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Difficulty: HardClient Care Assignments and Collaboration

A clinical nurse educator is reviewing incident reports related to improper delegation on a medical-surgical unit. Match each documented clinical scenario to the specific 'Five Rights of Delegation' principle that was primarily violated.

  • Assigning an experienced licensed practical nurse (LPN) to manage a client who suddenly developed hemodynamic instability and requires emergency pacing.Right Circumstance
  • Instructing an unlicensed assistive personnel (UAP) to perform a comprehensive swallowing assessment on a client who recently experienced a stroke.Right Task
  • Asking a care technician to 'watch the client's oxygen levels closely' without specifying the exact oxygen saturation threshold that requires immediate notification.Right Direction and Communication
  • Delegating hourly vital sign measurements to a nursing assistant but failing to check the documented trends or follow up on the client's clinical status before the end of the shift.Right Supervision and Evaluation

Answer

Hemodynamic instability violation aligns with Right Circumstance; Delegating a comprehensive assessment aligns with Right Task; Vague oxygen monitoring instructions align with Right Direction and Communication; Failing to review documented vital signs aligns with Right Supervision and Evaluation.
Each scenario specifically illustrates a failure in one of the National Council of State Boards of Nursing (NCSBN) Five Rights of Delegation. Matching them correctly requires analyzing whether the primary failure occurred in the appropriateness of the task, the stability of the client, the clarity of the instructions, or the follow-up evaluation.

Step-by-Step Solution

1
Analyze the scenario involving the hemodynamically unstable client.
Matches Right Circumstance.
The client's lack of stability makes the situation inappropriate for delegation, regardless of whether the task itself might normally fall under the delegatee's scope.
2
Analyze the scenario delegating a swallowing assessment to a UAP.
Matches Right Task.
Comprehensive assessments are legally non-delegable to unlicensed personnel, meaning the task itself is inappropriate.
3
Analyze the scenario giving vague instructions about oxygen monitoring.
Matches Right Direction and Communication.
Safe delegation requires specific, measurable parameters to ensure clear expectations between the delegator and delegatee.
4
Analyze the scenario where vital signs are delegated but not reviewed.
Matches Right Supervision and Evaluation.
The delegating nurse maintains ultimate accountability and must evaluate the client's outcomes following a delegated task.

Key Concept

The NCSBN Five Rights of Delegation
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Topics

Client Care Assignments and Collaboration

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