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Difficulty: HardAssignment, Delegation and Supervision

A charge nurse on a high-acuity neurovascular intensive care unit is planning client assignments for the upcoming shift. The available staff includes a core neurovascular registered nurse (RN), an RN floated from a general medical-surgical unit, an experienced licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which client care assignment is the most appropriate?

  1. Assigning the float RN to care for a client who had a transient ischemic attack (TIA) 48 hours ago, is neurologically stable, and is awaiting transfer to a rehabilitation facility.Answer
  2. B
    Assigning the LPN/VN to perform the initial neurological assessment and formulate the care plan for a client newly admitted with an acute ischemic stroke.
  3. C
    Assigning the UAP to evaluate a client's swallowing ability prior to providing a clear liquid meal tray to a client with a history of dysphagia.
  4. D
    Assigning the core neurovascular RN to complete routine discharge paperwork while delegating a client with a ruptured cerebral aneurysm and a suddenly decreasing Glasgow Coma Scale (GCS) score to the float RN.

Answer

The most appropriate assignment is delegating the neurologically stable client awaiting transfer to the float RN.
The correct assignment delegates a stable client with predictable outcomes (a TIA client awaiting transfer 48 hours post-event) to the float RN. Float nurses should be assigned to clients whose care requirements are similar to a general medical-surgical population, avoiding highly specialized or acutely unstable clients.

Step-by-Step Solution

1
Analyze the competency and legal scope of practice for each available staff member.
Recognize that RNs handle complex or unstable clients, LPN/VNs handle stable clients with predictable outcomes but cannot do initial assessments, and UAPs handle standard, unchanging tasks.
To ensure the 'Right Person' and 'Right Circumstance' delegation principles are met.
2
Evaluate the acuity and stability of each client presented in the options.
Identify the client with a decreasing GCS as highly unstable, the new admission as requiring an initial assessment, the client with dysphagia as requiring evaluation, and the TIA client as stable.
To match client physiological needs with the appropriate caregiver's skill level.
3
Apply prioritization frameworks (e.g., ABCs, acute vs. chronic, stable vs. unstable) to the assignments.
Determine that the core neurovascular RN must take the most unstable client (decreasing GCS), while the float RN safely takes the most stable, predictable client.
To maintain client safety and prevent adverse outcomes.

Key Concept

Delegation decisions must align with the Five Rights of Delegation and prioritize client stability, assigning the most complex and unstable clients to the most experienced, specialized RNs while delegating stable clients with predictable outcomes to float RNs or LPN/VNs.
Estimated Time:1m 30s
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Topics

Assignment, Delegation and Supervision

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