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Difficulty: HardAssignment, Delegation and Supervision

A primary nurse on a postpartum unit is collaborating with a licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP) to manage a group of clients. When deciding how to safely distribute the workload, which delegation decision by the primary nurse is most appropriate?

  1. A
    Directing the UAP to assist a client with early ambulation for the first time following a cesarean birth under spinal anesthesia.
  2. B
    Instructing the UAP to evaluate the amount and characteristics of lochia on a perineal pad for a client who gave birth 2 hours ago.
  3. Assigning the LPN/VN to insert an indwelling urinary catheter for a stable client experiencing postpartum urinary retention.Answer
  4. D
    Assigning the LPN/VN to assume primary care for a client presenting with sudden onset dyspnea and tachycardia 12 hours after delivery.

Answer

Assigning the LPN/VN to insert an indwelling urinary catheter for a stable client experiencing postpartum urinary retention.
The decision to assign the LPN/VN to insert an indwelling urinary catheter for a stable client experiencing postpartum urinary retention is correct. This is a routine sterile procedure that falls entirely within the LPN/VN scope of practice, provided the client has a predictable outcome and is physiologically stable.

Step-by-Step Solution

1
Analyze the scope of practice for each team member (RN, LPN/VN, UAP).
The RN is responsible for initial assessments, clinical judgments, teaching, and caring for unstable clients. The LPN/VN can perform sterile procedures and care for stable clients. The UAP can perform standard, routine, and non-invasive tasks.
Understanding scope of practice is essential for safe delegation.
2
Evaluate the clinical status and specific needs of the clients in each assignment.
The client with urinary retention is stable. The client post-spinal anesthesia requires initial postoperative assessment. The client with dyspnea is highly unstable. The client 2 hours post-birth requires careful assessment for hemorrhage.
Delegation decisions must factor in the client's physiological stability and acuity.
3
Determine the appropriateness of each delegated task based on the 'Five Rights of Delegation'.
Catheterizing a stable client is the 'right task' and 'right circumstance' for an LPN/VN. Evaluating lochia, initial ambulation post-anesthesia, and caring for an unstable client all involve clinical judgments that cannot be delegated to the individuals identified.
Only tasks matching the delegatee's competence and legal scope can be assigned safely.

Key Concept

Delegation to LPN/VN and UAP requires matching the task to the individual's scope of practice while ensuring the client is stable and does not require complex nursing judgment or initial assessment.
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Topics

Assignment, Delegation and Supervision

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