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Difficulty: Very hardAssignment, Delegation and Supervision

During the morning huddle on an acute nephrology and urology unit, a clinical coordinator evaluates the distribution of client assignments among the healthcare team. The available staff includes an advanced clinical RN, a recent graduate RN, a licensed practical/vocational nurse (LPN/VN), and unlicensed assistive personnel (UAP). Which of the following assigned pairings represents the most appropriate scope of practice and safe delegation?

  1. The LPN/VN is assigned to monitor continuous bladder irrigation and administer scheduled subcutaneous erythropoietin for a client who is two days post-transurethral resection of the prostate with light pink effluent.Answer
  2. B
    The UAP is tasked with measuring orthostatic vital signs for a client with adrenal insufficiency and instructed to return the client to a supine position if the systolic pressure decreases by more than 20 mm Hg.
  3. C
    The recent graduate RN is assigned to conduct the comprehensive admission assessment for a client arriving from the emergency department with acute pyelonephritis and sudden-onset disorientation.
  4. D
    The LPN/VN is delegated to initiate a secondary intravenous infusion of calcium gluconate for a client with a serum calcium level of 6.5 mg/dL (1.62 mmol/L) who is exhibiting a positive Trousseau's sign.

Answer

The most appropriate delegation is assigning the LPN/VN to monitor continuous bladder irrigation and administer subcutaneous erythropoietin for a stable post-operative client.
The assignment involving the LPN/VN monitoring continuous bladder irrigation is correct because the client is stable, the surgical recovery is progressing as expected (light pink effluent), and the tasks (monitoring established irrigation, administering subcutaneous injections) are firmly within the LPN/VN scope of practice.

Step-by-Step Solution

1
Analyze the stability of the client assigned to the LPN/VN in the correct option.
The client is two days post-TURP with light pink effluent, indicating a stable, expected post-operative course.
LPN/VNs must be assigned to clients with predictable outcomes and stable conditions.
2
Evaluate the UAP assignment for inappropriate delegation of the nursing process.
The UAP was told to evaluate a blood pressure drop and initiate an intervention (returning the client to a supine position), which constitutes clinical judgment.
The RN cannot delegate clinical judgment, evaluation, or decision-making to a UAP. The UAP should only gather data and report it to the RN.
3
Assess the acuity of the clients assigned to the recent graduate RN and the other LPN/VN assignment.
The client with pyelonephritis and new disorientation is highly unstable (sepsis risk). The client with hypocalcemia and Trousseau's sign is highly unstable (tetany risk).
Unstable clients with complex needs must be prioritized to the most experienced RN available. Intravenous high-alert medications for unstable clients fall outside the LPN/VN scope.

Key Concept

Principles of Safe Delegation and Prioritization
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Topics

Assignment, Delegation and Supervision

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