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Difficulty: HardClient Care Assignments and Collaboration

A healthcare team consisting of a registered nurse (RN) and a practical nurse (PN) is reviewing the morning care plan for a group of clients on a progressive care unit. The RN asks the PN to complete a list of specific interventions. Which intervention must the PN decline and return to the RN's responsibility?

  1. Titrating a continuous intravenous (IV) heparin infusion according to a facility protocol using recent laboratory resultsAnswer
  2. B
    Witnessing a client's signature on a surgical informed consent document after the provider has explained the procedure and risks
  3. C
    Providing a clinical status update over the telephone to a client's spouse who has correctly provided the facility privacy code
  4. D
    Performing sterile irrigation and applying a prescribed enzymatic debridement ointment to a client's stage 3 pressure injury

Answer

The practical nurse must decline the task of titrating a continuous intravenous heparin infusion based on laboratory results.
The practical nurse (PN) must decline the titration of a continuous high-risk intravenous medication such as heparin. Although it follows a protocol, titrating vasoactive or anticoagulant drips requires comprehensive assessment, continuous evaluation of patient response, and independent clinical judgment, which are strictly within the registered nurse (RN) scope of practice.

Step-by-Step Solution

1
Analyze the list of delegated interventions to determine which tasks fall within the practical nurse (PN) scope of practice versus those requiring a registered nurse (RN).
Three tasks involve established procedural skills or standard communication, while one task involves adjusting a high-risk intravenous medication.
The scope of practice dictates that PNs perform data collection and procedural skills on stable clients, whereas RNs manage comprehensive assessments and evaluate responses to unstable conditions or high-risk infusions.
2
Evaluate the task of titrating an IV heparin infusion.
This intervention requires independent clinical judgment to interpret systemic responses and adjust a continuous high-risk medication.
Titrating continuous anticoagulant infusions exceeds the PN scope in all jurisdictions because it requires RN-level clinical evaluation.
3
Verify the safety and appropriateness of the remaining tasks.
Witnessing informed consent, sharing information using a verified privacy code, and performing complex sterile wound care are all safely within the PN scope of practice.
These tasks follow established protocols and procedures that do not require independent clinical evaluation of unstable systemic conditions.

Key Concept

Delegation and Scope of Practice for Practical Nurses
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Topics

Client Care Assignments and Collaboration

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