Chapter 1, Managing client care:

• Prioritizing client care o Systemic before local o Acute before chronic o Actual

problems before potential ones o Listen carefully to clients and do not assume o

Recognize and response to trends vs transit findings

o Recognize indications of medical emergencies and complications vs expected

findings

o Apply clinical knowledge to procedural standars to determine the priority action

• Client care assignments o Assigning is performed in a downward or lateral manner with

regard to members of the healthcare team

o Client factors are:

Condition of client and level of care needed

Specific care needs such as cardiac monitoring or ventilation mechanical

Special precaution needs such as isolation or fall precautions or seizures,

procedures requiring time commitments

o Health care team factors:

Knowledge and skill levels of the team members

Supervision that is necessary

Nurse to client ratio

Experience with similar clients

Familiarity of staff member with unit o Additional factors;

If receiving an unsafe assignment the nurse should bring the unsafe

assignment to the attention of the scheduling charge nurse and negotiate

new assignment, if the issue is not resolve, take the concern up the chain

of command

Nurse should file a written protest to the assignment such as an

assignment despite objection (ADO) or document of practice situation

(DOPS) with the appropriate administratior

If not follow proper failure to accept the assignment following proper

channels could be considered client abandonment.

o Delegations to an assistive personnel

ADLS

Bathing, dressing, toileting, ambulating, feeding if pt has no problems

with swallowing

Positioning

Routine task, bed making

Specimen colletion