The student who wants to do the wound dressing alone
You are the RN preceptor on a surgical ward. A second-year nursing student, Priya, has been on the ward for three weeks. She asks to change the dressing on Mr Hall's abdominal surgical wound unsupervised. Mr Hall is day 5 post-appendicectomy, afebrile, with a clean wound and no signs of infection. The ward is busy; you have two discharges and a new admission to complete. Priya has observed three dressing changes but has not performed one. She is enthusiastic and says she feels confident.
1. Apply the delegation and supervision principles. Should Priya perform the dressing? What conditions would you set?
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Delegation is not the same as abdication. The RN retains accountability for the decision and for the standard of care.
Assessment of the delegation:
- Task complexity - a clean, healing wound in a stable patient is relatively low risk, but it is not a task for an unsupervised student who has never performed one.
- Student competence - Priya has observed three but performed none. Observation does not equal competence.
- Patient factors - Mr Hall is stable, but he has not consented to student involvement; I must ask him.
- Ward context - my workload is high, which is a reason for careful planning, not for cutting corners.
Decision: Priya may perform the dressing with direct supervision. I would not delegate it unsupervised.
Conditions:
- Obtain Mr Hall's consent for a student to participate.
- Confirm Priya's theoretical knowledge and check the procedure against policy.
- Supervise directly, with aseptic technique, and intervene if needed.
- Debrief afterwards and document her participation and my supervision.
I would also plan the discharges so that supervision is not rushed.
2. How would you structure the supervision and feedback, and what would you document?
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Structure:
- Before: brief Priya on the wound, the patient, the aseptic technique, the equipment, and what to do if something unexpected occurs. Ask her to talk me through the steps.
- During: observe silently unless safety is at risk. Use prompts rather than taking over.
- After: debrief using a structured model - what went well, what she would do differently, and one specific improvement goal.
Feedback principles: specific, timely, behavioural, and respectful. Name the behaviour, not the person. Ask her to self-assess first.
Documentation:
- The date and time of the procedure.
- That Priya performed it under my direct supervision.
- The wound appearance and any findings.
- The patient's tolerance and consent.
- The feedback given and any learning plan.
- My signature and designation.
I would also record her progress in her clinical learning record and inform her facilitator. If she struggled, I would plan a further supervised attempt rather than abandoning the learning opportunity. This protects the patient, supports the student, and meets my obligations under the RN Standards for Practice.