A practical nurse (PN) receives the morning shift report and is assigned to care for a newly admitted client experiencing acute respiratory failure who requires continuous mechanical ventilation and frequent complex assessments. The PN determines that this client's care requirements exceed the PN scope of practice. Place the following actions the PN should take to address this unsafe assignment in the correct order of escalation.
- 1Identify that the client's unstable condition and need for comprehensive assessment exceed the legal PN scope of practice.
- 2Communicate the specific scope of practice and client safety concerns directly to the charge nurse.
- 3Escalate the assignment concern to the nursing supervisor if the charge nurse declines to reassign the client.
- 4Refuse the specific client assignment to protect client safety and prevent a violation of the Nurse Practice Act.
Answer
The PN must first identify the scope violation, then address the charge nurse, escalate to the nursing supervisor if unresolved, and ultimately refuse the specific assignment if necessary to protect the client and their license.
When faced with an unsafe or out-of-scope assignment, the PN must follow a sequential process. First, the PN identifies the mismatch between client acuity and legal scope. Second, the PN follows the chain of command by addressing the charge nurse who made the assignment. If the charge nurse refuses to adjust the assignment, the third step is escalating to the nursing supervisor. Finally, if the issue remains unresolved, the PN is legally and ethically obligated to refuse the assignment, as accepting an out-of-scope assignment violates the Nurse Practice Act and endangers client safety. Refusing an assignment before accepting care does not constitute client abandonment.
Step-by-Step Solution
Key Concept
Scope of Practice and Chain of Command in Unsafe Assignments