NURSE DELEGATION SCENARIOS
The "Happy Dance', a private home care agency, does not employ any in-house nursing staff.
Occasionally, particularly after there has been a poor survey, Happy Dance contracts with Travel
Nurses at Demand to provide consulting services relating to survey and other issues. Several of
the medical professionals working at "Happy dance" have successfully completed the
state-approved training course on administration of medication. A survey has recently been
conducted, and the statement of deficiencies includes a medication administration citation
(medication error) that names Travel Nurses at Demand as being responsible for having
inappropriately delegated medication administration.
1. How could this have happened?
-​ Poor communication and unclear delegation roles. Travel Nurses may have overstepped
or been misinterpreted.
2. What can Happy Dance do to defend the violation? Correct the violation?
-​ Defend: Travel Nurses were only consultants, not delegators.
-​ Correct: Retrain staff, clarify delegation policies, and improve med safety procedures.
3. Should Travel Nurses at Demand be advising AT ALL on medications?
-​ No. Only on policy or training—not on specific medication delegation.
The Happy Dance assisted living community is fortunate to have Alen on staff as a registered
nurse. Although he is not the facility manager, Alen is in charge of the clinical operations at
Happy Dance. He ended up choosing carefully four people of the care staff to take part in the
medication administration training that was state-approved. Alen and the other staffers of the
care staff who got a training were giving the residents of the facility each one of their
medications. It is questionable whether there was a nurse delegation taking place for specific
drugs. The incident happened when Mrs. Adams was transported to Future Medical Center,
where she required cardioversion via a defibrillator and admission to the cardiac ICU. She was
placed for observation after one of the staff members accidentally gave Mr. Spirit's heart
medication to Mrs. Adams during the evening shift. Mrs. Adams' condition required her to
remain in the cardiac ICU for observation.
1. If you were Alan, what would actions would you take?
-​ Investigate, report the error, retrain staff, and add safety checks.
2. How would you handle delegation of medication in this place?
-​ Only delegate to trained staff. Document and monitor delegation closely.
3. What could they do better?
-​ Use double checks, improve documentation, and re-evaluate training regularly.
Missy is an advanced practice nurse who works at the assisted living facility known as Creek.
Although she is the administrator of the facility, she has a great deal of knowledge about the
patients, their conditions, and the treatments they receive. In in fact, the owner of the institution
hired her in part because of her clinical expertise. At the Creek facility, there is only one nurse
working .Blake, a resident at the facility, has his wet-dry dressing changed routinely by
caregiver MarMar, who learned how to perform this task from a former employee of the
facility. During a visit to the facility, the surveyor watches as the dressing is changed and
notices that it is being done incorrectly and that the wound is not healing. Because of these
observations, the surveyor cites Missy, the facility administrator, for improper nursing
delegation.
1.​Was Missy delegating?
-​ Yes, by allowing a non-nurse to perform a skilled task without formal delegation.
2. Can caregiver MarMar continue to do the dressing change?
-​ No, not until trained, evaluated, and properly delegated.
3. What can Missy do to protect her nursing license?
-​ Stop improper tasks, delegate correctly, document everything, and retrain staff.