Observation of Wrong Delegation of a Task in the Clinical Practice

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Observation of Wrong Delegation of a Task in the Clinical Practice

Wrong Delegation of a Task

In the department where l was working, the certified nursing assistant (CNA) reported to a registered nurse (RN) about a patient whose nasogastric tube had come out. The RN informed the CNA that the patient should be screened and the nasogastric tube inserted. The CNA told the RN that she has been practicing the insertion of nasogastric tubes for a while in a nearby facility. Just like that, out of ignorance, the RN agreed to let the CNA fix the tube but insisted that the patient not be fed until she was present to assess and evaluate the nasogastric tubes insertion. Approximately an hour later, the CNA came back to affirm and report to the RN that the tube was well inserted, and the patient did not show any signs of discomfort. The CNA was confident that the nasal gastric tube was placed in situ and should be used during feeding.

A little while after the CNA left, a fellow nursing student came and started feeding the patient. When the RN arrived, she noted that the patient was being fed, and hastened towards the patient. On arrival, she questioned the student and was told that feeding had already resumed immediately after the CNA had left. However, the patient started complaining of lower abdominal pain that is accompanied by a feeling of nausea. Feeding was halted with immediate effect as they looked forward to assessing the situation. The RN became skeptical and did a quick physical exam with the student. On inspection, the abdomen was distended while conducting palpation, the pain was confirmed by the grimacing of the patients face. The nurse immediately called for help from other healthcare disciplines, and the patient was transferred to an emergency care unit.

After a medical review by the consultant, the patient was diagnosed with Peritonitis. The assumption made was that the nasogastric tube was inserted in the peritoneal space resulting in the abdomen distending.

The nursing service manager brought the RN, CAN, and the student on board and scrutinized the matter together, embracing the spirit of espirit de corps as per Henry Fayol (Jang & Kim, 2017). At the end of the meeting, the allegation that was instituted against the RN was the wrong delegation of tasks and responsibilities. The RN failed to adhere to the set policies of the hospital in matters of proper task delegation. The family was later explained the matter vividly and, on a good heart, decided not to sue the nurse. However, the family and the nurse agreed on how the nurse could cater to the bills as the patient was receiving treatment at the facility.

Relevant Actions That Could Have Been Taken to Improve Delegation

The nurse could have reviewed the experience, knowledge, competencies, and skills that the CNA had acquired before deciding to delegate the job. Additionally, the RN could have looked into adversity training that she had acquired and completed successfully. The use of rational thinking and abstract judgment in clinical practice was essential for the RN. Follow-up after the delegation was paramount for the RN. Maybe, it could prevent the incidence from happening (Jang & Kim, 2017). The RN could have assessed and evaluated the task that was performed by the CNA and provided clear instruction about how the nasogastric tube was inserted. Lastly, the RN could have looked at and acknowledged the institutions policies regarding the employers policies and procedures that are supposed to be carried out in the practice setting.

Reference

Jang, E. J., & Kim, S. H. (2017). Delegation of nursing activities in long-term care hospitals. Journal of Korean Gerontological Nursing, 19(2), 101-112.

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