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Difficulty: Very hardAssignment, Delegation and Supervision

The charge nurse on a neurology step-down unit is planning assignments for the upcoming shift. The staffing mix includes a core unit registered nurse (RN), an RN floating from a general medical-surgical unit, a licensed practical nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which client assignment is the safest and most appropriate?

  1. A
    Assigning the float RN to conduct the initial admission assessment and establish the plan of care for a client transferred from the emergency department with an uncomplicated transient ischemic attack.
  2. B
    Delegating the UAP to assist with the initial out-of-bed ambulation of a client who is 12 hours post-operative from a lumbar laminectomy.
  3. Assigning the LPN/VN to administer scheduled enteral tube feedings and perform routine tracheostomy site care for a client who is two weeks post-ischemic stroke.Answer
  4. D
    Assigning the float RN to care for a client who is 12 hours post-craniotomy for a meningioma resection and currently has a stable Glasgow Coma Scale score of 15.

Answer

The most appropriate assignment is directing the LPN/VN to care for the client who is two weeks post-stroke, as enteral feedings and routine tracheostomy care on a stable client are within their scope of practice.
The correct answer is the assignment directing the licensed practical nurse (LPN/VN) to care for the client who is two weeks post-stroke. This client is clinically stable. Administering scheduled enteral tube feedings and performing routine tracheostomy site care on an established stoma follow standard protocols and have predictable outcomes, making them safe and appropriate tasks for the LPN/VN.

Step-by-Step Solution

1
Evaluate the assignment designated for the unlicensed assistive personnel (UAP).
The UAP is assigned to assist with the initial ambulation of a client who is 12 hours post-operative from a lumbar laminectomy.
The first ambulation after spinal surgery requires a nursing assessment to evaluate motor and sensory function, monitor for orthostatic hypotension, and ensure spinal alignment. Assessments cannot be delegated to a UAP, making this assignment unsafe.
2
Analyze the assignments given to the float registered nurse (RN).
The float RN is assigned to a new admission with a transient ischemic attack and a client who is 12 hours post-craniotomy.
Float nurses should be assigned stable clients with predictable outcomes similar to the population on their home unit. New admissions require comprehensive, unit-specific baseline assessments. Fresh post-craniotomy clients (even with a stable GCS) are highly acute and at risk for rapid neurological decline. Both clients must be assigned to the core unit RN.
3
Assess the tasks assigned to the licensed practical nurse (LPN/VN).
The LPN/VN is assigned enteral feedings and tracheostomy care for a client who is two weeks post-stroke.
The client is two weeks post-stroke, indicating a clinically stable condition. Enteral feedings and routine tracheostomy care on an established stoma are standard procedures with predictable outcomes that fall safely within the LPN/VN scope of practice.

Key Concept

Principles of Safe Delegation and Client Assignment
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Topics

Assignment, Delegation and Supervision

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