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Difficulty: HardAssignment, Delegation and Supervision

A nursing supervisor is finalizing the staff allocation for a pediatric step-down unit facing a sudden influx of admissions. The available personnel include a pediatric core staff registered nurse (RN), a float RN from an adult cardiac-telemetry unit, an experienced licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP). Which assignment represents the most clinically sound delegation of client care?

  1. Assigning the float RN from the adult cardiac-telemetry unit to care for a 15-year-old client admitted with syncope who requires continuous telemetry monitoring and routine vital signs.Answer
  2. B
    Delegating the UAP to observe an initial oral feeding and evaluate the swallowing tolerance of a 6-month-old infant admitted with bronchiolitis.
  3. C
    Assigning the experienced LPN to assume primary care for a 4-year-old client who has suddenly developed audible stridor, excessive drooling, and severe tachypnea.
  4. D
    Directing the core pediatric RN to perform routine morning hygiene and daily weights for stable clients, while tasking the LPN with administering intravenous push antibiotics to a client with sepsis.

Answer

Assigning the float RN from the adult cardiac-telemetry unit to care for a 15-year-old client admitted with syncope who requires continuous telemetry monitoring and routine vital signs.
The most clinically sound assignment utilizes the adult cardiac-telemetry float RN's expertise in cardiac monitoring for a client whose physiological needs and developmental stage closely mirror an adult population. A 15-year-old requiring telemetry for syncope is highly stable and falls well within the core competencies of a cardiac-telemetry RN, ensuring safe cross-population care.

Step-by-Step Solution

1
Analyze the competencies and scope of practice for each available staff member.
The float RN has cardiac expertise but limited pediatric experience; the core RN handles complex pediatric cases; the LPN cares for stable clients; the UAP performs routine, non-nursing tasks.
Effective delegation requires matching staff skills with client needs.
2
Evaluate the acuity and stability of each client scenario presented in the options.
The 15-year-old with syncope is stable; the infant requires evaluation; the 4-year-old has an unstable airway; the septic client is highly unstable and requires advanced interventions.
The National Council of State Boards of Nursing (NCSBN) dictates that only stable clients with predictable outcomes should be assigned to LPNs or float staff unfamiliar with the specialty.
3
Match the most appropriate staff member to the client based on the Five Rights of Delegation.
Assigning the 15-year-old cardiac client to the adult telemetry float RN is the only safe match, as it utilizes their specific skill set on a client developmentally similar to an adult.
This maintains safety while freeing up the core pediatric RN to manage the highly unstable pediatric clients.

Key Concept

Delegation to Float Personnel and Scope of Practice
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Topics

Assignment, Delegation and Supervision

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