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Difficulty: HardAssignment, Delegation and Supervision

An acute pulmonary care unit is staffed with a charge nurse, an experienced respiratory registered nurse (RN), an RN floating from the orthopedic unit, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP). Which delegation or assignment decision made by the charge nurse represents safe and effective care?

  1. Assigning the float RN from the orthopedic unit to care for a client admitted three days ago with a chronic obstructive pulmonary disease exacerbation who is receiving a tapered dose of oral corticosteroids and requires routine blood glucose monitoring.Answer
  2. B
    Directing the UAP to determine a client's response to a recently administered as-needed intravenous analgesic by asking for their current pain score and observing for nonverbal signs of discomfort.
  3. C
    Assigning the LPN to provide continuous monitoring and care for a client who arrived 15 minutes ago from the emergency department presenting with sudden-onset stridor, drooling, and severe restlessness.
  4. D
    Delegating the task of assisting with the first oral meal to the UAP for a client who was successfully extubated four hours ago but currently exhibits a weak, suppressed cough reflex.

Answer

The safest and most appropriate decision is assigning the float RN to care for the stable client admitted three days ago with a COPD exacerbation, who requires oral corticosteroids and blood glucose monitoring.
Assigning the float nurse to the client with COPD is correct because the client is stable, having been admitted three days ago. The required care involves administering oral medications and monitoring blood glucose, which are fundamental nursing skills applicable across various adult care settings. This aligns perfectly with the principle of assigning float nurses to clients with predictable outcomes.

Step-by-Step Solution

1
Analyze the staff mix available on the unit.
The team includes a charge nurse, an experienced respiratory RN, an orthopedic float RN, an LPN, and a UAP. Each has a specific scope of practice and competency level.
Understanding the qualifications of the personnel is the first step in the five rights of delegation (Right Person).
2
Evaluate the proposed assignment for the float RN.
The client with COPD exacerbation admitted three days ago is stable, has predictable outcomes, and requires interventions (oral medications, blood glucose checks) that are standard across all adult units. This is a safe assignment.
Float RNs should receive stable clients who do not require highly specialized, unit-specific critical care knowledge.
3
Evaluate the tasks delegated to the UAP and LPN.
Evaluating pain response (UAP), caring for a patient with acute stridor (LPN), and assisting with initial feeding post-extubation (UAP) all violate scope of practice or prioritization principles.
The RN cannot delegate clinical judgment, the evaluation of care, or the management of highly unstable clients with unpredictable outcomes.

Key Concept

Principles of Safe Assignment and Delegation
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Topics

Assignment, Delegation and Supervision

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