a person performing an activity delegated to them by a registered nurse
the organisation in which the nurse works has an appropriate policy, quality and risk management framework, sufficient staffing levels, appropriate skill mix and adequate access to other health professionals to support the person performing the activity, and to support the decision-maker in providing support and clinically-focused supervision (NMBA, 2013, p. 7)
In relation to the relief period and the surgical count, the ACORN Standards Management of Accountable Items (ACORN, 2016) state that one of the two nurses performing the surgical count shall be an RN. In this instance then, the RN circulating nurse would need to be relieved by another RN. Two ENs performing the surgical count would not comply with ACORN Standards.
b. What aspects of delegation must the EN take into account as the recipient of this delegation? Include rationales for your answers. You may benefit from reviewing the NMBA's Decision Making Framework (NMBA, 2013) and the ACORN Standards (ACORN, 2016) when considering your response.
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