Nursing Delegation and Negligence: Night Shift Responsibilities

This report analyzes nursing delegation and negligence in a healthcare setting, focusing on the roles and responsibilities of Enrolled Nurses (EN), Student Registered Nurses (SRN), and Assistants in Nursing (AIN) during a night shift. The report details the delegation of tasks, such as patient monitoring, medication administration, and wound care, considering each team member's experience and capabilities. It emphasizes the importance of proper supervision and documentation. Part A discusses delegation strategies, outlining specific responsibilities for each role. Part B examines a case study involving a medication error due to improper delegation, highlighting breaches of the five rights of delegation and negligence. The report concludes with recommendations for addressing the issues, including reporting the incident, providing further training, and ensuring adherence to nursing standards and legal regulations. The report underscores the need for clear communication, accurate documentation, and adherence to the standards of practice to ensure patient safety and quality care.

Running Head: Nursing
NURSING DELEGATION AND NEGLIGENCE
Name of the Student
Name of the University
Authors Note

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Part A
Introduction
The assignment focuses on delegation of nursing task and distribution of roles and
responsibilities of different team members in a nursing team for bedside handover from the
night shift. Assignment focuses on delegation and distribution of the responsibilities among
the Enrolled Nurse, Student Nurse and Assistant in Nursing in night shift. The rationale of
delegation of responsibility by Registered Nurses will be discussed.
Discussion
Delegation of Nursing Tasks and Rationale
As a Registered Nurse, I need to distribute the duties of different patients among the
nursing professionals in night asper their experiences and efficiencies toexecute the
responsibilities.
Delegation of tasks in the Enrolled Nurses
Every patient should execute their responsibility and duties for serving different
patient. Enrolled nurses can work as a supervisor in a ward. As a registered nurse, I will
assign Enrolled Nurse for super vision. I will plan her/him duties accordingly so that EN can
visit every patient with adequate time. Depending upon the patients’ condition I will assign
EN to direct supervision of more critical patients such as Joe Black,who is patient of cancer
and is under palliative care. He needs daily observation and artificial apparatus for feeding.
Other patients require 4 times observations in a day. However, EN should attend each of
them at least for three times and EN should supervise the other team members with proper
guidance and help. Administration of medicines and addition and removal of the cannula
should be supervised by EN. For Dorothy, Open Wound diagnosis and medications should be
checked by EN. More specifically,Biosafety Level needs should be checked by the EN as her
report states that Intra-venous cannulation attempt is failedfor the patient. Therefore the
patient needs more experienced and competent professionals to take care of the
administration of medication andBSL needs checking. In case of Joshua, shortness of
breathing has been observed. Therefore, peak flow and incentive spirometry should be

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regularly checked by the nurses and EN should monitor the process. Ruben is also a cancer
patient so that he should be monitored in a regular interval of time. EN must administer
medicines to him if any emergency situation arrives(Forough et al., 2018). Marrie Rosie who
is suffering from diverticulitis and bowel resection should be monitored with care and safety
as she has post operational wounds.
I would assign EN as the supervisor of all the other team members as only EN can
administer medicines, have the decision making authority and manage a team of different
nursing professionals in the absence of the Registered Nurses in a room. An EN can serve in
different domains such as “professional and collaborative care”, “provision of care” and
“reflective and analytical practices”(www.nursingmidwiferyboard.gov.au, 2020). However
theEN will work under the indirect supervision of mine so that I can check the documentation
and ask the patients about his or her services in Night shift.
According to the Standardof Practicesfor the Enrolled Nurses support the patients
with the references of Decision-making framework, nursing practice summary guide, nursing
practicedecision flowchart and code of conducts of
nurses(www.nursingmidwiferyboard.gov.au, 2020). The Enrolled Nurses should follow the
Standards for Practice by NMBA. The ENs can help Registered Nurses with proper
documentation of nursing details and communication between nurse and patient. Most
importantly ENs have theknowledge and understanding of laws, legislations and workplace
policies.
Delegation of tasks to the Assistant in Nursing
I would delegate the responsibilities of the Assistants in Nursing for helping enrolled
nurse and to attend patients in regular interval of time (Pradhan, Weech-Maldonado, Gupta,
&Dayama,2017). Most of the patients need four times visits in 24 hours so nurses have to
visit the patient at least for two times in night shift. Elderly patients like Dorothy, Isobel, Joe
Black and Marie Rossi should be helped by the AIN mainly along with EN and SRN.
Assistant in Nursing will help in the observation and taking care of wounds in the patients for
example;Marie Rossi, Ruben and Dorothy. AIN will help the patients by cleaning wounds for
pre or post operation condition. AIN will assist EN while taking care of Joe Black as he is in
palliative care. Catheter care, hygiene of cannula, implementation of naso-gastric tube and
spirometer should be assessed by the AIN. An AIN can administer the prescribed medication
when it is needed (Rausch, 2016). He/ She can help the EN in documentation and provision

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of care for different patients. He or she can schedule the food and medication and visits for
catheter checking. AIN can help in observing thepast recordsof critical patients to support EN
during emergency situations.
Assistants in Nursing can help the patients with room attendance, personal care of
patients, preparation of reports and documentation, transfers and manual handling of medical
equipment and recreation of the patients. They can serve the patient with the guidance and
help of RN and EN in palliative care, general medicine, and emergency, acute care units.
They can help the patient by giving motivation through a recreational way. Helping in
increasingthe mobility of patients is one of the most important duties of AIN and they
frequently execute the tasks related to transfers / transportation or manual handling of the
patients.
Delegation of tasks to the Student Registered Nurses
I will assign theStudent Registered Nurses (SRN) to assist both EN and AIN during
the night shift. I will strictly delegate SRN to observation and monitoring the patients as per
the requirements. The student nurses can be assigned to record vital signs of patients in a
regular interval of time. The patients who are facing difficulties in movements and have poor
mobility should be helped by the Student Registered Nurses along with the AIN. They should
help the patients during changing bandages, cleaning the wounds and observing the health
condition ofthe patients. I will assign them to analyse the histories of the patients to aware
the AIN in the situation of emergency.
The SRNs perform their responsibilities under the direct supervision of the RN or EN.
They can be involved in handover process, documentation of medical record and patient
discharge with the help of RNs(Kaihlanen, Haavisto, Strandell‐Laine&Salminen, 2018).
During indirect supervision SRNs can communicate with the family members and the
patients, assessment of patients during the admission procedure and basic hygiene of the
patients (Ross et al., 2018). During the admission procedure, SRNs must check allergy bands,
patient’s history, height and weight, collection of urines or faecal sample externally and pain
assessment techniques. Patients’ basic hygiene must be included with oral and eye care,
continence management, perineum hygiene. The basic hygiene parameters must be checked
by the SRNs as these are associated with the basic needs of patient care (Ryan, Jackson,
Woods & Usher, 2020). Pressure area management and analysis should be managed bythe

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SRNs. They can manage basic wounds with care provision with the assessment of pressure
ulcer risks.
Team members’ roles and responsibilities
In this team, three types of nurses are included so that the distribution of roles and
responsibilities is one of the most important aspect for increasing effectiveness of the team.
ENs should take care of acute care or palliative care patients for providing the best patient
care. Critical patients such as Joe Black, Isobel and Rubel should be treated with proper
assistance and care. The documentation of the patients should be done with accuracy. EN
should take care of the schedule of medication and visits. The EN shouldkeep a track for
every patients and support themwith administrating appropriate medications when it is
needed (Endacott et al., 2018). During the emergency situations, EN and AIN should treat the
patients with a collaborative approach. The duties and responsibilities have been discussed
abovebut there are several responsibilities which can be served by the nurses will be
discussed inthis part. Isobel is a patient of hypertension, anxiety and depression along with
bladder cancer. Therefore, EN should help her by enhancing interpersonal communication,
regular visits and assuring her for a better and safer clinical environment. AIN should help
her by making toilet schedule, Mental Health assessment and serving properly measured
foods or fluid (Faithfull-Byrne et al., 2017). Dorothy, Peter, Marie and Joe should be
monitored properly by the AIN as they are more prone to catheter related infection for their
IV cannulas. On the contrary, the spirometer and naso-gastric tube should be checked by the
AIN along with EN to prevent the infection related risks Student Nurses should assist the EN
and AIN for providing better support to the patient in terms of administering medications and
record keeping. They should help the other team members by helping the patient in maintain
personal hygiene, assisting AINs in wound management, recording the vital signs and
assessing the medical history of the patient and his or her family.
Conclusion
Different nurses with various designations can manage 7 patientsif they are delegated
with proper duties and responsibilities as per their ability and authority to serve the patients.
Enrolled Nurse, Assistant in Nursing and Student Registered Nurses were delegated to the
respective patients with appropriate responsibilities. The delegated nurses should help the
patients in different ways for maintaining the treatment for provision of better services.

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Part B
Introduction
Delegation means transfer of responsibility of a nurse to another nursing staff for
maintaining the accountability of the nurse’s duties or responsibilities (Siegel,
Bakerjian,Bettega, &Sikma, 2017). On the contrary, negligence stands for failure of taking
care of any patientwith proper responsibility and duty. Loss and injury during treatment can
be counted as the negligence of treatment (Baskaran, Kokilavani&Sekar, 2018). This part of
the assignment will focus on the delegation and negligence during treatment of a patient in
the following paragraphs.
Discussion
The case study states that during the treatment, enrolled nurse gives instruction to a
student nurse to administer an IV flucloxacillin to Mr Ruben who is allergic to Penicillin. The
administration of Penicillin gives rise to anaphylactic reactions in the body of the patient.
This case shows breach of5 rights of delegation which comprises with right person, right task,
right directions and communication, right circumstance and right supervision and evaluation.
The nurse failed comply with three attributes of the 5 rights of delegation such as right
communication and evaluation, right person and right direction (National Council of State
Boards of Nursing., 2016). During handover the responsibility, the EN should ensure that
Ruben should not be administered with any penicillin. However, he asked to administer IV
flucioxacilline without re-evaluating the patient’s record. The negligence has been
observedas it violates Standard 9 of NMBA by providing care to the patient without safety
and quality improvement of treatment. Moreover, this action violates NMBA standard 7
which states that nurses should communicate and use documents properly so that quality of
care can be provided. The standard 5 of NMBA has been breached as the EN does not
collaborate with the student nurse properly in terms of responsibilities. The first standard for
Registered Nurses of NMBA has been violated as the student nurse failed to analyse and
implement the treatment to the patient(www.nursingmidwiferyboard.gov.au, 2020). As the
documentation and handover process were erroneous to contribute in the treatment procedure.
Conclusion and Next Step
The case study depicts that the EN has failed to execute the responsibility and
delegations properly. Moreover, the student nurse cannot maintain the NMBA standards for

6NURSING DELEGATION AND NEGLIGENCE
nursing. The nurse was failed to comply with the five rights of a delegation associated with
the Australian legislation. Australian Health Practitioner Regulation Agency should be
informed and the case study should be reported as the incident report (Wolf, 2014). The
family members of the patient should be informed about the health condition of the patient.
They must be ensured that any kind of mistakes and negligence willnot take place and Ruben
willbe provided quality of care. The enrolled nursesshould beinvolved in a proper training
and monitored by appropriate clinical supervision.

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