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Difficulty: MediumAssignment, Delegation and Supervision

During a busy shift on a medical-surgical unit, a nurse evaluates the care needs of four clients to determine appropriate task delegation. Which of the following tasks is most appropriate to delegate to the unlicensed assistive personnel (UAP)?

  1. A
    Instructing a client newly diagnosed with deep vein thrombosis on the correct application of anti-embolism stockings
  2. Recording the hourly urine output from an indwelling urinary catheter for a clinically stable client with renal calculiAnswer
  3. C
    Evaluating the relief of abdominal pain in a client 30 minutes after the administration of an oral analgesic
  4. D
    Assisting a newly admitted client experiencing acute respiratory distress to transfer from the bed to a bedside commode

Answer

The most appropriate task to delegate is recording the hourly urine output from an indwelling urinary catheter for a clinically stable client with renal calculi.
Measuring and recording intake and output, including urine from an indwelling catheter, is a standard, routine procedure that involves no clinical judgment. Because the client with renal calculi is described as stable, this task perfectly aligns with the Five Rights of Delegation and the UAP's scope of practice.

Step-by-Step Solution

1
Identify the principles of safe delegation for unlicensed assistive personnel (UAP).
UAPs can perform routine, standard, and unchanging procedures on stable clients, such as vital signs, hygiene, and measuring intake and output.
Establishing the UAP's scope of practice is necessary to rule out inappropriate tasks.
2
Apply the 'EAT' acronym (Evaluate, Assess, Teach) to the choices to eliminate RN-only responsibilities.
Instructing a client is teaching, and evaluating pain relief is evaluation. Both of these fall strictly under the RN's scope.
NCSBN delegation rules explicitly prohibit delegating clinical judgment, initial teaching, and nursing assessments.
3
Evaluate the stability of the clients described in the remaining options.
The client with acute respiratory distress is highly unstable and unpredictable, whereas the client needing urine output recorded is clinically stable.
Tasks should only be delegated for clients whose conditions are stable and predictable.

Key Concept

Principles of Safe Delegation and UAP Scope of Practice
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Topics

Assignment, Delegation and Supervision

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