管理和委任类型题（Management and Delegation）：NCLEX®系列考试中有很多管理和委任类的题目，让新手护士或护校生非常为难，我们都是菜鸟怎么懂得如何管理和委派别人工作呢?有一点必须记住，护士不是孤胆英雄，护理工作也不能像好莱坞的电影宣传个人英雄主义，我们需要庞大的团队协作才能维护患者的健康和生命。作为团队中的一份子，必须要了解管理、委派、监督和优先行动的基本的原则，否则会影响病人的安全。

委任的原则

总结下来，很像一句绕口令---合适的状况下，把合适的任务交给合适的人去做，并且确保这个行动是正确的，能够在正确的监管之下完成。

具体分析委任

1、当你需要把一个任务委派下去的时候，要慎重考虑这个任务是否为常规护理的一部分?需不需要做护理诊断和评估?是否存在威胁患者安全的隐患?患者状况是否稳定，结果是不是都在自己的预料之中?这个任务是不是有医院规定的标准化程序做依据?任务的复杂性是否与被委派者的能力、熟练程度和专业程度相匹配?整个过程是不是能够有效的监管和及时的跟进等等。

2、由于美国护士是分级制，你一定要充分了解不同级别的护士的执业范围。

For RNs only：

Performing head-to-toe assessment including complex and/or routine vital signs.

Administering basic and advanced life support.

Assessing--data collection and analysis.

Diagnosing--identifying and prioritizing client problems.

Planning--stating expected outcomes and methods for achievement.

Implementing--interventions to achieve expected outcomes.

Evaluating--analysis of plan of care and client outcomes.

Caring for invasive lines (examples: PICC)

Feeding clients with oral or swallowing problems.

Administering blood and blood product transfusions.

Titrating medications based on specific client needs and physician orders.

Performing extensive or complex dressing changes or wound care.

Teaching of clients and families.

RNs主要负责一些复杂的侵入性操作和全面的体格检查以及情况较为严重和不稳定患者的操作，还包括护理评估和诊断以及宣教方面的内容，当然LPN/LVN能做的一切也都是RNs的执业范围。

The licensed practical/vocational nurse

Taking routine vital signs.

Providing basic life support.

Bathing, giving oral hygiene, and changing bed linens.

Turning and positioning.

Administering enemas, digital fecal removal.

Administering medications via PO, NG, PEG, IM, Z-track, intradermal, SQ, suppository, topical, and sublingual routes.

Administering instillations in the eyes, ears, nose, buccal muscosa, and rectum.

Administering enteral or tube feedings.

Monitoring blood glucose.

Oral suctioning.

Feeding clients without any oral or swallowing problems.

Performing simple dressing changes.

Inserting and removing Foley catheters.

Caring for ostomies.

Administering respiratory treatments.

Providing postmortem care.

Inserting rectal tubes.

Removing sutures and staples.

Caring for newborns including cord care, vital signs, and feeding.

Performing noncomplex procedures requiring sterile technique.

Documenting the care given to the client and the client’s response to that care.

Updating an initial assessment; the data that is collected by the LVN must be validated by the RN.

Reinforcing the teaching performed by the RN.

Teaching from a standard care plan, noncomplex teaching.

LPN/LVN做一些最基本的护理操作，包括除了静脉液路、子宫内用药等其他的灌注和肌注等给药操作。可以进行初级评估，但是记录的数据要由RN审核，还要对UAP做简单的教学指导。

The unlicensed assistive person (UAP)

Obtaining routine vital signs.

Bathing, providing oral hygiene, changing bed linens.

Turning and positioning.

Feeding clients without any oral or swallowing problems.

Providing basic life support.

Providing postmortem care.

Ambulating. (Stable/noncomplex clients only)

Obtaining height and weight measurements.

Assisting with elimination.

Monitoring input and output (I & O).

Administering soapsuds enemas.

Assisting with general activities of daily living (ADLs).

Obtaining specimens.

Transferring clients with the use of proper body mechanics.

Documenting and reporting information related to client care to the RN.

Reporting unusual observations and symptoms reported by the client or observed to the RN.

Administering gastrostomy feedings (NO NG TUBE FEEDINGS)

Utilizing proper communication techniques.

Prioritizing tasks (per the direction of the RN or LPN/LVN).

Handling complaints.

UAP不能执行任何侵入性或无菌操作，也不能做任何对病人宣教的工作。

3、充分了解了任务也明确了合适的人选，还要考虑委任的时间节点是不是合适。如果此时病人的病情因某些治疗措施变得不稳定，有可能突发状况，或者RN没有办法及时给与支援，又或者是你选的人还不熟悉工作环境，设备也不够完善的情况下就不适合委任。

管理工作的原则

记住一定要分清轻重缓急，第一时间看那些more acute, unstable的患者，特别留意有生命危险的征兆和并发症。

这类题目看起来让人迷糊，不过记住我们最终的目的是有效的合作，而且在提高的工作的效率的同时还要保持高标准的护理服务。