Intake and Output Delegation to an Unlicensed Assistive Personnel Tyler Andersen Creighton University School of Nursing



Nursing is an excellent career and one that is in very high demand. Many times, the workload required of nurses is too much to bare. When working as a nurse, it is often necessary to delegate tasks to others in order to provide the best possible care for a patient. Before delegating to assistive personnel, the nurse must make sure the assistant is competent in performing the desired task. All 5 rights of delegation must be met. These rights include the right task, circumstance, person, direction/communication, & supervision. There are some tasks that a nurse must not delegate to others. Those tasks include the assessment, planning, evaluation and nursing judgment of a patient (Nebraska Department of Health and Human Services, 2004). These tasks are only within the RN’s scope of care and cannot be passed to other members of a team who are there to assist. This paper looks at the care of a 40-year-old male patient with cellulitis and type 2 diabetes. The monitoring of his intake and output are necessary and is an appropriate task to delegate to a nursing assistant. The reasons for delegating this task are the topic of this paper. Before the delegation is made to the assistant, a delegation decision-making grid was completed to assess the client’s level of stability and the assistant’s competence to see if delegation is appropriate for the patient. This tool is very helpful in ensuring that the patient is cared for in the most appropriate method possible. The client in this situation shows a condition that has a moderate potential for change according to the

Running  head:  INTAKE  AND  OUTPUT  DELEGATION   delegation decision-making grid. This is due to the fact that the patient has a stage 3 ulcer, pitting red edema and very unstable blood sugars ranging from 50-450. These extreme blood sugars can lead to complications that may be outside of an assistive personnel’s scope of care. The patient’s vital signs are stable which keeps the patient from receiving a score that would indicate a current unstable state or strong potential for change. The unlicensed assistive personnel has 1 year of experience and is new to the unit. She shows confident in her skills and is trusted by the nursing staff. While she lacks the experience to be an expert in this population, the 1-year experience and the all-around confidence of everyone in the unit shows that the assistant is appropriately competent in the defined population’s tasks. Measuring of intake and output is a task that an unlicensed assistive personnel could master within a year of working. The nurse received a score indicating that the RN is experienced in the patient’s needs and can delegate properly. The nurse has 2 years of experience on the step down unit, which is enough to learn how to delegate simple tasks and supervise those doing them. More experience is needed on this particular unit in order to be a complete expert. With this particular patient, the task of documenting input and output has almost no potential for harm. The risk involved would receive no score on the delegation chart making it a suitable task for a UAP. Documenting intake and output is performed daily so its frequency is fitting for an unlicensed assistive personnel. Measuring of intake and output is a simple task and has no connection with evaluating the status of the client. The simple math involved has no potential for change. The data collected from the UAP may


Running  head:  INTAKE  AND  OUTPUT  DELEGATION   alert the RN to a patient’s condition but regardless of what the patient is experiencing, the actual task of measuring intake and output stays the same. The scenario that this patient is in received a final delegation grid score of 10. The final decision regarding the measuring of intake and output is to delegate the task to the unlicensed assistive personnel. The client’s condition is not the best but the task being delegated has almost no influence on the client’s personal health other than the risk of a urinary tract infection if a catheter is being used and is not emptied in a timely matter. Because the UAP has some amount of experience, the tasks involved should cause no problem. In this patient’s situation, measuring intake and output is the right task for the right person for an appropriate circumstance. The UAP will be directed and supervised by a nurse with adequate experience.




References National Council of State Boards of Nursing. , & National Council of State Boards of Nursing (2012). national council of state boards of nursing. Retrieved from Leadership Delegation Powerpoint




Patient Profile: A 40 year old male patient admitted with cellulites of the right lower leg with a Stage 3 ulcer. He has a history of type 2 diabetes mellitus. He is receiving Sliding Scale insulin, blood sugars every 4 hours while awake, IV antibiotics, and physical therapy. Stability of Patient: He has pitting red edema. Vital signs are stable. Blood sugars are unstable with blood ranging from 50-450. Experience of Unlicensed Assistive Personnel (UAP): She has been a certified nursing assistant for 1 year and recently began working on the unit. She is confident in her abilities. The RN staff have confidence in her abilities also. Experience of Registered Nurse: The RN has 2 years of experience working on the step down unit. Nursing Orders: • Assess intravenous site daily. • Complete wound assessment on R lower leg. • Monitor intake and output • Blood sugars every 4 hours while awake.



Elements  for  Review Ac3vity/Task Level  of  Client   Stability Describe  ac3vity/task:

Client  A

Score  the  Client’s  Level  of  stability: 2 (1) Client  condi.on  is  chronic/stable/predictable. (2) Client  condi.on  has  minimal  for  change. (3) Client  condi.on  has  moderate  for  change. (4) Client  condi.on  is  unstable/acute/strong  for  change. Level  of  Assistant   Score  the  assistance  competence  on  comple3ng  delegated  nursing  care  ac3vi3es   2 Competence in  the  defined  client  popula3on: (1) Expert  in  to  be  delegated  in  defined  popula.on. (2) Experienced  in  to  be  delegated  in  defined  popula.on. (3) Experienced  in  but  not  in  defined  popula.on. (4) Novice  in  performing  and  in  defined  popula.on. Level  of  Licensed   Score  the  licensed  nurse’s  competence  in  rela3on  to  both  knowledge  of  providing   2 Nurse  Competence nursing  care  to  a  defined  popula3on  and  competence  in  implementa3on  of  the   delega3on  process: (1) Expert  in  the  knowledge  of  nursing  needs/  of  defined  client   popula.on  and  expert  in  delega.on  process. (2) Either  expert  in  knowledge  of  needs/  of  defined  client  popula.on  and   competent  n  delega.on  or  experienced  in  the  needs/  of  defined   client  popula.on  and  expert  in  the  delega.on  process. (3) Experienced  in  the  knowledge  of  needs/  of  defined  client  popula.on   and  competent  in  the  delega.on  process. (4) Either  experienced  in  the  knowledge  of  needs/  of  defined  client   popula.on  or  competent  in  the  delega.on  process. (5) Novice  in  knowledge  of  defined  popula.on  and  novice  in  delega.on. Poten3al  for  Harm Scoring  the  poten3al  level  of  risk  the  nursing  care  ac3vity  has  for  the  client  (risk  is   2 probability  of  suffering  harm): (1) None (2) Low (3) Medium (4) High Frequency Score  based  on  how  oMen  the  assistant  has  performed  the  specific  nursing  care   0 ac3vity: (1) Performed  at  least  daily. (2) Performed  at  least  weekly. (3) Performed  at  least  monthly. (4) Performed  less  than  monthly. (5) Never  performed.

Level  of  Decision-­‐ Making Score  the  decision-­‐making  needed  related  to  the  specific  nursing  care  ac3vity,   0 client  (both  cogni3ve  and  physical  status)  and  client  situa3on: (1) Does  not  require  decision-­‐making. (2) Minimal  level  of  decision-­‐making. (3) Moderate  level  of  decision-­‐making. (4) High  level  of  decision-­‐making. Ability  for  Self  Care Score  the  client’s  level  of  assistance  needed  for  self-­‐care  ac3vi3es: 2 (1) No  assistance. (2) Limited  assistance. (3) Extensive  assistance (4) Total  care  or  constant  aPendance. TOTAL  SCORE CORE10


Delegation  Project Clinical  Delegation  Narrative  Summary

Possible  Points 5 20 35   20 5 15

Points Earned

Nursing  Task  Chosen  for  Decision  to  Delegate  or  Not   Delegate Short  statement  regarding  the  4  components  in  the   RN  scope  of  practice  that  cannot  be  delegated  (4). Strong  rationale  for  the  score  on  the  Delegation  Grid   subcomponent. Final  delegation  grid  score  with  a  statement  on  the   decision  to  delegate  or  not  delegate  with  rationale/ justiTication. Paper,  case  study,  delegation  grid,  and  rubric   submitted. Typed,  clear  concise  writing,  uses  grammar   appropriately,  referenced,  and  formatted  according  to   APA.   Evidence  of  scholarly  application  in  communication   and  presentation  of  the  topic.     TOTAL


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