Role Of A New Graduate Nurse In Delegating Work And Diabetes Self-Management Education In A Busy Medical Ward

NSG3NCR Consolidating Reflective Clinical Practice

Five Rights of Delegation and Their Importance in Clinical Practice

Delegation of work is the most important aspect of teamwork. A graduate nurse needs to look into the role of a professional health care worker in addition to supervising and delegating the work of the subordinate team members. A graduate nurse should have the skills to utilize the five rights of delegation in actual clinical practice. A nurse should have the knowledge and experience to identify the right task in right circumstances to be assigned to the right person. It is mandatory that the task is communicated in the right manner. At the end, a right feedback is equally important to discuss the positive as well as negative aspects of the care plan delivered by the subordinate team members. This essay is aimed to discuss the role of a new graduate nurse in managing a busy medical ward by utilizing the right of delegating the work to an RN and a Health Assistant.

As a new graduate nurse, I know the importance of teamwork in managing the work of a busy medical ward. As a graduate nurse, I need to identify the priority cases before delegation (Hach, Aaberg, Lempert & Danielsen, 2017). After identifying and categorising the priorities, I need to delegate the right task in right circumstances to the right person. In the provided case study, Mary is a certified division 2 nurse. She should be given the task of administering the preoperative oral and intravenous medications to the patients in the surgical ward who will be proceeding for surgery in a short while as she is a certified nurse and is thus the right person to do this. Similarly, Jodie is a Health Assistant in nursing who should be provided the task of assisting the nurses and the patients in the medical ward to take care of other immediate medical needs such as helping to feed and give shower to the patients. Also, it includes helping with blood testing, urine tests, X-ray or ECG (Wilkinson, 2016). Periodic recording and documentation of patient’s vitals is a critical aspect of nursing care as per NMBA Standard 1. Therefore, Jodie should be provided the task of monitoring, observing and documenting the patient’s vitals such as pulse, temperature, respiration and blood pressure (Hughes, 2017). I should analyse and supervise their work so that I can access their areas of improvement and to provide them the right feedback.

Just as a dentist cannot perform appendectomy and a physician cannot perform tooth extraction surgery, similarly, delegating the right task to the right person is important aspect of transforming practice in nursing. As a graduate nurse, I should identify the roles and responsibilities of my team members. As a general practicing nurse, I need to be well aware of the qualifications of my team members. Delegating the work to a member who is unqualified to perform that role is an illegal offense. I can cost the life of the patient (Sayani, 2016). Similarly, communicating the expected goals and action plan to the team is a critical aspect of nursing intervention plan. The teammates should get a clear, precise and accurate idea of the action plan. Finally, a right feedback is essential for the maintenance of any relationship. The person should be motivated rather than feel offended by the feedback. Incorporating the five rights of delegation can not only decrease the workload of the graduate nurse, but also, it can increase the quality of the work and provide best patient outcome (Hughes, 2017).

Identifying the Right Task and Person for Delegation

Diabetes self-management education (DSME) is a challenging and important part of a busy hospital environment. DSME is the process of imparting the necessary knowledge, skills and the ability to the diabetic patients for the self-care and management of their condition. The educators needs to understand the requirements, desired outcome and lifestyle factors of the patient before devising a self-care plan for the diabetes patients. The intervention plan should be devised after utilizing the evidence-based standards. The overall aim of self-management education is to facilitate self-care behaviours and informed decision-making ability of the patients (Ferguson, Swan & Smaldone, 2015). This will enhance the problem-solving skills and achieve best patient outcome by incorporating patient centred approach to improve the quality of life of the patients with diabetes.

Teaching self-management skills to diabetic patients can be a perplexing task in the hospital environment. Hospitalized diabetic patients are under great stress due to their debilitating condition and therefore a busy hospital environment is not a conductive place for diabetes education. An outpatient program is generally the most preferable place for Diabetes self-management education. However, for the hospitalized patients, it is important to teach them “sufficient survival skills” to cope up with their condition (Yacoub et al., 2015). Survival skills should include home care remedies and management skills to prevent subsequent episode of hospitalization (Lewis et al., 2016).  As a part of discharge planning, a nurse ought to consider referral to an outpatient diabetes education program or for a home health referral. After considering the following referral points, the diabetes education plan should start as soon as hospitalization:

A diabetes educator should be assigned to the patient who will help the patient with the recovery process. Assessment of the level of understanding related to diabetes, glucose monitoring, management and care planning should be undertaken by the nurse professional. The educator should explain the cause and meaning of hypoglycemia and hyperglycemia and educate them regarding the management techniques for both (Lewis et al., 2016). Also, education should also be given regarding safe disposal of insulin needles (Ferguson, Swan & Smaldone, 2015).

The patients ought to be imparted necessary knowledge and skills for the self-management of diabetes. The nurse professional should timely provide data to the physician regarding alteration of hypoglycaemic drug, required blood and urine tests and the need of follow up visits (Munshi et al., 2016). DSME is appropriate for those patients who have a significant level of consciousness and who are capable of conducting diabetes self-management at home. The patients should be capable of using multiple daily insulin injections, proficient in glucose monitoring techniques.

Self-management of diabetes in the hospital is appropriate only for those patients who are conscious and reasonably stable. The patients should be taught all the necessary skills such as insulin administration techniques, safe insulin needle disposal, glucose monitoring techniques and knowledge of hypoglycaemic medications (Powers et al., 2017). After thorough consideration of all these factors, the diabetes self-management plan should be carried after consultation with the patient’s physician.

References

Ferguson, S., Swan, M., & Smaldone, A. (2015). Does diabetes self-management education in conjunction with primary care improve glycemic control in Hispanic patients? A systematic review and meta-analysis. The diabetes educator, 41(4), 472-484.

Hach, M., Aaberg, K. B., Lempert, S. M., & Danielsen, B. (2017). Work assignments, delegation of tasks and job satisfaction among Danish dental hygienists. International journal of dental hygiene, 15(3), 229-235.

Hughes, M. E. (2017). Nurses storied experiences of direction and delegation.

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.

Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., … & Haas, L. B. (2016). Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes care, 39(2), 308-318.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.

Riisgaard, H., Sondergaard, J., Munch, M., Le, J. V., Ledderer, L., Pedersen, L. B., & Nexoe, J. (2017). Work motivation, task delegation and job satisfaction of general practice staff: a cross-sectional study. Family practice, 34(2), 188-193.

Sayani, A. H. (2016). Delegation, a Strategy to Prepare Second Line Nursing Management in Health Care Setting. International Journal of Innovative Research and Development, 5(13).

Wilkinson, K. (2016). Sharing supervision and liability as a nurse manager. Nursing management, 47(4), 11-13.

Yacoub, M. I., Demeh, W. M., Barr, J. L., Darawad, M. W., Saleh, A. M., & Saleh, M. Y. (2015). Outcomes of a diabetes education program for registered nurses caring for individuals with diabetes. The Journal of Continuing Education in Nursing, 46(3), 129-133.