It is important for you to have an understanding of the organizational chart for your facility. Where does the buck ultimately stop? Who is that person? In addition to the organization, it's vital for you to know who is in charge on your unit at any given time. Don't be surprised to find yourself in that role someday. It may happen sooner than you think or hope for. Be prepared and know who your organizational support members are.

There may be a time to delegate and a time not to. It's important to understand the full situation and not to waste time and resources. The important thing to remember is who is responsible for what. Work your way backwards from the person providing the direct care all the way to the physician who prescribed the care. The responsible parties also include everyone in the chain of command in the nursing realm. Where you fit into that realm, along with the extent of your personal responsibility, may differ for each of your assigned patients depending on who is assisting you in their care for that particular shift.

The goal is always to provide the best care possible for each patient. If some of your patients require more of your time and attention than others, you may need to delegate. If you are the LPN, you cannot delegate, but perhaps you can discuss the situation with your supervisor and have some of the responsibilities reassigned. If you are the R.N., you need to keep in mind that you are still ultimately responsible for those patients whose care you have delegated to others.

If you are in charge of the unit, you are further responsible for all patients and the staff under you providing their care. In this situation, you really need to know your own capabilities as well as those of your staff. You will need to implement a plan and allow yourself time to supervise all staff. In the event that you find yourselves short staffed, you will need to call upon all your leadership abilities to ensure that everyone is working together and knows their responsibilities.

Each person needs to understand his own scope of practice and when to ask for help. It is vital to the well being of all involved that no one oversteps his bounds. This situation seems to arise when staff members are also nursing students.

As an example, your best nursing assistant is in his last year of a B.S.N.

program. You're short staffed and an M.D. wants you to assist with a procedure now! Another patient needs to have a Foley catheter inserted because of incontinence issues and no one else can do it right now. The aide has inserted many catheters in the past month under the supervision of his instructor and feels confident. He volunteers to help you out. Don't do it! Ask the aide to explain to the patient that you have been delayed and to assist the patient by offering a bedpan or padding the bed with some waterproof pads until you can get there.

Perhaps the aide is a graduate nurse who hasn't taken boards yet — you still shouldn't take chances. An LPN may have been allowed to perform a procedure in a previous job and is willing to help out, but isn't allowed to do it here. Again, delegate responsibilities that assist you in getting to your duties quicker but that don't exceed anyone's scope of practice. On the other hand, if you're being asked to do something outside of your scope, suggest something that you can do to assist the situation, but don't take on the responsibility for something you are not allowed to do.