A registered nurse (RN) on a urology and renal medical-surgical unit is coordinating care for a group of clients. Which of the following tasks are appropriate for the RN to delegate to a licensed practical nurse (LPN/VN) or an unlicensed assistive personnel (UAP)? (Select all that apply)
- LPN/VN: Administering a scheduled subcutaneous dose of epoetin alfa to a client with chronic kidney disease.Answer
- BLPN/VN: Instructing a client with newly diagnosed calcium oxalate kidney stones on specific dietary modifications.
- CUAP: Adjusting the flow rate of a continuous bladder irrigation system to maintain clear, light pink drainage.
- UAP: Measuring hourly urine output and notifying the RN if the volume is less than 30 mL in a one-hour period.Answer
- ELPN/VN: Formulating a structured bladder retraining care plan for a newly admitted client with urge incontinence.
- UAP: Applying a prescribed moisture barrier ointment to the intact perineal skin of an older adult client.Answer
Answer
The appropriate tasks to delegate are: the LPN/VN administering subcutaneous epoetin alfa, the UAP measuring hourly urine output with specific notification parameters, and the UAP applying moisture barrier ointment to intact skin.
According to the National Council of State Boards of Nursing (NCSBN) delegation guidelines, the RN retains responsibility for the nursing process, which includes assessment, diagnosis, planning, and evaluation (commonly remembered by the mnemonic EAT: Evaluate, Assess, Teach). Delegating the administration of subcutaneous medications to an LPN/VN is safe and within their standard scope of practice. Delegating routine, unchanging tasks with predictable outcomes, such as applying barrier ointment to intact skin and measuring urine output, is highly appropriate for a UAP. Providing the UAP with explicit parameters for notifying the RN (less than 30 mL/hr) safely demonstrates the 'right direction and communication' principle.
Step-by-Step Solution
Key Concept
Scope of Practice and Safe Delegation Principles