Jamie normally works the overnight shift on a general medical floor  and was floated to an orthopedic unit for the night shift due to increased patient census on that unit.  Jamie has worked for the organization for 15 years and was working with four new RNs that recently completed orientation on the orthopedic unit.  Jamie was assigned to be the charge nurse on this unit for this shift.  Jamie was not happy about this assignment and was concerned about adequate staffing.  In addition to the other 4 RNs, the patient care team for the night shift included 3 patient-care technicians (PCT) . One was newly hired in the health system and still orientating, but the other PCTs had worked on this unit for over 5 years.

Jamie focused on creating an effective team and ensuring effective communication.  A few hours into the shift, Jamie noticed that one of the RNs was delegating patient care tasks that were outside the scope of practice for the PCT and should not be delegated by the RN. When Jamie asked the RN and PCT about this delegation,  PCT had been doing this for “years” and had indicated that they were always trusted to perform these particular tasks.

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