Delegation of the Urinary Catheterization

Acute shortage of the advanced nurse practitioners in the US requires delegation of the routine tasks by the NPs (nurse practitioners) to assistant personnel. To ensure high quality of health care and minimize the danger of the procedure for the patient, the NP must adhere to strict regulations of the delegation process. The success of the delegated procedure depends on the followed rules and responsibilities of the NP, task-related resources and considerations, as well as monitored process and timely evaluated outcomes of the intervention.

In this scenario, NP is a delegator, while RN (registered nurse) is a delegatee. Due to the understaffing of the healthcare personnel, NP delegates the task of urinary catheterization to the RN, his subordinate. Bob is a geriatric patient who currently resides in the retirement facility and needs intermittent catheterization every three to four hours after developing acute urinary retention. For timely urinary management, routine bladder catheterization is advised for Bob until he recovers from the symptoms of the acute urinary retention.

Prior to delegating the task to the RN, NP has to follow a set of predefined clinical guidelines to ensure safety and comfort of the patient. According to the rules of delegation, a delegatee has a legal permission to perform a particular nursing procedure which exceeds his current job description only if the supervisor formally allows it (National Council of State Boards of Nursing, 2016). The delegated task should be within the parameters of the RN’s scope of practice. The NP maintains full accountability for the patient’s health condition despite the precedent of the delegated activity. The NP cannot legally delegate the activity which incorporates nursing judgment, clinical reasoning, or critical decision making (NCSBN, 2016). In other words, the advanced nurse does not delegate the entire nursing process but the part of the process or a specific task. The scope of the NP’s responsibilities includes identifying a nurse leader, developing delegation procedures and policies, promoting positive culture at the work environment, and periodically assessing the delegation process.

The responsibilities of the advanced nurse practitioner are formed according to the five rights of delegation. First, Motacki and Burke (2016) wrote that the NP should choose the right task which falls within the frames of the delegatee’s skills and does not contradict the established procedures of the nursing setting. Second, the delegation should be executed under the right circumstances when the patient’s health condition is stable. In case of the sudden change of the patient’s condition, NP must stop the delegation process and reassess the situation and the appropriateness of care as soon as RN reports the issue. Third, the NP should ensure that the delegatee is the right person who possesses the relevant skills to perform the delegated activity. Forth, the delegation process should be accompanied with right directions and specific communication. The NP has to provide particular instructions and maintain a two-way communication with an opportunity for the RN to ask clarifying questions (Motacki & Burke, 2016). Finally, the advanced nurse has to exhibit right supervision and evaluation, monitoring the delegated task and assessing patient outcomes.

To ensure safe delegation, the NP should consider the RN’s professional competences and a demonstrated scope of nursing practices. If the subordinate does not have the needed expertise, the NP has to provide educational resources and hands-off training for the proper bladder catheterization (Wagner, 2018). Brochures from the Royal College Nursing, American Academy of Pediatrics, and Bladder and Bowel Community can be utilized to explain the procedure in detail. Prior to delegation, the RN should be fully informed about the patient’s health history, physical and mental condition (Wagner, 2018). Nurse-patient relationship should be established before the medical intervention to promote individual approach in treatment.

Other people who may be included in the delegation process include but are not limited to nursing associates and healthcare support workers. Once the patient’s health condition is stable, the task of re-catherization can be delegated from the NP to the relative or carer, provided they possess relevant competence and knowledge to manage the drainage system. Before the delegatee can execute the assigned task, the NP has to confirm RN’s understanding of the procedure (Wagner, 2018). To confirm RN’s understanding of the instructions, the NP can ask direct questions about the delegated task and inquire the subordinate to restate the instructions in his own words. The RN can also be requested to provide step-by-step plan on reporting to the supervisor in case of emergency.

The delegated activity of urinary catheterization should be closely monitored during the RN’s shift and checked for completion every three to four hours as recommended by the health practitioner. The completion of the task can be checked verbally with the RN or de-facto by the NP (NCSBN, 2016). Follow-up with the RN at the end of the day and feedback from the patient, assessing pain or concomitant symptoms, are crucial in determining the success of the bladder catheterization. In terms of clinical signs, the amount of urine collected in the container by the end of the day should be considered.

References

Motacki, K., & Burke, K. (2016). Nursing delegation and management of patient care. Elsevier Health Sciences.

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14.

Wagner, E. A. (2018). Improving patient care outcomes through better delegation-communication between nurses and assistive personnel. Journal of Nursing Care Quality, 33(2), 187-193. Web.

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