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Difficulty: MediumAssignment, Delegation and Supervision

A registered nurse (RN) on a general surgical unit is preparing to delegate a complex sterile wound dressing change to a licensed practical nurse (LPN). Arrange the RN's actions in the correct chronological sequence to comply with the national guidelines for safe delegation. (Place the first action at the top and the final action at the bottom.)

  1. 1Evaluate the client's current physiological stability and the complexity of the wound.
  2. 2Confirm the LPN's documented competency and previous experience with this specific type of dressing.
  3. 3Provide explicit instructions regarding the required supplies, timeframe, and expected reporting parameters.
  4. 4Remain accessible on the unit to provide guidance and observe the procedure if necessary.
  5. 5Determine the client's tolerance of the procedure and review the accuracy of the LPN's documentation.

Answer

The correct sequential order for safe delegation is: Evaluate the client's stability, confirm the LPN's competency, provide explicit instructions, remain accessible for guidance, and finally determine the client's response to the procedure.
Safe delegation requires a specific chronological process outlined by the Five Rights of Delegation. The RN must first evaluate the client (Right Circumstance/Task), then verify the delegate's skill (Right Person), communicate the plan (Right Direction), oversee the execution (Right Supervision), and finally evaluate the results (Right Evaluation).

Step-by-Step Solution

1
Assess the client's needs and the task requirements.
Establishes if the task is appropriate to delegate at this time.
The RN must ensure the client is stable and the task involves a predictable outcome before considering delegation.
2
Assess the delegate's capabilities.
Verifies that the LPN is legally and clinically competent to perform the dressing change.
Delegation must align with the individual's scope of practice and validated skill set.
3
Communicate expectations clearly.
Provides the LPN with the necessary parameters for the task.
Clear directions prevent errors and ensure the delegate knows exactly what to do and what to report.
4
Provide ongoing supervision.
Maintains RN accountability while the task is executed.
The delegating RN remains responsible for the overall care and must be available if complications arise.
5
Evaluate the clinical outcome.
Confirms the task was completed safely and the client responded well.
The RN must close the loop by verifying the results and ensuring accurate documentation.

Key Concept

The NCSBN National Guidelines for Nursing Delegation require a systematic approach: Assessment and Planning (client and delegate), Communication, Surveillance and Supervision, and Evaluation and Feedback.
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Topics

Assignment, Delegation and Supervision

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